Trauma Exam 1 Flashcards
(203 cards)
0
Q
What is the most devastating natural disaster?
A
Earthquake
1
Q
When is the best time for changes to happen during disaster preparedness, including funding?
A
After the disaster happens
2
Q
Are disasters common?
A
Yes
3
Q
Who requires hospitals to exercise disaster plans periodically?
A
Joint Commission
4
Q
What are disasters classified as?
A
The necessary response that’s need by levels
5
Q
This type of disaster requires local emergency response personnel
A
Level I disasters
6
Q
This type of disaster requires regional efforts from surrounding communities
A
Level II disaster
7
Q
This type of disaster requires state and federal aid plus local and regional assistance
A
Level III disaster
8
Q
Who must be included in disaster planning immediately?
A
Medical personnel
9
Q
What are the four phases of disaster?
A
Mitigation
Planning
Response
Recovery
10
Q
This phase of the disaster cycle reduces devastating effects
A
Mitigation
11
Q
This phase of the disaster cycle is detailed paper plans
A
Planning
12
Q
This phase of the disaster cycle is activation, implementation, and activation
A
Response
13
Q
This phase is extremely important. It is under emphasized, order is restored, tx of responders which is vitally important, and debriefing or lessons learned.
A
Recovery
14
Q
This information is obtained from all parties involved in disaster response effort. “Lesson learned”
A
Debriefing
15
Q
Tabletop exercises are excellent training tools but they are
A
Costly
16
Q
A planned exercise is called
A
Rehearsal
17
Q
A group of 30 volunteer physicians, nurses, EMS personnel and others. This group is transferred to disaster sites.
A
DMATS (disaster medical assistance teams)
18
Q
Who requires hospitals to exercise disaster plans periodically
A
Joint commission
19
Q
A system developed by the department of defense, fema, and department of health and human services.
A
Federal response plan
20
Q
Medical triage process at several levels to rapidly identify critical injuries from total number of casualties
A
Disaster triage
21
Q
Simple triage/rapid treatment categorizes victims based on ability to
A
walk
Mental status
Presence
Absence of ventilation or capillary perfusion
22
Q
Red =
A
Emergent and 1st priority
23
Q
Yellow =
A
Urgent
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Green =
Non- urgent
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Black =
Dead or severely injured and not expected to survive
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Give them comfort measures and move on. Do not treat.
Black category
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Who informs the patient and family collaboratively?
The nurse and doctor
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During transport what is essential for the patient to have?
An IV drip
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What do we know is a safety concern and must be reported to all transport team members?
The weather
30
Stabilizing the airway, ensuring O2 therapy, working the ambu bag, ensuring working suction, 2 large bore IV's, secured lines, secured foleys, cardiac monitoring, and assessing temperature is imperative for patients before what happens?
Transporting
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Staying clear of the tail rotor, approaching only when directed, and securing the door open with a strap is a ___________ _____________ that has to be addressed before take off on the helicopter.
Safety issue
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A brief clinical assessment with a decision made based on a short eval by the overall hx of illness, injury, or mental status of the patient
Triage
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This type of triage is a nationally validated criteria used to triage injured
Trauma triage
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What criteria is used to determine the level of trauma and triage needed?
Mechanism of injury
Anatomical criteria
Medical criteria
35
Who triages in the field?
EMS
36
Where does triage start?
911 systems
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These people send ambulances with/without lights or sirens on the scene based on assigned protocols
Dispatchers
38
What does the EMTALA (emergency medical treatment/active labor act) state?
No one can be turned away and have to receive medical treatment
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Federal law states that all persons who present to the ED and request medical care must have what performed?
MSE (medical screening exam)
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The MSE must assess what at the least?
```
Chief complaint
Vitals signs
Mental status
General appearance
Ability to walk
```
41
A change in what is very troubling?
Mental status
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Before a patient is admitted to inpatient or discharged the patient must be stabilized where?
The ER
43
Who makes the best decisions in the ED when it comes to the patient?
The most experienced medical provider and Ed nurses
44
Triage specificity/sensitivity increases with what?
Time
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It is essential that patients wait no longer than ____________ after ED arrival for initial triage
A few minutes
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A re-triage of the most acute levels of triage must be reevaluated within how long of the initial triage?
2 hours
47
Do minor problems need frequent reassessment?
No
48
How many trauma levels are at Beebe?
5 levels
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What system is used in most hospitals?
ESI (emergency severity index)
50
A category I = emergent patient needs what 2 things
Continuous evaluation
| MD examination ASAP
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What are some examples of ESI I?
```
Cardiac arrest
Severe chest pain
Massive vomiting or blood loss
Sudden LOC
major trauma with hypotension
S/S of stroke
```
52
A category II = urgent patient needs what 2 things?
Full eval and treat by MD within 20min to 2hrs
| Reevaluation every 30-60 minutes
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What are some examples of a category II trauma?
```
Acute dyspnea
Acute abdominal pain
Acute chest pain
Acute confusion
Severe pain
High temp
Diastolic BP over 130
```
54
A category III = non-urgent can wait how long?
Hours
| Reevaluate in 1 - 2 hours
55
Some examples of a non urgent s/s are
Lacerations
Sprain
Rash
URI or cold
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What category do most arguments occur?
Level III
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Severe pain must be seen by a physician within how much time?
20 minutes
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Person performing triage cannot judge if person is
Exaggerating pain
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What two levels of ESI are considered acuity levels?
1 & 2
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What are the 3 objectives of emergency management?
Preserve life
Prevent deterioration
Restore patient
61
A belief that ones well being is in jeopardy is called an
Emergency
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What are the vital questions important on assessment?
```
Chief complaint
Life threatening injuries
Precipitating events/onset of symptoms
Mechanism of injury
Time factor
```
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What source of data can we use to determine answers
Patient
Family
Emergency personnel
Bystander
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Mnemonic for ABCDEFGHI
```
Airway
Breathing
Circulation
Disability
Exposure/environmental
Full set vs/five ni's/family
Give comfort measures
History/head-to-toe
Inspect posterior surfaces
```
65
What is the hallmark primary survey?
ABCD
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Secondary survey?
EFGHI
67
Do we resuscitate as we go down the assessments?
Yes!!
68
If there is an airway issue what do we always assume?
Cervical spine injury
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What are other causes of airway problems?
Inhalation injury
Obstruction
Penetrating wound/blunt trauma
70
When we assume a cervical injury is present what do we avoid?
Hyperextension of the neck
71
When we do a breathing assessment what are we assessing?
Ventilation
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If the patient isn't breathing well on their own or not at all, what do we vent with?
Bag-valve mask (BVM) with 100% O2
73
If respiratory arrest present or poor ventilation is apparent what do we anticipate?
Intubation
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If there are breath sounds absent prepare for?
Thoracotomy/chest tube insertion
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What are the four main causes of circulatory problems?
Direct cardiac injury
Pericardial tamponade
Shock
Uncontrolled hemorrhage
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What do we need to do during circulatory assessment?
Make sure the patient is not cold
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If absent pulse, what is initiated?
CPR
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If shock symptoms/hypotension present?
Start 2 large bore IV's and initiate rapid infusion
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What fluid is used for rapid infusion?
Normal saline
| Lactated ringers
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How do we control bleeding?
Apply direct pressure
81
What do we consider for chest trauma?
Auto transfusion
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During the disability assessment what is the first thing assessed?
LOC (level of consciousness)
83
What tool is used for verbal response?
GCS (Glasgow coma scale)
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If combative consider?
Hypoxia
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If herniation (posturing) present assume?
Hyperventilation
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What are the 3 categories of the Glasgow coma scale?
Eye opening
Verbal response
Motor response
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How brief must an emergency head-to-toe assessment be in time?
90 seconds
88
What is the pneumonic for AMPLE?
```
Allergies
Medication history
Past health history
Last meal
Events/environment preceding injury
```
89
Assessing tympany in the abdomen means?
Excessive air
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Assessing dull sounds in the abdomen means?
Excessive fluid
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What station is closest to the entrance?
The nurses station
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Who are the 6 groups of medical providers needed for a trauma?
```
Team leader/trauma surgeon
PA
Primary RN
additional nursing
Radiology techs
Respiratory therapy
```
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If we assume an airway problem what is the intervention?
Jaw thrust and suction
94
What is the percentage of the injured require the highest level of trauma care?
10-15%
95
Trauma center designation is done by
ACS surveyors
96
What are the levels of trauma centers?
1-5
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Level 1 is a regional resource trauma center.
Christiana Care
98
Level 2 centers may not provide definitive care for more complex injuries.
A.I.Dupont
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Level 3 trauma hospital may not have immediate access to a level 1 or 2 center
Beebe, Bayhealth, Nanticoke
100
Level 4 would be resuscitation and transfer
St. Francis, Wilmington general
101
Full trauma team activated for every trauma patient is what response system?
Non-tiered
102
Selective team members respond based on prehospital report of injuries or severity
Tiered
103
Someone who crosses the line in the trauma room must have 2 things
A legitimate reason
| Universal precautions garb
104
What needs to be over emphasized in the trauma room?
Noise control
105
Who should be speaking?
Team leader
106
What is the most common cause of death in pregnancy?
Trauma
107
Injury increases during pregnancy. What is the percentage for each trimester?
1 - 10%
2 - 40%
3 - 50%
108
What is the leading cause of trauma during pregnancy?
MVCs
109
What is the leading cause of maternal death?
Head injury and exsanguination
110
What is the leading cause of fetal death?
Maternal death
111
What is the leading cause of fetal death when the mother lives?
Abruption
112
What is the rate uterine blood flow?
500ml/min
113
How much blood volume is within the uterus during full term?
1/6 of the total blood volume
114
At term, how much uterine blood flow goes to the placenta?
80%
115
All critically injured pregnant patients greater than 20 weeks needs what in the emergency room?
An OB doc
116
What respiratory state are all pregnant women in?
Chronic compensated respiratory alkalosis
117
We cannot determine perfusion of pregnancy by vital signs. We need what to determine?
Draining foley
118
If a mom has lost a lot of blood it may not affect her but the baby may be
In shock
119
ACOG states pregnancy should not result in any restriction of the usual diagnostic, pharmacologic, or resuscitative procedures or maneuvers of the critically ill trauma pt. what does this mean?
We do what we need to do to save the patient regardless of protocol.
120
What is the #1 rule of thumb for the pregnant patient during trauma?
The mom always comes first.
121
ACOG minimal standards suggest fetal monitoring for at least how long after injury?
4-6 hours
122
ACOG recommends how long for treatment after an injury has occurred and there is bleeding, contracting, or uterine tenderness present?
24-48 hours
123
An inviable uterus is always a
Trauma
124
Has little or no diaphragm function. Has neck motion. Needs mechanical ventilation to breathe.
C3
125
Not sustainable to life
C1-C2
126
Has neck motion. Has shoulder elevation (shrug)
C4
127
Has some elbow motions. Quality of movement may not be smooth. Has some elbow flexion.
C5
128
Has shoulder and scapula motion. Elbow flexion present. Wrist extension present.
C6
129
Shoulder and scapula motion. Elbow flexion. Elbow extension provided by triceps. Wrist extension and flexion. Limited finger flexion and extension.
C7
130
Has all motions in the arms except small muscles of the hands. Weak and unbalanced grasp. Decrease in precise movements of the fingers.
C8
131
Full arm use. May have a weak grasp.
T1
132
Full hand strength.
T2-5
133
Progressive increased abdominal functioning: the lower the injury level, the more the abdominal muscles work. If the injury is below T-12 - full use of abdominal muscles.
T6-12
134
Has hip flexors. Able to lift hip toward ribs. Able to bend at the hips (knees to chest)
L2
135
Able to bend and straighten knee.
L2-5
136
Legs have full use. Some foot muscles may be weak.
S1-2
137
Paralysis of lower portion of the body and both legs. Injury T2; lumber - arms are spared
Paraplegia
138
Paralysis on all four extremities and usually the trunk. C1-T1
Quadriplegia
139
All motor and sensory tracts below the level of the lesions affected.
Complete cord transaction
140
Sparing some motor, sensory tracts. Mixed loss of voluntary motion and sensation.
Incomplete cord transection
141
Swelling of cord secondary to trauma. Can make an incomplete lesion complete.
Cord edema
142
Neuron whose cell body lies in the motor area of the cerebral cortex. The axon passes down the spinal cord and synapses with lower motor neurons.
Upper motor neurons
143
Neuron whose cell lies in the anterior gray column of the spinal cord. It's axon innervates striated muscle fibers. (L1-L2)
Lower motor neurons
144
Healthcare providers see this as the most devastating injury
Spinal cord injury
145
What arteries feed the spinal column?
COW (circle of Willis)
146
Vertical compression or axial loading is an injury caused by what?
Diving or falling head first
147
The spinal column is how long?
18 inches long.
148
The spinal column extends where?
The base of the brain to the hips.
149
A spinal rotation injury is caused by what?
Extreme lateral flexion and twisting
150
A penetrating spinal injury is caused by what?
Missiles, bullets, knives
151
Which is more common quad or para?
Quad
152
If the upper motor neurons are damaged, the lesions cause
Spasticity or hyperreflexia
153
If the lower motor neurons are injured the lesions will cause
Weakness, paralysis, flaccidity
154
How many rings of bone does the spinal column have?
33
155
How many cervical bones are there?
7
156
How many thoracic bones are there?
12
157
How many lumbar bones are there?
5
158
How many sacral bones are there?
5 but they are fused as 1
159
How many coccygeal bones are there?
4 and they are fused as 1
160
What scale is used to determine spinal column disability?
ASIA scale A-E
161
What is the actual mechanism of a spine injury in a car accident.
Head erect-collision-seat pushed forward- moves back-rebound-flexion
162
When the neck moves forward and snaps back is called
Hyper extension
163
When the neck snaps back is called
Hyperreflexion
164
What are the 3 was to hyperreflex the neck?
Acceleration (hit while stopped)
Deceleration (stopped in motion)
Deformity
165
What are the 3 types of spinal cord injury
Vertebral column injury without SCI
Vertebral column injury with SCI
SCIWORA syndrome (spinal cord injury without radio graphic abnormality
166
What are the three types of vertebral fractures?
Simple (singular break)
Compression (wedge)
Communited (burst)
167
What is the injury where one vertebrae overrides another?
Dislocation
168
This type of cervical fracture is rare. It is s burst fracture of the C1.
Jefferson fracture
169
This cervical fracture is an avulsion of the C1 from the occipital bone and is immediately fatal
Atlanto
170
This is called a Dens fracture of the C2 and is ruled out in all MVC with neck pain. A standard CT is performed.
Odontoid
171
This is separation of the C2 from the body. It is often fatal and has the most stable neuro deficits.
Hangmans fx
172
This fracture is when 1/2 of the cord is transected in north and south. It manifests with ispsilateral paralysis or paresis with contralateral loss of pain and temp.
Browns-Seqward Syndrome
173
This is injury or edema of the central cord with upper extremity weakness, paralysis, lower extremity intact but bowel and bladder dysfunction. A hyper extension injury.
Central cord syndrome
174
This is disruption of the blood flow, flexion injury, loss of pain, temp, and motor function below the injury but light touch, position, and vibration intact.
Anterior Cord Syndrome
175
Nosetail injury with flaccid bowel and bladder effects
Cauda Equina Syndrome
176
This is when the motor sensory function is intact but lose position sense and vibration. Proprioception. Compression of the posterior artery. Very Rare!
Posterior cord injury
177
Losing feeling or touch, position, or temp is an injury to the
Dermatomes
178
Losing motor function is an injury to the
Myotomes
179
What is the major predisposed area of injury
C5-C6
180
Can you have a fracture without cord injury?
Yes called a vertebral injury
181
What are the 4 chain events of spinal cord injury?
Hemorrhage
Edema
Ischemia
Necrotic
182
After 1 hour of spinal cord damage there is what happening?
Petechial hemorrhaging in gray matter
183
What happens after 4 hours of a SCI?
Infarction or swelling of gray matter
184
What happens when the spinal cord becomes ischemic?
It becomes necrotic from reduced O2 below the injury.
185
Within 24 hours after a SCI what has happened?
Permanent damage
186
What is the standard diagnostic done to treat?
CT scan
187
We want to give fluids to the SCI patient with LR but we do not want to over hydrate why?
This can lead to cord edema
188
We give steroids but not greater than 8 hours why?
It makes the injury worse
189
A bolus of solumedrol is given at what equation
30mg/kg
190
A drip rate is maintained for solumedrol at what equation
54mg/kg/hr
191
Why do we decrease solumedrol on the 10th day?
Immune system is decreased and sugars are increased
192
Why do we maintain BP of greater than 90 for a SCI?
Spinal shock could present
193
What is the goal of a spinal cord shock?
Sustain life and prevent further cord shock
194
What is the complication that comes after spinal shock with vasoconstriction. It occurs above the T6, in response to visceral stimulation, and occurs in persons with spinal cord injury lesions?
Autonomic dysreflexia
195
What complication is the most common cause of distention of the bladder or rectum?
Autonomic dysreflexia
196
Autonomic dysreflexia present with what vital change?
Increased BP of greater than 20 over baseline (SBP can be over 300mmHg)
197
What are the signs and symptoms of autonomic dysreflexia?
```
HA
Flushing
Diaphoresis
Pale skin
Bradycardia
Nasal congestion
Vision changes
Anxiety
```
198
What is the first thing we do when suspecting autonomic dysreflexia?
Check BP
199
If BP is greater than 140 we give
Nitro paste
200
If BP is greater than 160 we give
Procardia SL q 20-30 mins
201
What complication is a paralysis of the cervical sympathetic nerve trunk?
Horners Syndrome
202
What are the signs and symptoms of Horners Syndrome?
Ptosis of the eye
| Loss of sweating
