Trauma pt eval

Question 1

Most common causes of Trauma Mortality?

Answer 1

CNS injury (1/2)
Exsanguination

Question 2

Exacerbating factors in Trauma Mortality? (3)

Answer 2

Warfarin
Low Glascow Coma rating
Old age

Question 3

Immediate death from Trauma U result of? (4)

Answer 3

(death at scene)
Disruption of:
Great vessels
Heart
Lungs
Major body cavity

Question 4

Early death from trauma U result of?

Answer 4

(w/i 4 hrs of injury)

CV or pulmonary collapse

Question 5

Late death from trauma U result of?

Answer 5

(days to wks post)
sepsis
multiorgan failure

Question 6

Level I Trauma Center provides?

Answer 6

Tertiary care

24 hr in-house surgeons + promptly available specialists

Question 7

Level II Trauma Center provides?

Answer 7

Initiates definitive care

24 hr surgeon + specialty except for cardiac or microvascular surgery, dialysis

Question 8

Level III Trauma Center provides?

Answer 8

Assessment, resuscitation, stabilization, intensive care

24 hr ER docs and general surgeons

Question 9

Level IV Trauma Center provides?

Answer 9

Advanced traumatic life support prep for transfer

24 hr ED and labs

Question 10

Level V Trauma Center provides?

Answer 10

Eval, stabilization, diagnostics, prep for transport

After hr protocols

Question 11

ATLS includes? (4)

Answer 11

1) initial eval
2) resuscitation
3) stabilization
4) transfer

Question 12

Initial Eval of trauma includes? (4)

Answer 12

Stabilization
Identification of life-threat injury
Initiate support
Rapid organization of definitive care or transfer

Question 13

Primary Eval must assess and address?

Answer 13

Airway
Breathing
Circulation
Disability
Exposure

Question 14

End-organs are? (4)

Answer 14

Brain
Heart
Kidneys
Eyes

Question 15

Airway management includes? (5)

Answer 15

1) Assess conscious pt (w/ question)
2) Protect airway/cervical spine of unconscious pt
3) Observe (signs of difficulty)
4) Inspect mouth/throat (obstacles)
5) Inspect/palp anterior neck

Question 16

Tracheal Intubation used to?

How?

Answer 16

Mechanical ventilation

Endotracheal tube passed b/w vocal cords,
Requires direct visualization of cords,
Tube tip placed 1/2 b/w clavicle and carnia (trach spit into bronchi)

Question 17

Cricothyroidotomy is?

Answer 17

insertion of tube thru incision in cricothyroid membrane

Question 18

Breathing/Ventilation management includes? (6)

Answer 18

1) O2
2) Chest wall inspection (asymm/paradox mvmt)
3) Auscultate (apices and axillae)
4) Palpate (crepitus/deformity)
5) CXR for unstable pt
6) r/o pneuom/hemothorax, tamponade

Question 19

Treatment when signs of pneumothorax?

Answer 19

hypoTN, dyspnea, ipsilateral ↓ breath sounds

Needle Decompression:
2nd ICS @ MCL
5th ICS @ MAL

Tube thoracostomy:
immediately follows needle decomp
5th ICS, MAL

Question 20

Vent treatment when unstable pt?

Answer 20

anticipate pneuno/hemothorax

Tube thoracostomy

Question 21

Circulation management includes? (5)

Answer 21

1) Palpate central pulses (carotid/femoral)
2) Observe for external hemorr
3) Place IV catheters
4) Blood typing
5) Determining exact BP not necessary

Question 22

Arterial Hemorrhage management?

Answer 22

Manual pressure
Proximal compression
Elevation
Hemostatic agents

Question 23

Venous hemorrhage management?

Answer 23

Direct pressure

Question 24

Tx for pts w/o central pulse?

Answer 24

emergency thoracotomy

Question 25

Disability/Neuro management includes? (4)

Answer 25

1) Eval level of consciousness / Mental status 2) Pupil size, symm, light response 3) Motor/Sensory 4) Imaging

Question 26

Exposure/Environment Control includes?

Answer 26

1) Visualize entire body | 2) Hypothermia

Question 27

If pt is hemodynamically unstable, next step after primary survey?

Answer 27

Skip 2° survey | Send right to angio or major trauma center

Question 28

2° Survey in trauma includes? (3)

Answer 28

Head to toe exam (fingers and tubes in every hole) Detailed hx (of traumatic event and of pt's medical hx) X-Ray/CT

Question 29

Common Misses in trauma: Blunt Abd? Penetrating Abd? Thoracic? Extremity?

Answer 29

Blunt abd trauma: hollow viscus pancreatoduo diaphrag Penetrating abd trauma: rectal or urethral Thoracic trauma: pericardial tamponade aortic injuries esophageal perf Extremity trauma: fractures vascular disruption compartment synd

Question 30

2° Survey: C-Spine management

Answer 30

``` Clear (no x-ray needed) if: non-tender alert not intoxicated no distracting injury ``` If can't clear, do CT *neg CT AND tenderness, still cannot clear

Question 31

2° Survey: Tube considerations?

Answer 31

Foley: blood at meatus pelvic fracture NG Tube: mid face fractures

Question 32

2° Survey: Abdomen?

Answer 32

Diagnostic Peritoneal Lavage CT US

Question 33

Most frequently injured organ w/ penetrating trauma?

Answer 33

liver

Question 34

Most frequently injured organ w/ blunt abd trauma in adults?

Answer 34

Spleen

Question 35

What vaccines recommended w/ loss of spleen?

Answer 35

pneumo h. flu meningococc

Question 36

Common result of splenectomy?

Answer 36

thrombocytosis

Question 37

2° Survey: Chest? (6)

Answer 37

``` Crepitus Tenderness JVD (SVC compression) Tracheal deviation (tension pneumothorax) Respiratory effort CXR ```