Assessment & Management
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| Give three signs for transport to trauma center | 1-GCS < 14 2-RR < 10 or > 29 3-SBP < 90
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| Give twelve MVA criteria for transport to trauma center | 1-Ejection 2-Death 3-Run over or thrown 4-Unrestrained > 40 mph 5-Deformity > 20 in 6-Intrusion > 12 in 7-Extrication > 20 min 8-Fall > 20 ft 9-Rollover 10-Hit > 5 mph 11-Motorcycle > 20 mph 12-Separation
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| Give nine situations prompting transport to trauma center | 1-Flail 2-Fx 2+ proximal long bones 3-Amputation > wrist or ankle, crushed, mangled, degloved 4-Penetration to head, neck, chest, extremities prox to knee or elbow 5-Open or depressed skull 6-Paralysis 7-Pelvic fx 8-Trauma & burns 9-Isolated major burns
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| After evaluating airway, | Protect the cervcial spine
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| When is definitive airway management indicated? (3) | 1-Tracheal/laryngeal fractures 2-GCS < 8 3-Nonpurposeful motor responses
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| How do you confirm ETT placement? (5) | 1-Auscultation bilateral breath sounds 2-Watching chest rise & fall 3-End-tidal CO2 detector 4-Visualizing ETT through cords 5-CXR
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| What is No. 1 cause of preventable post-traumatic death? | Hemorrhage
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| Give three examples of occult hemorrhage | 1-Thoracic/abdominal cavity 2-Surrounding femur fracture 3-Pelvic fx c retroperitoneal hemorrhage
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| What is an unlikely cause of occult hemorrhage? | Neurogenic shock secondary to spinal cord injury
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| ___ patients may not demonstrate ____ as an early sign of significant blood loss. | Elderly, pediatric, athletic....tachycardia
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| How should rapid external hemorrhage be controlled during the primary survey? | direct manual compression
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| GCS measures ____ ____ and ____. | Eye opening, BEST Motor Response, and Verbal Response
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| Give four contributions to low GCS | 1-Hemorrhage 2-Hypoglycemia 3-Meds & Drugs 4-C-spine injury
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| Which type of hematoma leads to rapid ____ sometimes after a ____ interval? | alteration in mental status lucid epidural, not subdural
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| What factors determine maximum rate of fluid administration? | 1-Internal diameter of IV catheter and 2-inversely, the length of IV catheter, not the size of the vein
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| Which IV fluid is preferred and how is it prepared? | Ringers lactate warmed
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| What can IV NS cause? | hyperchloremic acidosis, especially with impaired renal function
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| Give blood priority: | MTSp UTSp ONeg
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| Give three considerations in PEA | 1-Cardiac tamponade 2-Tension Pneumothorax 3-Massive hemorrhage c hypovolemia
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| When should urethral injury be suspected? (6) | 1-Blood at penile urethral meatus 2-Perineal ecchymosis 3-Nonpalpable prostate (high-riding) 4-Ecchymotic scrotum 5-Blood in scrotum 6-Pelvic fracutre
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| When should a Foley not be inserted? | When urethral injury suspected
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| Best way to diagnose urethral injury | Retrograde urethrogram
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| Give four complications of NG tube insertion | 1-Insertion into brain via fx cribriform plate 2-Pulmonary aspiration of oropharyngeal or gastric contents 3-Bradycardia 4-Vomiting
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| What does pulse oximetry measure? | Percent of hemoglobin saturated with oxygen
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| Give four ways to evaluate cervical vasculature | 1-U/S 2-Contrast CT 3-MRI/MRA 4-Angiography
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| Give four criteria for surgical exploration of penetrating trauma to neck | 1-Expanding hematoma 2-Airway compromise 3-Arterial bleeding 4-New bruit
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| Give two examples of delayed abdominal trauma | 1-Small bowel injury 2-Pancreatic injury
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| Which findings are consistent with tension pneumothorax? (5) | 1-Distended neck veins 2-Hyperresonance to percussion 3-Decreased breath sounds 4-Tracheal deviation 5-Hypotension
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| Which findings are consistent with cardiac tamponade? (3) | 1-Hypotension 2-Distended neck veins 3-distant heart sounds
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| Which findings are consistent with aortic rupture? (7) | 1-Widened mediastinum 2-Blurring/obliteration of aortic knob 3-Rightward deviation of trachea and esophagus 4-Depression of left mainstem bronchus 5-Obliteration of space between PA and Aorta 6-Widened paratracheal stripe 7-Widened paraspinal interface
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| Three indications for DPL | 1-Unexplained hypotension 2-Abdominal pain and tenderness 3-Inability to perform reliable exam d/t neuro injury or altered mental status
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| Urethral injury is more common in ____. | Males
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| Immobilization if neuro injury suspected | 1-Semi-rigid cervical collar 2-long spine board
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| Adult maintenance urine output | 0.5 mL/kg/hour
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| Child maintenance urine output | 1.0 mL/kg/hour
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| Under 1 year of age maintenance urine output | 2.0 mL/kg/hour
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| Route of pain meds for trauma patient | IV, not oral or IM
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| Best method for opening airway in trauma patient | Chin lift or Jaw thrust
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| What should you do with an open pneumothorax? | Seal it on three sides, not four
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| Ten steps in initial assessment process 1-8 | 1-Preparation
2-Triage
3-Primary Survey
4-Resuscitation
5-Adjuncts to Primary Survey and Resuscitation
6-Consider need for Patient Transport
7-Secondary Survey (Head to Toe Evaluation and Patient History
8-Adjuncts to Secondary Survey
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| Ten steps in initial assessment process 9-10 | 9-Continued Postresuscitation Monitoring and Reevaluation
10-Definitive Care
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| Prehospital emphasis | 1-Airway maintenance
2-Control of external bleeding and shock
3-Immobilization of patient
4-Transport to closest appropriate facility
5-Minimization of scene time
6-Obtaining/reporting information, mechanism of injury
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| Give six more reasons to transfer to trauma center | 10-Crush, degloved, or mangled extremity
11-Pregnancy > 20 wks
12-Time-sensitive extremity injury
13-End-stage renal disease requiring dialysis
14-Burns w/o trauma: Triage to burn facility
15-Burns w trauma: Triage to trauma center
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| Considerations for Hospital Phase of trauma care (6) | 1-Proper airway equipment
2-Warmed IV crystalloid solutions
3-Appropriate monitoring capabilities
4-Method to summon additional help
5-Transfer agreements
6-Universal precautions
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| Appropriate patients should arrive at | appropriate hospitals.
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| Two types of triage situations | 1-Multiple casualities
2-Mass casualities
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| Characteristics and goal of Multiple Casualities | 1-Number and severity do not exceed ability
2-Life-threateningand multiple-system injuries treated first
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| Characteristics and goal of Mass Casualities | 1-Number and severity DO exceed capability
2-Greatest chance of survival and least expenditure treated first
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| Ten-second assessment (3) | 1-injuries
2-vital signs
3-injury mechanism
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| Trauma is a common cause of death in the | elderly.
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| Two things to promote survival in elderly trauma patients | 1-prompt, aggressive resuscitation
2-early recognition of preexisting conditions and medication use
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| What suggests airway is not in immediate jeopardy? | Patient able to communicate verbally.
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| Does neurologic exam alone exclude C-spine injury? | No
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| Assume a C-spine injury in patients with (3) | 1-multi-system trauma
2-altered level of consciousness
3-blunt injury above the clavicle
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| Airway patency alone does not ensure | adequate ventilation.
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| Ventilation requires adequate function of the (3) | lungs, chest wall, and diaphragm
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| Impaired ventilation during primary survey (4) | 1-tension pneumothorax
2-flail chest w pulmonary contusion
3-massive hemothorax
4-open pneumothorax
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| Impaired ventilation during secondary survey (4) | 1-simple pneumothorax
2-simple hemothorax
3-fractured ribs
4-pulmonary contusions
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| Intubation and vigorous bag-valve ventilation can make patient worse with | pneumothorax or tension pneumothorax
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| Until proven otherwise, injury related hypotension is considered | hypovolemic in origin.
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| Three elements of hypovolemia | 1-level of consciousness
2-skin color
3-pulse
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| A conscious patient may have lost | a significant amount of blood.
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| Skin in hypovolemic patient may show | 1-ashen, gray facial skin
2-white extremities
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| Easily accessible central pulses | carotid and femoral
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| Pulses in hypovolemia | thready, rapid, irregular, absent
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| What kind of hemorrhage is identified and controlled during what survey? | external primary
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| Two things not to use during primary control of hemorrhage | tourniquets and hemostats
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| When is a rapid neuro exam done? | at the end of the primary survey
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| Four things assessed during rapid neuro exam | 1-level of consciousness
2-pupillary size and reaction
3-lateralizing signs
4-spinal cord injury level
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| What correlation with CO does BP have in elderly? | little
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| What can increase blood loss in elderly? | anticoagulation therapy
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| Regarding room temperature, consider ____ rather than ____. | patient's body temp health-care providers
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| Immediate ____ should be started if tension pneumothorax is suspected. | chest decompression
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| How many, and what kind of IV catheters? | Two, large-bore
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| Prioritize volume resuscitation vs definitive control of hemorrhage | definitive control of hemorrhage
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| Shock w injury most often ____ in origin. | hypovolemic
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| What can and cannot be warmed in a microwave oven? | crystalloid fluids blood products
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| Name nine adjuncts used during primary survey | 1-electrocardiographic monitoring
2-urinary catheters
3-gastric catheters
4-ventilatory rate
5-ABG levels
6-pulse oximetry
7-blood pressure
8-x-rays
9-diagnostic studies
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| Dysrhythmias can indicate | blunt cardiac injury
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| Hypoxia, hypoperfusion and/or hypothermia can cause what dysrhythmias? (3) | 1-bradycardia
2-aberrant conduction
3-premature beats
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| Rectal exam and genital exam should be done before | inserting a urinary catheter
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| Gastric tube used to | 1-reduce stomach distension
2-decrease risk of aspiration
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| Blood in gastric aspirate may indicate (3) | 1-oropharyngeal (swallowed) blood
2-traumatic insertion
3-actual injury to upper digestive trace
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| Capnography does not confirm | proper placement of tube in trachea.
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| Pulse oximetry does not measure | the partial pressure of oxygen, nor
the partial pressure of carbon dioxide
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| Blood pressure may be a poor measure of | actual tissue perfusion
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| On which arm should pulse oximetry not be placed? | the one with the blood pressure cuff on
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| Essential x-rays should be obtained EVEN | in pregnant patients
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| F A S T | Focused Assessment Sonography in Trauma
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| D P L | Diagnostic Peritoneal Lavage
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| Two limiting factors in FAST | obesity and intraluminal bowel gas
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| Three limiting factors in DPL | 1-obesity
2-previous abdominal operations
3-pregnancy
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| Potential in unresponsive or unstable patient (2) | 1-missing an injry
2-failing to appreciate significance of injury
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| Medical assessment always includes | history of mechanism of injury
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| A in AMPLE | Allergies
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| M in AMPLE | Medications currently used
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| P in AMPLE | Past illness and Pregnancy
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| L in AMPLE | Last Meal
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| E in AMPLE | Events/Environment related to injury
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| Four categories of injury | 1-Blunt trauma
2-Penetrating trauma
3-Thermal injuries
4-Hazardous environment
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| Considerations in blunt trauma from MVC (5) | 1-seat-belt use
2-steering wheel deformation
3-direction of impact
4-damage (deformation or intrusion)
5-ejection
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| Considerations in penetrating trauma (2) | 1-organs in the path
2-velocity of the missile
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| Clues to extent of injury in gunshot victims (4) | 1-velocity
2-caliber
3-presumed path of bullet
4-distance from weapon to wound
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| Burns can occur ____ or with ____ | alone blunt and penetrating trauma
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| Two considerations in a fire | 1-inhalation injury
2-carbon monoxide poisoning
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| Two considerations about exposure to hazardous environment | 1-pulmonary, cardiac, internal organ dysfunction in patient
2-hazard to healthcare providers
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| Eyes should be evaluated for (7) | 1-visual acuity
2-pupillary size
3-hemorrhage of conjunctiva and/or fundi
4-penetrating injury
5-contact lenses (remove before edema)
6-dislocation of lens
7-ocular entrapment
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| Mechanism of Injury (5) | 1-Frontal impact
2-Side impact
3-Rear impact
4-Ejection
5-Pedestrian struck by motor vehicle
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| MOI | Mechanism of Injury
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| SIP | Suspected Injury Pattern
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| SIP in Frontal Impact MVC (7) | 1-Cervical spine fracture
2-Anterior flail chest
3-Myocardial contusion
4-Pneumothorax
5-Traumatic aortic disruption
6-Fractured spleen or liver
7-Posterior fracture/dislocation of hip and/or knee
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| SIP in Side Impact MVC (8) | 1-Contralateral neck sprain
2-Cervical spine fracture
3-lateral flail chest
4-Pneumothorax
5-Traumatic aortic disruption
6-Diaphragmatic rupture
7-Fracture spleen/liver and/or kidneys, depending on side of impact
8-Fractured pelvis or acetabulum
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| SIP in Rear Impact MVC (2) | 1-Cervical spine injury
2-Soft tissue injury to neck
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| SIP in Ejection from vehicle | Meaningful pattern precluded
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| SIP in Pedestrian Struck by Vehicle (4) | 1-Head injury
2-Traumatic aortic disruption
3-Abdominal visceral injuries
4-Fractured lower extremities/pelvis
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| Patient with mid-face fracture can have | fracture of cribriform plate
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| Presumption with maxillofacial or head trauma | unstable cervical spine injury
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| Does not exclued injury to cervical spine | absence of neurological deficit
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| Exam of neck includes (3) | 1-Inspection
2-Palpation
3-Auscultation
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| Unexplained or isolated paralysis of upper extremity | suspect cervical nerve root injury and document
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| Palpation of chest cage includes (3) | 1-clavicles
2-ribs
3-sternum
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| Auscultation of breath sounds for hemothorax | posterior bases
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| Auscultation of breath sounds for pneumothorax | high on anterior chest
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| Children often sustain significant injury to the ____ without evidence of ____. | 1-intrathoracic structures
2-thoracic skeletal trauma
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| What are you looking for in vaginal exam? | 1-blood in vaginal vault
2-vaginal lacerations
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| Pelvic fractures should be suspected when you identify ecchymosis over the (4) | 1-iliac wings
2-pubis
3-labia
4-scrotum
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| Manipulation of the pelvis should be done | only once
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| Complete musculoskeletal exam includes | the back
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| Prioritize treatment vs consent | consent, then treatment, usually, but when not possible, treat, then obtain consent
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