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HCPAR6002 Exam Revision > Trauma Quiz > Flashcards

Trauma Quiz Flashcards

1
Q

What are the airway and ventilation considerations in the traumatic head injured patient?

A
  • If airway patent and tidal volumes adequate (with trismus) DO NOT insert OPA or NPA (BVM only)
  • If airway not patent, and gag is present, insert NPA and ventilate (BVM)
  • If intubation is not possible/not authorised and gag is absent, insert LMA
  • Ventilation: 10ml/kg tidal volume
  • Maintain Sats >94$
  • ETCO2 30-35
  • BP >120
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2
Q

How many vertebrae are there?

A

33

Cervicle = 7
Thoracic = 12
Lumbar = 5
Saccral = 5
Coccyx = 4

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3
Q

Where would a spinal injury have to occur to result in loss of sympathetic tone?

A

Above T2

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4
Q

What is different about the vagus nerve?

A

It is a parasympathetic cranial nerve that exists at the BOS and therefore bypasses the spinal column

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5
Q

What is neurogenic shock?

A
  • shock that is caused by the sudden loss of autonomic nervous system signals to the smooth muscles in vessel walls
  • With sudden loss of background sympathetic stimulation, the vessels suddenly relax, resulting in a sudden decrease in Peripheral Vascular Resistance and decreased BP
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6
Q

What are some signs and symptoms of spinal cord injury?

A
  • Hypotension - due to venous pooling and decreased venous return
  • Bradycardia - due to unopposed parasympathetic response
  • Paralysis - due to damage to motor nerves
  • Priaprism - due to neurological and vascular causes
  • Paradoxical respirations - loss of innervation to thoracic masculature
  • Paraesthesia -damage to sensory nerves
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7
Q

What is the modified NEXUS criteria?

A

Increased Injury Risk
- Age >65
- Hx of bone or muscle weakening injury/disease

Difficult patient assessment
- Altered conscious state
- Intoxication
- Significant distracting injury

Actual evidence of structural injury
- midline pain/tenderness on palpation of the vertebrae

Neck range of motion
- Unable to actively rotate the neck 45 degrees left and right without pain

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8
Q

How much fluid will you administer to the patient with a GCS 15, HR 48, RR 14, BP 80/40 with a suspected spinal cord injury?

A

If SBP <90 systolic, 10mls/kg IV

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9
Q

What is a pneumothorax?

A

Air in the pleural space

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10
Q

What are the signs and symptoms of a tension pneumothorax?

A
  • hypotension
  • increased intrathoracic pressure (harder to breathe)
  • decreasing conscious state
  • tachycardia
  • +/- increased jugular venous pressure
  • decreased sats (late sign) in the setting of blunt or penetrating trauma
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11
Q

Your patient presents with subcutaneous emphysema. What happened and what does this mean?

A
  • air has escaped the pleural space and accumulated in the subcutaneous tissue
  • the patient has tensioned (no longer tensioning)
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12
Q

Who can you needle decompress?

A
  • the traumatic cardiac arrest patient
  • any trauma patient with a GCS <10 and a BP <70 (where cardiac arrest is imminent)
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13
Q

What sort of dressing do you apply to a patient who has been stabbed in the torso?

A
  • no dressing unless there is haemorrhage
  • do not occlude open pneumothorax
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14
Q

What is a flail segment?

A

2 or more rib #’s that allow part of the chest to move independently to the rest. It is extremely painful

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15
Q

Why is an open pevlic fracture significant?

A
  • life threatening
  • 1.5-3 litres of blood can be lost
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16
Q

What does an open book pelvic fracture mean?

A

That the pelvic ring which is normally strong is now broken or interrupted

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17
Q

What are the signs that make you suspect an open pelvic fracture?

A
  • mechanism - fall, MVA, MBA, fall from horse, blunt injury
  • Deformity/bruising/legs raised (unable to straighten)
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18
Q

How can the Trauma Triad of Death affect our patient with major/multiple traumatic injuries?

A
  • severe haemorrhage in trauma diminishes the oxygen delivery, causing the patients body temperature to drop (hypothermia). This is turn can halt the coagulation cascade, preventing blood from clotting (coagulopathy)
  • In the absense of blood bound oxygen and nutrients (hypoperfusion) the body’s cells burn glucose for energy (lactic acidosis). Such an increase in acidity can further reduce the efficacy of the heart muscles (myocardial performance), further reducing the oxygen delivery and triggering a deadly cycle.

OR

  • Hypothermia - environmental and hypovolaemia (due to bleeding) will make them cold. Intoxication and head injuries impair the bodies ability to regulate temperature
  • Coagulopathy - as the body gets colder, they loose the ability to clot. Impaired platelet function, inhibition of clotting factors (they need blood not normal saline)
  • Acidosis - lactic acis rapidly accumulates in the tissues causing the pH to drop, resulting in severe metabolic acidosis. This process frequently occurs in the presence of normal vital signs (think poor perfusion to tissues as a factor)
  • if left untreated the 3 create a cycle that propagate each other and lead towards a predictable and irreversible progression to death
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19
Q

In the absence of visible blood loss, what are some signs to look for (in suspected hypovolaemic patient)

A
  • internal signs e.g. pulmonary bleeding including haemoptysis and respiratory crackles
  • visible bruising on chest/abdomen
  • peritoneal signs - such as tenderness/guarding/rigidity/distension of abdo can suggest abdo bleeding
  • long bone fractures/open book pelvic fractures
  • abnormal vital signs e.g. isolated tachycardia, +/- hypotension
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20
Q

What are the 5 types of forces that can cause injuries?

A
  • acceleration
  • deceleration
  • rotational
  • horizontal
  • vertical
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21
Q

Define coup contre-coup injury.

A
  • coup - moving objects impacts the stationary head
  • contre-coup - moving head strikes a stationary object
  • the injury may occur directly under the site of impact, or on the opposite side of the impact
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22
Q

How much blood loss can occur with a fractured left femur?

A

approx 1000mls

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23
Q

If a patient is eye opening to voice, verbally inappropriate, and localising, what is their GCS?

A

GCS 11

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24
Q

How much blood loss is considered life threatening in an average adult person?

A

> 2000mls or greater than 40% blood loss (extremely poor perfusion)

25
Q

Which distribution of death can, paramedics have the most influence and why?

A

Progressive. Paramedics can influence this by recognition of severity of injuries/time criticality (utilising a standard patient assessment) essential patient care practices and then transfer to the patient to the highest level of care within 60 mins, with prehospital notification

26
Q

How much blood loss can occur with a right tib/fib frature?

A

up to 500mls

27
Q

Is a subarachnoid haemorrhage considered a non-TBI or a TBI?

A

Non-TBI

28
Q

If a patient is not eye opening, not talking, and has abnormal extension to pain what is their GCS?

A

GCS 4

29
Q

What patient management can paramedics influence to help prevent a secondary brain injury?

A

Avoid hypoxia
- Ventilate 6-7mls/kg
- consider elevation of HOB 30 degrees if no spinal considerations
- SpO2 >94%
- ETCO2 30-35

Avoiding hypovolaemia/hypotension
- maintain BP >120
- this will maintain CPP
- RSI MICA

30
Q

What is Central Perfusion Pressure (CPP)?

A
  • CPP is the pressent gradient which the circulatory system must work against to maintain cerebral perfusion
  • CPP = MAP - ICP
  • MAP = driving blood into the pain
  • ICP = providing resistance to keep it out
31
Q

How much blood loss can occur in an open book pelvic fracture?

A
  • 1.5-3L
32
Q

What is the cushings triad and what does this indicate?

A
  • irregular decreased respirations
  • bradycardia
  • systolic hypertension (widening pulse pressure)

This indicates increasing ICP, it is a late sign, indicates the brain herniation is imminent

33
Q

If a patient is eye opening, confused and localizing to pain, whats their GCS?

A

GCS 13

34
Q

How does the brain maintain ICP?

A

the brain has a steady and constant flow of cerebral blood and can maintain this as even as cerebral perfusion pressure changes. This is called autoregulation. It does this by vasoconstriction (decreasing blood flow) and vasofilation (increasing blood flow)

35
Q

What are the 3 major factors that influence ICP?

A
  • Hypoxia
  • Hypercapnia
  • Hypotension
36
Q

Which medications (that AV carry) can influence blood pressure?

A
  • morphine
  • midazolam
  • GTN
  • Stemetil
  • Ketamine
  • Frusemide (MICA only)
37
Q

How do you manage a combative head injured patient?

A
  • analgesia (NO MIDAZ)
  • IV morphine 5mg, repeat 5mg at 5/60 intervals, max 20mg
    OR
  • IV fentanyl 50mcg, repeat 50mcg at 5/60 intervals, max 200mcg

If no IV access:
- IN fentanyl 200mcg, repeat 50mcg at 5/60 intervals, max 400mcg
- IN fentanyl 100mcg, repeat 25mcg at 5/60 intervals, Max 200mcg (if frail or under 60kg)

Last resort:
- IM morphine >60 kg 10mg, repeat 5mg at 15/60 once only
- <60kg 0.1mg/kg, single dose only

38
Q

If a patient is eye opening to pain, incomprehensible, and withdrawing, what is their GCS?

A

GCS 8

39
Q

What are the paramedics goals in treating a head injured patient?

A

To correct or fix:
- hypoxia
- hypotension
- hypovolaemia
- avoiding initiating the gag reflex
- hypo/hyperventilation

40
Q

What should the SBP be in a trauma patient before fluids are adminsitered?

A

SBP <70

41
Q

If your trauma patient is trapped (with injuries and a falling BP), what do you need to request from the clinican?

A
  • blood products to be bought to the scene (MICA/HEMS)
42
Q

How much fluid will you administer to a patient with a fractured femur?

A
  • none, unless their BP is <70 (analgesia and splint first)
43
Q

Name 6 complications of chest injuries

A
  • rib fractures
  • flail segments
  • pulmonary contusions
  • myocardial tamponade
  • myocardial contusion
  • open pneumothorax
  • haemo/pneumothorax
  • ruptured diaphragm
44
Q

If the patient presents with ‘crackling emphysema’ to any part of their torse, what does this mean?

A
  • air has accumulated in the subcutaneous tissues
  • air has passed from the lungs, through the pleural space and into the tissues
45
Q

If your above patient was a GCS <9 and a BP <70 would you decompress their chest?

A
  • yes, if cardiac arrest was imminent
46
Q

Why do we decompress a chest?

A

to make a hole in the pleural space to release the trapped air

47
Q

Name 7 signs and symptoms of the patient presenting with a suspected tension pneumothorax

A
  • increased PIP’s
  • stiff bag
  • increasing ETCO2
  • poor perfusion of increased HR +/- decreasing BP
  • increased JVP
  • decreased conscious state (in the previously awake patient)
  • tracheal shift (late sign)
  • low SpO2 (late sign)
48
Q

what does SMART stand for?

A
  • second intercostal space
  • mid-clavicular line
  • above the rib elbow
  • right angles to the chest
  • towards the posterior spinal processes
49
Q

what is paradoxical respirations?

A
  • the chest wall moves inwardwhen breathing instead of outward
  • often the chest wall and abdominal wall move in opposite directions (there is damage to the underlying structures involved in breathing)
50
Q

If you want to spinally immobilise a patient, what does this involve?

A
  • collar
  • neutral position
  • lumbar support, maybe small head padding
  • spineboard and straps for extrication
  • co-ordinated lifting and rolling (extra people)
  • talking to the patient at their head
  • +/- antiemetics
  • seatbelts when on the stretcher
51
Q

A patient has a femur fracture #, ankle #, multiple contusions, # wrist, GCS 10 (head injured) and a BP 85. Would you initiate IV fluids? How much?

A

Yes, traumatic head injury, aim for SBP >120, start with 250ml bolus, aim for 20mls/kg, regular reassessments (HR, BP and chest auscultation)

52
Q

Why do you want a minimum BP of 120 systolic in the head injured patient?

A

to maintain cerebral blood f low (CPP) and prevent a secondary head injury

53
Q

If you have a patient that is spontaneously eye opening, incomprehensible verbal and localising, what is their GCS?

A

GCS 11

54
Q

What is one of the reasons the intoxicated patient with a blunt head injury and a GCS 13 goes to a trauma centre?

A
  • alcohol can mask injuries
  • alcohol thins the blood, therefore they can bleed more
  • They need to be spinally immobilised, meet the trauma criteria (GCS 13)
55
Q

What do vital signs have to be to meet major trauma criteria?

A
  • HR <60 or >120
  • BP <90
  • RR <10 or >30
  • SpO2 <90%
  • GCS 13 (age >16 yrs)
  • GCS <15 (age <15 yrs)
56
Q

What is the target scene time for the non-trapped trauma patient?

A

20 minutes

57
Q

What are the contraindications for the haemorrhagic hypovolaemia guideline?

A
  • traumatic head injury
  • isolated spinal cord injury
  • Ante post partum heamorrhage
  • post partum haemorrhage
58
Q

How long should you tolerate a BP or 70 in the trauma patient?

A

Up to 2 hours

59
Q

What is the maximum dose of fluids you can give to the above patient? (no head injury)

A
  • 2 litres (you need to consult after this, this patient actually needs blood)

HCPAR6002 Exam Revision (13 decks)

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