Trauma Management

Question 1

Trauma patients requiring fluid resuscitation should not receive more than _____ mL of total fluid

Answer 1

2000 mL

Question 2

Patients that meet the NEXUS criteria and are not multi-trauma require _____ (simple / full) SMR

Answer 2

simple

Question 3

TXA must be administered within ___ hours of the injury

Answer 3

3 hours

Question 4

When managing a crush injury, you may need to apply a __________ proximal to the injury site before releasing the crush if it is not possible to alkalize the blood on scene

Answer 4

tourniquet

Question 5

TXA may only be delivered by ______ (route)

Answer 5

IV

Question 6

Oxygen administration should be routine in major trauma to avoid __________

Answer 6

hypoxia

Question 7

Caution should be taken when administering TXA because rapid administration can __________

Answer 7

potentiate futher hypotension

Question 8

Patients’ clothes should be removed _____ (on scene / in the ambulance)

Answer 8

in the ambulance

Question 9

Non-ABC interventions (splinting, wound care, etc.) should be performed _____ (on scene / en route) in major trauma

Answer 9

en route

Question 10

Trauma patients with head injury should receive fluid resuscitation targeting a systolic BP of at least _____ mm Hg

Answer 10

120 mm Hg

Question 11

Major trauma patients should routinely recieve 2 large bore IVs _____ (en route / on scene)

Answer 11

en route

never delay transport of a major trauma patient to obtain IV access

Question 12

In head injury, the patient should be positioned _______

Answer 12

head elevated at 30 degress

Question 13

When preparing TXA for administration using a 50mL N/S mini bag you should first __________ (spike the bag / inject the medication into the bag)

Answer 13

inject the medication into the bag

spiking the bag and priming the line first means that the line will not contain any medication, delaying administration of the TXA

Question 14

Hypotensive trauma patients without head injury should be resuscitated targeting a systolic blood pressure of ______ (range) mm Hg

Answer 14

70 - 90 mm Hg

Question 15

The three components of simple SMR are:

Answer 15

• Cervical collar on - head not taped
• Mattress not clamshell
• Head of stretcher up 30 degress - only if head-injured

Question 16

The 5 modified NEXUS criteria for SMR are:

Answer 16

1. Is there midline tenderness?
2. Is there altered LOC?
   
   • must be alert/oriented x 3
3. Are there new focal neurological deficits?
4. Are they intoxicated?
   
   • judgement and pain sensation must be intact
5. Is there a major distracting injury?
   
   • significant enough to interfere with their ability to assess pain response when palpating spine

Question 17

Adult dosage for TXA is ____

Answer 17

1g

Question 18

Criteria for “high risk group” patients with regards to SMR are: (list 3)

Answer 18

• Age >65
• Osteoporosis
• Pre-existing spinal condition (ex: ankylosing spondilitis)

Question 19

Crush injuries will often warrant an early call to clinicall for guidance on __________ (acidifying / alkalyzing) the blood prior to releasing the crush

Answer 19

alkalyzing

Question 20

Indications for administration for TXA are:

Answer 20

trauma with signs of shock/hypoperfusion in association with injury suggestive of occult or ongoing bleeding

Question 21

The primary goal of care in major trauma management is ________

Answer 21

Efficient scene management and expeditious transport to hospital

Question 22

1g TXA should be administered over a period of ___ minutes

Answer 22

10 minutes

Question 23

Contraindications for administration of TXA are: (list 4)

Answer 23

• Hypersensitivity to Tranexamic Acid
• Not administered if greater than 3 hours after the injury
• Dialysis
• Not for actual/estimated age 16 yrs or less

Question 24

Three options for delivering IV TXA are:

Answer 24

• IV slow push over 10 minutes from 10cc syringe
• Added to 50mL mini bag and delivered through piggy-back macro drip set at 1 gtt/sec
• Added to 250mL N/S bag and run through macro drip set at 5 gtts/sec (wide open)

Question 25

Findings that would warrant caution for thoracolumbar spine injury in patients not requiring SMR would be: (list up to 7). These patients should not be sat up or have their head elevated.

Answer 25

• Dangerous MOI
• Fall from height >3m
• Axial load to head or base of spine
• High speed MVC (>100km/h)
• Rollover MVC
• Pre-existing spinal pathology
• New back deformity, bruising, or bony midline tenderness on log roll