EMS Cases
EMS sends an E-bridge for a 72 year old female fall from standing two days ago. Patient is complaining of shortness of breath and their oxygen saturation is 86% on room air.
Category 1 for age over 72, trauma- fall, and respiratory compromise- think rib fractures, pneumo/hemothorax
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.
What is the most life threatening complication of a femur fracture
Hemorrhage. 500-2000 mL can be lost, 1500 mL is most common. TNCC pg.193
EMS sends a E-bridge for a 85 year old man found down in an assisted living. Last known well 2000 the night before. Patient was found with a table on top of him, was possibly moving furniture. O2 sat is 73% on r/a, pt usually wears 3L N/C. Initial BP is 70/P. GCS 10
Category 1 for age, respiratory compromise, hypotension, geriatric considerations, trauma (possible rib fractures)
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 blood type is the universal PLASMA donor
AB
C.A CMED call
Category 1- 22 year old MCC, partial amputation of right leg with multiple angulated fractures with femoral head exposure with complete dissassociation of connective tissue per EMS report. Right leg reported as no distal pulse due to injury, Initial BP 96/44, IVF bolus given. On arrival to the trauma bay, pulses were initially not present, no sensation, however after reduction of the RLE and immobilization pulses were strong, sensation intact, and movement of toes intact. The patient was brought immediately to the OR due to ongoing bleeding and hemodynamic lability.
Not enough info given on call to meet cat 1 so a cat 2 was called
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
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)
52 year old female was struck head on by a drunk driver. Was the potential dose of energy high or low?
High. The closing speed of two vehicles traveling toward each other at 65mph is 130mph. Even if both cars were only going 25mph they are coming together 50mph. TCAR pg.19
D.M. CMED call
54 y/o s/p MVC. Pt reported that he went off the road with + LOC and required extrication. Pt was c/o of difficulty breathing with diminished left lung sounds. Needle decompression was performed in the field, swelling/mass noted to chest, c/o pain with breathing. Pt was placed on 5L of oxygen via NC at 83% and c-collar was placed. O2 sat on arrival was 83% on 5L-patient placed on NRB t 15L. Efast was noted to have lack of lung sliding on the left side. Following CXR, a left sided thoracostomy was performed with a 28 french tube for hemopneumothorax with minimal blood return in pleurevac. Post procedure, the patients O2 Sat was 94% of 15L NRB.
Injuries included:
small left pneumothorax
left pulmonary contusion
large splenic laceration
Left sided rib fx 4-12 with 5-8 displaced
The patient was admitted to the trauma service-intercare level of care for rib fx protocol, f/u with thoracic surgery.
CATEGORY 1
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
What test can be performed with readily available equipment to test for compartment syndrome?
Compare WAVEFORMS on pulse ox reading for injured and uninjured extremity. TCAR pg. 115
A.L. CMED Call
Category 1 for hypotension, spinal deformity from field. Patient's car rolled down 100+ft embankment, o2 sat 90% admitted to SICU. Unrestrained back seat passenger. Patient had L1 step-off, hemothorax, and rib fractures.
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
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
The American College of Surgeons requires level one trauma centers to collect which data metrics (vitals) within the first 30 minutes of arrival?
GCS, BP, HR, O2, RR, and TEMP. Height and weight required within 24 hours of arrival. National Trauma Data Standard Data Dictionary pgs. 39-55