Are you dying?
The ESI triage algorithm is based off of four key questions; what are they?
It this patient dying?
Is this a patient who shouldn’t wait?
How many resources are needed?
What are the vital signs?
What part of survey involves assessing neurological status?
D (disability)
What is the most common cause of shock in an injured patient?
Hemorrhage from acute blood loss
Why is asking for mechanism of injury important during assessment?
Knowing the mechanism of injury (MOI) is vital for predicting injuries, prioritizing treatment, guiding diagnostic tests, and ultimately improving patient outcomes. It helps anticipate hidden injuries, informs treatment decisions, and is crucial for legal documentation.
What special considerations in charting do we take for potentially crime related injuries?
Charting wounds just as wounds and numbering them; we are simple nurses...
I woke up this morning, and there was a bat flying around our bedroom. Scared me half to death, and now I am so worried about rabies,” an anxious 48-year-old female tells you. “My husband opened the window, and the bat flew out.” Past medical history of ovarian cysts, no meds or allergies, vital signs are within normal limits. What is their ESI?
Level 4
What special consideration do we take for patients who have presumed crime-related injuries during the exposure stage?
DAILY DOUBLE
How do we collect potential forensic evidence?
Don’t cut through bullet holes – or other forensic evidence
Collect into paper bags; one item per bag
Shearing forces are commonly associated with what type of trauma?
Blunt trauma
A restrained driver in a head-on collision sustains a fractured sternum and multiple rib fractures. Which MOI principle is most likely responsible for these injuries?
A. Shearing forces
B. Penetration
C. Deceleration forces
D. Compression forces
Deceleration forces; in head-on collisions, the sudden deceleration forces the chest to compress against the steering wheel or restraint system, resulting in sternal and rib fractures.
Why is it critical to prevent hypothermia in trauma patients?
Hypothermia impairs coagulation, increases acidosis, and can worsen outcomes. Trauma triad of death!
What respiratory intervention should be done for every critically injured patient?
15L O2 ona non-rebreather mask; this also applies to critically ill patients with increased O2 and metabolic demand.
Which of the following describes a distracting injury?
A. A moderate laceration with moderate bleeding
B. A fracture of the tibia that causes significant pain
C. A small burn on the hand.
D. A patient experiencing angioedema.
B) A fracture of the tibia that causes significant pain
What step is necessary right after applying a tourniquet?
Time of application
During the secondary survey of a trauma patient, you note bruising behind the ear ("Battle's sign"). What injury should you strongly suspect?
Basilar skull fracture; battle's sign (bruising behind the ear) is a classic indicator of a basilar skull fracture, which is a serious injury, and also a common sign in domestic violence patients
What device is used to determine appropriate medication dosages for pediatric patients?
Broselow tape
What do A-I stand for in primary/ secondary survey?
A) Airway/alertness/cervical spine immobilization
(B) Breathing
(C) Circulation
(D) Disability
(E) Exposure
(F) Full set of vital signs/family
(G) Get resuscitation adjuncts (Gadgets)
(H) History/Head to toe
(I) Inspect posterior surfaces
What special consideration needs to be taken for ALL trauma patients during secondary survey?
All trauma patients should be log-rolled (spine protection)
Which assessment finding is MOST suggestive of a penetrating chest injury?
A. Paradoxical chest movement
B. Subcutaneous emphysema
C. Decreased breath sounds on one side
D. JVD
B. Subcutaneous emphysema; subcutaneous emphysema (air under the skin) is a sign of air leaking from the lungs, often due to a puncture in the lung or chest wall.
Describe suspicious burn mark patterns that would make you think of potential child abuse.
Creases in the stomach/ abdomen from hunching over, brun free spot on the rear from sitting down, etc
Why are vital signs unreliable during shock states for gauging if tissue perfusion has been restored?
Because they can be compensating with “normal” VS and urine output
My pain medications are not working anymore. Last night I couldn’t sleep because the pain was so bad,” reports a 47-year-old female with metastatic ovarian cancer. “My husband called my oncologist, and he told me to come to the emergency department.” The patient rates her pain as a 9/10. Vital signs are within normal limits. What's her ESI?
Level 2
What are the six questions to ask a patient during the secondary survey?
Symptoms assoc. with injury or illness
Allergies and tetanus status
Medication history
Past health history
Last meal/oral intake
Events leading up to the incident
A patient presents with a penetrating wound to the abdomen. They have a dropping blood pressure and increasing heart rate. Besides aggressive fluid resuscitation, what intervention is indicated?
A. Broad-spectrum antibiotics
B. Placement of a chest tube
C. Surgical exploration
D. Observation and monitoring
Surgical exploration; penetrating abdominal trauma requires immediate surgical exploration to control hemorrhage and address potential bowel or organ injury. Fluid resuscitation is important but isn't sufficient without surgical intervention
A patient with blunt cardiac injury often presents with which initial finding?
A. New murmur
B. Decreased blood pressure
C. ST segment changes on EKG
D. Symptoms of heart failure
ST segment changes on EKG; ECG changes are common early findings that indicate possible myocardial contusion (bruising of the heart muscle) from blunt trauma.
When can the patient use a family member/ friend as an interpreter?
When the patient is told that free interpreter services are available and the patient specifically requests that an accompanying adult interpret instead of the free qualified healthcare interpreter, or the hospital interpreter cannot speak the language or there isn't any other more reliable alternative.