Trauma (Exam #1) Flashcards by Kyle Campbell

What is the most common cause of preventable mortality in trauma?

Hemorrhage

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What are the three levels of trauma mortality - describe each?

Immediate: death at scene of injury
Early: death 1-4 hours post-injury
Late = less common: death days/weeks post-injury (often due to sepsis, multiple organ failure)

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What two types of injury are often associated with trauma deaths? What two factors can increased this?

CNS injury
Exsanguination

Increased with low GSC score or old age

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What are the three levels of SALT Mass Casualty Triage?

1st: still/obvious life threat
2nd: wave/purposeful movement
3rd: walk

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What are the five levels of Trauma Centers?

Level 1: highest level of care
Level 2: definitive care in wide range of complex traumatic patients
Level 3: initial stabilization + tx, can care for uncomplicated trauma patients
Level 4/5: initial stabilization → transfer ALL trauma patients

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What approach is used with Primary Survey (PPE)/Initial Evaluation?

“ABCDE”

Airway
Breathing
Circulation
Disability
Exposure

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What is the definitive way to maintain airway patency and support? What is an alternative option?

Endotracheal intubation = definitive

- Cricothyroidotomy

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What three conditions are considered immediate threats to Breathing?

Tension PTX
Massive hemothorax
Cardiac tamponade

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With an unstable trauma patient, what two diagnostic tests should be performed to anticipate for PTX or hemothorax?

- Tube thoracostomy

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With Circulation, what two tasks should be performed on a trauma patient?

Place catheters

- Obtain blood type and cross match

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With Circulation and trauma, as blood is lost, what two vitals increase and which three findings decrease?

HR and RR increase

- BP, UO and GCS decrease

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What approach is used to treat shock, and what are the three steps?

Step down approach

1 L NS/LR
1-2 units O- RBCs
Start MTP (1:1:1 ratio of PRBC:FFP:platelets)

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What is MTP, and what is it used to treat?

Massive Transfusion Protocol for SHOCK

- 1:1:1 ratio of PRBC:FFP:platelets

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What is the AVPU scale?

Assess alertness vs. verbal vs. pain vs. unresponsive

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What is a normal GCS score? At what score is there a need to intubate?

15 points = normal

- <8 points = coma, need to intubate

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What is the Lethal Triad in trauma?

Hypothermia
Coagulopathy
Acidosis

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What temperature is considered hypothermia?

<35 C

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With a trauma patient, why would you order a Lipase?

Pancreatic trauma

- Can also indicate infarcted bowel or peritonitis

What does AMPLLE history stand for?

Allergies
Medications
PMH
Last meal
LMP
Events leading to trauma

What is the anticoagulation reversal for Antiplatelets (2)?

Platelets

+/- DDAVP

What is the anticoagulation reversal for Coumadin (4)?

Vitamin K
FFP
PCC
Factor VIIa

What is the anticoagulation reversal for Heparin?

Protamine sulfate

What is the anticoagulation reversal for Pradaxa (2)?

Praxbind

- PCC

What is the anticoagulation reversal for Xarelto/Eliquis?

PCC

What standard is used to evaluate for C spine injury, and what are the five components?

NEXUS - No midline spinal tenderness - No focal neuro deficits - Normal alertness - No intoxication - No painful distracting injury

What standard is used to evaluate for head injury in peds, and what are the four components?

PECARN = order CT if... - LOC of 5+ seconds - Non-frontal hematoma - Not acting normal - Severe MOI

What sign involves edema and bruising of subcutaneous fatty tissue around umbilicus, and what could this indicate?

Cullen’s Sign | - Possible retroperitoneal hemorrhage

What sign involves bruising of flanks, and what could this indicate?

Grey Turner’s Sign | - Possible retroperitoneal hemorrhage

What is the most frequently injured organ in penetrating trauma?

Liver

What is the most frequently injured organ in blunt trauma?

Spleen

What should be placed around the hips with a pelvic fracture?

Binder

With traumatic Vascular Injury, what are considered hard signs (5), and what is the recommended treatment?

Hard signs = go to OR - Active/pulsatile bleeding - Expanding hematoma - Pulseless limb - Shock - Compartment syndrome

With traumatic Vascular Injury, what are considered soft signs (4), and what is the recommended treatment?

Soft signs = obtain ABI/CT - Small/non-expanding hematoma - Venous oozing - Hx pulsatile bleeding - Unexplained neuro defect

What is an abnormal ABI value, and what test should then be obtained?

ABI <0.9 = abnormal | - Order CT angiogram of extremity if abnormal

What condition is associated with the 6 P's, and what are they?

Compartment Syndrome - Pain - Paesthesias - Pallor - Poikilotherma-polar - Paralysis - Pulselessness

What are the six symptoms associated with Compartment Syndrome?

- Pain - Paesthesias - Pallor - Poikilotherma-polar - Paralysis - Pulselessness

Under what 5 conditions would a wound be more likely to develop Tetanus?

- 6+ hours - Stellate/avulsion/abrasion wound - 1+ cm deep - Crush/burn/missile wound - Presence of signs of infection + devitalized tissue + contamination + ischemic tissue

What two types of burns require grafting?

- Deep partial thickness (2nd) | - Full thickness (3rd)

What position should a pregnant trauma patient be placed in, and why?

Left lateral decubitus position | - Avoid IVC compression

What is the time frame for a Perimortem C-Section (initiate vs delivery)?

- Initiate procedure within 4 minutes of maternal arrest | - Deliver within 5 minutes

What medication should be considered in a geriatric trauma patient?

Warfarin

With OP use of narcotics, what is the recommended administration?

Use for 3 days then throw away

With IP use of narcotics, what is the recommended administration?

Alternate opioids and non-opioids | +/- NSAIDs