ABCDEF
In general, does a patient who is speaking to you and answering questions have a need for immediate airway management?
No, not generally.
How many levels of trauma care are there?
Five.
Is blunt trauma or penetrating trauma more easily diagnosed?
Penetrating, because of the more obvious injury signs.
What are the ABCDEFs of trauma?
A- airway
B- breathing
C- circulation
D- deficit (neurological)
E- exposure of patient
F- full set of vitals
How long should it take for a primary survey to be completed after first seeing the patient?
1-2 minutes at most.
What are the two main mechanisms of injury?
Blunt trauma and penetrating trauma.
What is a coup-contrecoup injury?
A type of traumatic brain injury where the brain smacks the front and back of the skull.
List at least three ways we could assess a patient's airway.
-Vital signs (RR, O2 sat)
-Mental status (agitation, drowsy, coma)
-Airway patency (secretions, stridor, obstructions)
-Traumatic injury above the clavicles
-Ventilation status (accessory muscle use, retractions, wheezing, dyspnea)
Is trauma center designation determined at a state or federal level?
The state level. The state determines the criteria for categorization.
Bonus Q: which trauma center level deals with more severe, critical cases- level 1 or level 5?
What is the “golden hour” of the trimodal distribution of death?
80% of trauma deaths occur in the first hour after injury.
What types of tissue and structures in the body are more likely to be damaged less in the event of blunt trauma because of their elasticity?
Low density porous tissues and structures
Bonus Q: name an example of an organ that falls into this category.
What is the difference between airway and breathing in the ABCs?
Airway: physical airway, the ability to get air effectively into the lungs
Breathing: gas exchange between blood and the air in the lungs, allowing for adequate oxygenation and CO2 elimination
What is the main goal of a primary survey?
To identify any life threatening injuries (ABCs) and treat them as they're identified.
What 3 things are measured for a Glasgow coma scale?
-eye-opening
-verbal response
-motor response
What organs are more likely to rupture or fragment in the case of blunt force trauma?
The heart, spleen, and liver
What are we assessing for during a physical exam when it comes to breathing in the ABCs?
-breath sounds (absent)
-air hunger
-distended neck veins
-tracheal shift
What does it mean to triage?
Sort patients by level of acuity.
What are some potential adjuncts to a secondary survey?
-CT scan
-plain radiographs
-blood tests
-urinary bladder drainage
What two pieces of equipment are used for spinal protection?
-rigid cervical spinal collar
-long rigid spinal board/immobilization on a flat surface
Bonus Q: when do we lift spinal precautions?
When assessing circulation, what are at least 3 signs of inadequate tissue perfusion?
-pale skin color
-cool, clammy skin
-delayed cap refill
-altered LOC
-decreased urine output
What is the difference between a primary and secondary survey?
Primary: identifies and treats life threatening injuries
Secondary: complete a full history and physical exam to evaluate for other traumatic injuries. This is when we transfer to definitive care (ICU, OR, other unit, or another facility)
What is a laparotomy?
A surgical incision into the abdominal cavity.
What are at least 3 clinical insights when it comes to spinal precautions? (What is important for us to know, what we should do, what we shouldn’t do)
-treatment (immobilization) comes before diagnosis
-return head/keep head in neutral position
-resuscitation takes priority (diagnosis of spinal cord injury should not precede resuscitation)
-vehicle crashes are most commonly associated with with spinal cord injuries
-do not apply traction
Main focus: prevent further injury.
What are three ways to rapidly assess neurologic status to identify life-threatening injuries?
-pupil size and response
-mental status (GCS)
-motor and sensory exam
Match the trauma care level to the definition:
Can provide total care of injury, from prevention through rehabilitation.
Can provide advanced trauma life support (ATLS) prior to transfer of patients to a higher level trauma center. Provides evaluation and stabilization of injured patients.
Can provide prompt assessment, resuscitation, surgery, critical care and stabilization of injured patients and emergency operations
Can provide initial evaluation, stabilization and diagnostics, and prepares patients for transfer to higher levels of care
Can initiate definitive care for all injured patients
1
4
3
5
2
How long does each peak in the trimodal distribution of death take to occur after the time of injury?
First peak: seconds to minutes from time of injury to death.
Second peak: minutes to several hours.
Third peak: several days to weeks after the initial injury.
Bonus Q: Give at least 2 examples of injuries/problems that would fall under each peak.
What is a flail chest?
An acute chest injury in which 2 or more ribs become detached from the rest of the ribcage, allowing them to move separately from the rest of the thoracic cage.
Bonus Q: What sign of this will be found during a physical exam?