Prehospital Care
What does CSM stand for when assessing extremities?
Circulation, Sensory, Motor function
1 unit of PRBCs will raise the hemoglobin by how many points?
1. TCAR pg. 43
List two or more (acceptable) ways to obtain a temperature on a trauma patient.
Oral, rectal, esophageal probe (intubated patients), and temp sensing foley catheter.
Axillary temperatures are not approved sources of initial trauma patient temperature as it is not a core temperature measurement. TNCC pg.35
Failure to recognize that a patient requires trauma care, resulting in adverse patient outcomes describes which triage issue?
Undertriage. Activating trauma care when not needed resulting in over-utilization and costs- Overtriage- is preferred over undertriage.
The most appropriate airway maneuver in the initial management of a trauma patient is...?
Jaw thrust.
What does DCAP-BTLS stand for when assessing a trauma patient?
Deformities-Contusions-Abrasions-Penetrations/Punctures-Burns-Tenderness-Lacerations-Swelling
Which aspect of the trauma triad of death (acidosis, coagulopathy, and hypothermia) is a NURSING responsibility?
Hypothermia. Human life requires that thousands of enzyme systems work simultaneously, at all times. Each enzyme system is TEMPERATURE DEPENDENT. TCAR pg.35
What type of dressing should be placed on a partial thickness burn wound prior to transfer to burn center?
Dry sterile gauze covered by a sheet/warm blanket/sterile blanket. (Trauma M&M Minutes)
How should you care for an amputated body part?
remove dirt and debris from exposed end, place in a sealed bag, preserve on ice. TNCC pg. 203
What does DOPE stand for when re-assessing an intubated patient?
D-Dislodgement
O-Obstruction
P-Pneumothorax
E-Equipment
PHTLS (9th edition, Lesson 3-Airway and Breathing)
What is the appropriate dose and administration route for Tranexamic Acid (TXA)?
1 gram IV over 10 minutes
Which trauma patient is most likely to have a poor outcome? Obstetric, Pediatric, or Geriatric?
Older adults have BY FAR the poorest outcomes following trauma. Geriatric patients not only need to have their injuries treated, but also an investigation of the underlying cause of their trauma. Never underestimate the potential impact of even a minor injury in older adults. TCAR pg.126
A patient with 35% partial thickness burns receives fluid resuscitation. Which parameter can nursing monitor to ensure adequate resuscitation?
Urine Output. 0.5 mL/kg/hr or approximately 30-50 mL/hr is the goal. Fluid rate should be adjusted as needed to maintain adequate urinary output. Lactated ringers is the fluid of choice because it approximates the intravascular solute contents. TNCC pg.221
Epistaxsis, rhinorrhea, and subconjuctival hemorrhage in the periorbital spaces (raccoon eyes) are all symptoms of which type of skull fracture
Basilar skull fracture. (STN TCRN study guide pg 42)
"Inadequate cellular perfusion; cells are not receiving oxygen and glucose needed to create energy (adenosine triphosphate [ATP])" is the definition of what?
Shock
(PHTLS (9th edition, Circulation)
You arrive on scene to find a 70 y/o F at the bottom of the staircase with blood on the stairs. She presents GCS 14 (E4-V4-M6). She has a small laceration above the left eye, bleeding controlled. Family reports the patient is taking Coumadin for AFIB. Should this be a trauma alert? Why or why not?
Yes. Based on age, mechanism, blood thinners; the patient should be activated as a trauma.
List three assessment findings that suggest a tension pneumothorax?
Early to late: Pleuritic chest pain, respiratory distress, tachycardia, hypoxemia, agitation, diminished/absent breath sounds, chest dissymmetry, hypotension, JVD, tracheal deviation. TCAR pg.57
Name at least 3 team member resources that a high level (category 1) activation prepares
Trauma attending, blood bank (MTP), radiology, OR, laboratory (TEG/type and screen), ICU (critical care bed/RN), and respiratory therapy. ACS Resources for Optimal Care of the Injured Patient pg. 37
In disaster management triage, Red indicates a patient is what?
Likely salvageable with immediate intervention
Prehospital providers have treated a sucking chest wound with an occlusive dressing. During transport to the hospital the patient develops increasing respiratory distress with increased respirations and absent lung sounds are noted on repeat auscultation. What is the most appropriate next intervention?
Daily Double- What activation criteria makes this a category 1 trauma?
Release the occlusive dressing.
Category 1 for respiratory compromise
PHTLS 8th edition, Thoracic Trauma
What's the diagnosis?
Your patient presents with blunt trauma to the chest c/o diff breathing. BP 100/60, HR 110, RR 28, Spo2 88% on RA, ETCO2 22mmHg. LS diminished on the left, clear on the right. Dull percussion in the lungs (hypo-resonant). No JVD or TD. Symmetrical chest rise.
Potential hemothorax.
In the absence of JVD/TD with hypo-resonant lung sounds, hemothorax should be considered.
What indicates that a resuscitation is complete?
Normalization of vital signs and restoration of aerobic metabolism (lactate <1, pH 7.35-7.45). TCAR pg. 47
What does TEG stand for and what is it used for?
Thromboelastometry. It is a point-of-care testing method to evaluate the efficiency of blood clotting in the actively bleeding patient.
TNCC 8th edition pg. 86
A 24 year old female with an A-negative blood type can safely receive which blood product?
type O FFP
type AB FFP
A+ RBC
AB- RBC
AB FFP is the universal donor for FFP
What are the steps of the Primary Survey in PHTLS?
X-Bleeding control
A-Airway
B-Breathing
C-Circulation
D-Disability
E-Environmental/Expose
PHTLS (9th Edition, Lesson 2)