Trauma Mechanics
A patient strikes the steering wheel when their vehicle suddenly stops. Which Newton's Law explains why the patient's body keeps moving forward?
Newton's First Law / Law of Inertia.
What is a late sign of a tension pneuothorax?
Tracheal Deviation
Why are pediatric trauma patients at greater risk for multiple internal organ injuries from blunt abdominal trauma?
Less protective fat/muscle, more compliant chest/abdominal walls, and relatively larger/exposed organs.
An EVD is leveled to what anatomical landmark?
The tragus/external auditory meatus, which approximates the foramen of Monro.
What is the amount of time a tourniquet can stay on?
2 hours
Kinetic energy increases dramatically as which factor increases: mass or velocity?
Velocity.
KE = ½mv², so velocity is squared.
A trauma patient has hypotension, JVD, and muffled heart sounds. What life-threatening injury should you suspect?
Cardiac tamponade
A pregnant trauma patient becomes hypotensive while lying flat. What simple positioning intervention may improve her hemodynamics?
Left uterine displacement/left lateral positioning to reduce aortocaval compression.
What three components make up the GCS?
Eye opening, verbal response, and motor response.
Where should a pelvic binder be positioned?
Over the greater trochanters, not the waist/iliac crests.
A patient falls 20 feet and lands feet first. What mechanism occurs through the skeleton, and what injuries should you anticipate?
Axial loading — consider calcaneal/long-bone fractures, pelvic injury, and spinal compression injuries.
What is the difference between a pneumothorax and a hemothorax?
Pneumothorax = air in the pleural space.
Hemothorax = blood in the pleural space.
In a pregnant trauma patient, who must be stabilized first to provide the best chance for fetal survival?
The mother. Maternal resuscitation is the priority.
Your patient has an EVD. Before repositioning the patient or changing the head of the bed, what must you consider?
appropriate clamping when indicated and re-leveling/re-zeroing the system after repositioning before resuming drainage.
TRUE or FALSE: By not answering "would you like more blood" after retrieving blood from the blood kiosk times out the system and stalls the transaction like it never happened.
TRUE.
A restrained driver in a high-speed MVC has significant bruising across the lower abdomen from the seatbelt. What injuries should you anticipate?
Intra-abdominal injury, including bowel/mesenteric injury, solid-organ injury, vascular injury, and associated lumbar spine injury.
A patient with blunt chest trauma develops increasing respiratory distress several hours later. Initial imaging wasn't dramatic. What injury can evolve/worsen over time?
Pulmonary contusion.
Why can a child maintain a seemingly normal blood pressure despite significant blood loss and then suddenly deteriorate?
Children can compensate with tachycardia and vasoconstriction for a significant period; hypotension is a late and concerning sign of shock.
A head-injury patient develops hypertension, bradycardia, and irregular respirations. What is this called, and what does it suggest?
Cushing's triad — concerning for significantly increased ICP/impending herniation.
Your patient has a deep, actively hemorrhaging junctional wound that cannot be treated with a tourniquet. What's your intervention?
Pack the wound tightly with hemostatic gauze/gauze and apply sustained direct pressure.
A patient is struck by an explosion. Name the four categories of blast injury.
Primary — blast-wave injury
Secondary — flying debris/shrapnel
Tertiary — patient thrown into another object
Quaternary — burns, inhalation injury, crush/toxic exposures, etc.
Your trauma patient suddenly becomes profoundly hypotensive and hypoxic. The right chest has no breath sounds. What is the priority: wait for chest X-ray or treat the suspected injury?
Treat immediately for suspected tension pneumothorax. In an unstable patient with classic findings, treatment should not be delayed for imaging.
A third-trimester patient is involved in an MVC. She initially looks stable but develops abdominal pain, uterine tenderness, and vaginal bleeding. What traumatic complication should you suspect?
Placental abruption.
Your severe TBI patient suddenly develops a unilateral blown pupil and rapidly declining LOC. What should you suspect?
Brain herniation from rising intracranial pressure until proven otherwise; this requires immediate escalation/intervention.
Name the classic DIAMOND OF DEATH associated with severe hemorrhagic trauma.
Hypothermia + Acidosis + Coagulopathy + Hypocalcemia