ESI
Triage
Triage
An ambulance arrives with an unresponsive 20 year old with a single, self inflicted gun shot wound to the head. Prior to intubation his GCS was 3.
ESI 1-Immediate life saving measures
List 2 oxygen delivery devices used for a trauma patient.
Nasal Cannula, Oxymask, C-PAP/Bi-PAP, ET Tube, Non-Rebreather
MCI
Mass Casualty Incident
List 2 ways to warm your trauma patient in the ED.
Warm blankets, warm fluids/blood products, increase room temperature
What 4 components make up the trauma lethal triad?
Hypothermia, Acidosis, Coagulopathy, Hypocalcemia
A 50 year old man presents to the ED stating he ran out of blood pressure medication and his doctor is on vacation. He is requesting a refill prescription. His vitals are BP 125/84, HR 75, RR 18, SpO2 95% on room air.
ESI 5-No resources; RX refill only
How do you reprioritize the trauma assessment when uncontrolled hemorrhage is present?
C-ABC
GCS
Glasgow Coma Scale
What medication must be given to the patient during MTP after 4 units of blood product.
1g Calcium Gluconate, IVP
Name 2 causes of hypothermia in a trauma patient.
Hemorrhagic Shock; Brain Injury; Alcohol Intoxication; Patient of extreme age w/DM or thyroid disease; Prolonged extraction time; Temperature of fluids/blood infused
A 27 year old female presents to the ED with c/o nausea and vomiting when she attempts to eat or drink. She is 8 weeks pregnant. Her lips are dry and cracked. Vital signs are: T 36.1°C, HR 114, BP 104/68, SpO2 99% on RA, pain 2/10.
ESI 2- Patient's HR is 114, automatically making her an ESI 2 regardless of resources required.
What is the most important thing to remember when using any type of tourniquet?
Time the tourniquet was placed or inflated
ROSC
Return of spontaneous circulation
When is inserting an NG/OG contraindicated based on the patient's injury?
Facial injuries/deformities and anterior skull fractures
Hypothermia is a core body temperature less than what?
34 C
A 56 year old male presents to the ED c/o LLQ abd pain for 3 days. He denies n/v/d and has no change in appetite. PMH of hypertension. Vital signs are: T 36.9°C, RR 18, HR 80, BP 126/70, SpO2 98% on RA, pain 5/10.
ESI 3 - This patient has stable vital signs and requires 2 or more resources, likely including blood labs, urinalysis, and a CT, X-ray, or ultrasound.
What is the reason why the trauma MD checks the patients rectal tone?
Poor rectal tone is one symptom of a severe spinal cord injury
LMNOP
Labs, Monitor, NG/OG, Oxygen, Pain
You are assessing a 20 year old trauma patient. He moans, bends his arms towards his chest, and points his toes when another RN attempts to start an IV. You notice his eyes are closed. What is his GCS?
GCS 6
Eye Opening = 1
Verbal = 2
Motor = 3
Which component of the trauma lethal diamond plays a role or is crucial to the function of the other 3?
Hypocalcemia
A 52 year old female presents to the ED for possible UTI. She is complaining of dysuria and frequency. She denies abdominal pain or vaginal discharge. NKDA. Takes vitamins and has no significant medical history. Vital signs are: T 36.5°C, HR 78, RR 16, BP 138/72, SpO2 98% on RA.
ESI 4 - She will need labs which will include a urinalysis and urine culture. She most likely has a UTI and will be treated with oral antibiotics.
In the secondary survey, what does SAMPLE stand for?
Symptoms
Allergies
Medications
Past medical hx
Last oral intake
AVPU
Alert, Voice, Pain, Unresponsive
Another way to assess for level of consciousness
What is the most accurate way to verify placement of an endotracheal tube (ETT) if X-Ray is not available?
End tidal carbon dioxide (ETCO2) capnography.
The number 1 treatment to stop the lethal diamond is?
Stop the bleed!!!