Podcast
Questions and Answers
Anyone who presents with decreased LOC should be considered to have _______.
Anyone who presents with decreased LOC should be considered to have _______.
TBI
What are the goals of damage control surgery? (Select all that apply)
What are the goals of damage control surgery? (Select all that apply)
- Inspection of deep organs (correct)
- Placement of Hartmann's pouch (correct)
- Limit gastric contamination (correct)
- Stop the hemorrhage (correct)
- Identify bleeding and assess the cavity (correct)
What should you do if during damage control surgery, the patient becomes progressively more hypotensive despite fluid and pressor administration?
What should you do if during damage control surgery, the patient becomes progressively more hypotensive despite fluid and pressor administration?
Communicate with the surgeon about the patient's refractory hemodynamics.
How much time does the radiologist have to stop the bleed in case of a splenic injury?
How much time does the radiologist have to stop the bleed in case of a splenic injury?
What should occur if the patient in IR begins to decompensate?
What should occur if the patient in IR begins to decompensate?
What are the 4 mechanisms of traumatic brain injury?
What are the 4 mechanisms of traumatic brain injury?
What is the highest cause of mortality in trauma (neuro)?
What is the highest cause of mortality in trauma (neuro)?
What three things should you avoid with TBI patients? (Select all that apply)
What three things should you avoid with TBI patients? (Select all that apply)
What are the 4 examples of primary TBI injuries? (Select all that apply)
What are the 4 examples of primary TBI injuries? (Select all that apply)
What is the reason why TBI patients are more prone to trauma induced coagulopathy?
What is the reason why TBI patients are more prone to trauma induced coagulopathy?
What is the treatment for TBI coagulopathy?
What is the treatment for TBI coagulopathy?
What is the most common TBI that has the highest mortality?
What is the most common TBI that has the highest mortality?
What main artery is disrupted with the epidural hematoma?
What main artery is disrupted with the epidural hematoma?
What is the volume that mandates immediate decompression of the epidural hematoma if supratentorial compression occurs?
What is the volume that mandates immediate decompression of the epidural hematoma if supratentorial compression occurs?
What is the leading cause of mortality and morbidity for all age groups?
What is the leading cause of mortality and morbidity for all age groups?
What is the most important aspect in the treatment of trauma patients?
What is the most important aspect in the treatment of trauma patients?
What does the 'E' stand for in the 'ABCDE' approach to trauma assessment?
What does the 'E' stand for in the 'ABCDE' approach to trauma assessment?
A shearing injury is considered to be a penetrating wound.
A shearing injury is considered to be a penetrating wound.
What are the primary injuries associated with blast injury components?
What are the primary injuries associated with blast injury components?
What are the secondary injuries associated with blast injury components?
What are the secondary injuries associated with blast injury components?
What results from being thrown by the blast wave?
What results from being thrown by the blast wave?
What are quaternary injuries in the context of blast injuries?
What are quaternary injuries in the context of blast injuries?
What are some examples of thoracic injuries?
What are some examples of thoracic injuries?
How will you prepare to intubate a patient with respiratory distress and hoarseness?
How will you prepare to intubate a patient with respiratory distress and hoarseness?
What percentage of progressive blood loss could be inferred for an 88-year-old patient with HR of 114 and decreased SBP?
What percentage of progressive blood loss could be inferred for an 88-year-old patient with HR of 114 and decreased SBP?
What are the three important aspects of initial airway management?
What are the three important aspects of initial airway management?
What are the four trauma-related indications for airway management?
What are the four trauma-related indications for airway management?
What are the five components to RSI?
What are the five components to RSI?
What should you do if your patient has a grade III view worsened by cricoid pressure?
What should you do if your patient has a grade III view worsened by cricoid pressure?
What is the RSI dose for Vecuronium?
What is the RSI dose for Vecuronium?
Why does Boyle's law apply to apneic ventilation?
Why does Boyle's law apply to apneic ventilation?
Difficult intubation is the ______ most common respiratory-related event leading to death and brain damage.
Difficult intubation is the ______ most common respiratory-related event leading to death and brain damage.
What are your main goals with airway management?
What are your main goals with airway management?
What should be presumed in any trauma patient complaining of neck pain?
What should be presumed in any trauma patient complaining of neck pain?
What percentage of trauma patients have cervical spine injuries?
What percentage of trauma patients have cervical spine injuries?
What additional aspect should you assume for cervical spine injured patients until proven otherwise?
What additional aspect should you assume for cervical spine injured patients until proven otherwise?
How do you maintain c-spine precautions during intubation?
How do you maintain c-spine precautions during intubation?
What are the two ways question makers can ask about the best airway technique for trauma patients?
What are the two ways question makers can ask about the best airway technique for trauma patients?
What is the name of the airway device that can block the esophagus and facilitates easy access to the trachea?
What is the name of the airway device that can block the esophagus and facilitates easy access to the trachea?
Which cuff blocks entry to the esophagus in the Combi or King tube?
Which cuff blocks entry to the esophagus in the Combi or King tube?
Which cuff stabilizes the tube and seals the oropharynx in the Combi or King tube?
Which cuff stabilizes the tube and seals the oropharynx in the Combi or King tube?
Current evidence suggests that prehospital airway devices improve patient outcomes.
Current evidence suggests that prehospital airway devices improve patient outcomes.
What should you have in the room upon induction for a MVA patient with distorted facial anatomy?
What should you have in the room upon induction for a MVA patient with distorted facial anatomy?
Between what two cartilages should you place the cricothyrotomy incision?
Between what two cartilages should you place the cricothyrotomy incision?
Nasal intubation is contraindicated for a comatose patient with trauma near the zygoma.
Nasal intubation is contraindicated for a comatose patient with trauma near the zygoma.
Describe the Le Fort fracture I.
Describe the Le Fort fracture I.
Describe the Le Fort fracture II.
Describe the Le Fort fracture II.
Describe the Le Fort fracture III.
Describe the Le Fort fracture III.
What are the most common lung injuries present in 70% of blunt traumas?
What are the most common lung injuries present in 70% of blunt traumas?
With pulmonary contusions, which law should be considered when decreased gas exchange occurs?
With pulmonary contusions, which law should be considered when decreased gas exchange occurs?
What condition is indicated by multiple injuries, distended neck veins, decreased chest wall movement, and persistent hypotension despite IV fluid resuscitation?
What condition is indicated by multiple injuries, distended neck veins, decreased chest wall movement, and persistent hypotension despite IV fluid resuscitation?
In flail chest, when does lung compliance become decreased?
In flail chest, when does lung compliance become decreased?
What is the highest mortality injury related to unrestrained MVA?
What is the highest mortality injury related to unrestrained MVA?
Why are trauma patients more at risk for ARDS?
Why are trauma patients more at risk for ARDS?
What should you think about when assessing the 'D' for stability of the trauma patient?
What should you think about when assessing the 'D' for stability of the trauma patient?
What is the cause of 40% of deaths within the first 24 hours of trauma?
What is the cause of 40% of deaths within the first 24 hours of trauma?
What are the three stages of shock?
What are the three stages of shock?
What fraction calculation is used to assess the blood loss and degree of shock?
What fraction calculation is used to assess the blood loss and degree of shock?
What is the normal shock index?
What is the normal shock index?
What are the uses for the shock index?
What are the uses for the shock index?
What does a shock index of 1.1 indicate?
What does a shock index of 1.1 indicate?
What population should the shock index be used with caution?
What population should the shock index be used with caution?
The shock index will underestimate the degree of shock in the elderly due to a higher heart rate.
The shock index will underestimate the degree of shock in the elderly due to a higher heart rate.
An acute trauma patient presents with UOP of 5-15 ml/hr, confused and a heart rate of 130. What class of blood loss would you guess?
An acute trauma patient presents with UOP of 5-15 ml/hr, confused and a heart rate of 130. What class of blood loss would you guess?
After a patient in shock is stabilized, what is their metabolic and hemodynamic state?
After a patient in shock is stabilized, what is their metabolic and hemodynamic state?
What is the triple threat of trauma patients?
What is the triple threat of trauma patients?
For every 1 ml of blood loss, how much crystalloid should be replenished?
For every 1 ml of blood loss, how much crystalloid should be replenished?
What is hypotensive resuscitation?
What is hypotensive resuscitation?
What are the SBP goals for the hemorrhaging patient?
What are the SBP goals for the hemorrhaging patient?
Name that class of blood loss that causes sympathetic response, increased DBP and HR.
Name that class of blood loss that causes sympathetic response, increased DBP and HR.
Name that class of blood loss where compensatory mechanisms are not sufficient to maintain perfusion and meet metabolic demands.
Name that class of blood loss where compensatory mechanisms are not sufficient to maintain perfusion and meet metabolic demands.
Name that blood loss class that will develop trauma-induced coagulopathy and require 1:1:1 ratio transfusions.
Name that blood loss class that will develop trauma-induced coagulopathy and require 1:1:1 ratio transfusions.
What can occur shortly after a traumatic injury before resuscitative efforts?
What can occur shortly after a traumatic injury before resuscitative efforts?
What are the three reasons why trauma-induced coagulopathy occurs in trauma patients?
What are the three reasons why trauma-induced coagulopathy occurs in trauma patients?
What is the role of activated protein C in trauma-induced coagulopathy?
What is the role of activated protein C in trauma-induced coagulopathy?
What is the dose and timeframe TXA should be given for major trauma?
What is the dose and timeframe TXA should be given for major trauma?
What is the result of activated protein C?
What is the result of activated protein C?
How does FFP correct the activated protein C pathway?
How does FFP correct the activated protein C pathway?
Platelets and cryo are essential to the initial phase of hemostatic resuscitation.
Platelets and cryo are essential to the initial phase of hemostatic resuscitation.
What are the contradictory points for hemostatic resuscitation?
What are the contradictory points for hemostatic resuscitation?
What are the recommendations with lab values for managing coagulopathy?
What are the recommendations with lab values for managing coagulopathy?
What is the potential risk associated with damage control resuscitation?
What is the potential risk associated with damage control resuscitation?
What are the hazards associated with blood component transfusions?
What are the hazards associated with blood component transfusions?
What factors should you consider when deciding whether to transfuse?
What factors should you consider when deciding whether to transfuse?
What is an additional point for the need for MTP beyond SBP < 90, HR > 120, and the presence of penetrating mechanism?
What is an additional point for the need for MTP beyond SBP < 90, HR > 120, and the presence of penetrating mechanism?
In what situation is emergency thoracotomy indicated in pulseless or organized cardiac activity?
In what situation is emergency thoracotomy indicated in pulseless or organized cardiac activity?
How can you minimize the risks of exposure and heat loss?
How can you minimize the risks of exposure and heat loss?
Renal, liver, and spleen injuries are managed with surgical intervention.
Renal, liver, and spleen injuries are managed with surgical intervention.
What is the most common solid organ injured in trauma?
What is the most common solid organ injured in trauma?
Non-operative treatment for spleen laceration consists of what?
Non-operative treatment for spleen laceration consists of what?
What is the second most common solid organ injury but has the highest cause of death?
What is the second most common solid organ injury but has the highest cause of death?
During the intraoperative period, what is one consideration you should think prior to giving multiple units of blood?
During the intraoperative period, what is one consideration you should think prior to giving multiple units of blood?
During the abbreviated interview prior to induction, what should be explained to the patient?
During the abbreviated interview prior to induction, what should be explained to the patient?
This inhalational agent is contraindicated with bowel injury, pneumothorax, and closed head injuries.
This inhalational agent is contraindicated with bowel injury, pneumothorax, and closed head injuries.
What two anatomical structures stent open the subclavian artery?
What two anatomical structures stent open the subclavian artery?
What is one essential component to apnea ventilation?
What is one essential component to apnea ventilation?
How is apnea ventilation performed?
How is apnea ventilation performed?
What are the mechanics of apnea ventilation?
What are the mechanics of apnea ventilation?
What are the IV access considerations for patients with vena cava injuries?
What are the IV access considerations for patients with vena cava injuries?
Study Notes
Trauma Overview
- Trauma is the leading cause of mortality and morbidity across all age groups.
- A consistent approach to resuscitation is critical in treating trauma patients.
ABCDE Trauma Assessment
- The "E" in "ABCDE" stands for Environment and Exposure; undressing the patient is essential to identify all injuries.
Injury Types
- Shearing injuries are not classified as penetrating wounds; they fall under blunt injuries, which include cervical fractures and traumatic brain injuries.
- Blast injuries have four components:
- Primary injuries: damage from the blast wave affecting the head, organs, or lungs.
- Secondary injuries: result from flying debris.
- Tertiary injuries: occur due to being thrown by the blast wave.
- Quaternary injuries: exacerbation of pre-existing conditions.
Thoracic Injuries
- Common examples include tension pneumothorax, pericardial tamponade, massive hemothorax, cardiac rupture, traumatic aortic rupture, tracheal injuries, and commotio cordis.
- Respiratory distress in a patient with potential cervical spine injury necessitates rapid sequence intubation (RSI) and neck stabilization.
Hemorrhagic Shock in Elderly
- Elderly patients may show delayed compensatory responses; up to 40% blood loss may be present before significant signs.
Airway Management Key Principles
- Prepare for potential failed intubation.
- Assume a cervical spine injury until ruled out.
- Consider risk of aspiration due to presumed full stomach.
Indications for Airway Management
- Loss of airway reflexes, decreased level of consciousness (GCS < 8), requirement for pain management with deep sedation, and inadequate ventilation or oxygenation.
Rapid Sequence Intubation (RSI) Components
- Key steps: pre-oxygenation, cricoid pressure, induction, apneic ventilation, and direct laryngoscopy.
Difficult Intubation
- A Grade III view worsens with cricoid pressure may require alteration or removal of pressure.
Airway Devices
- Combi or King tube: blocks the esophagus and facilitates tracheal access.
- The distal cuff blocks esophageal entry, while the proximal cuff seals the oropharynx.
Prehospital Airway Devices
- Current evidence suggests limited improvement in patient outcomes with prehospital airway management in trauma.
Le Fort Fractures
- Le Fort I: maxilla fracture.
- Le Fort II: separation of the upper mouth and nose.
- Le Fort III: involves the entire face.
Lung Injuries
- Lung contusions are the most common lung injury in blunt trauma, occurring in 70% of cases.
- Tension pneumothorax prompts immediate intervention; positive pressure ventilation is contraindicated.
Trauma Resuscitation
- Hemorrhage is responsible for 40% of deaths within the first 24 hours post-injury.
- The three stages of shock include compensated, progressive, and irreversible.
Blood Loss Classification
- Class II (15-30% loss): sympathetic response triggered.
- Class III (30-40% loss): metabolic acidosis may require transfusion.
- Class IV (>40% loss): severe coagulation issues with a need for a 1:1:1 transfusion ratio.
Trauma-Induced Coagulopathy
- Caused by dilution of factors, hypothermia, acidosis, and hemorrhagic shock.
- Activated protein C plays a prominent role in coagulation dysregulation post-injury.
- Tranexamic acid (TXA) administration is crucial within the first 3 hours post-trauma.
Damage Control Surgery Goals
- Identify and control bleeding, limit contamination, inspect deep organs.
Management of Solid Organ Injuries
- Spleen is the most commonly injured solid organ in trauma cases, often managed non-operatively.
- Liver injuries are the second most common, yet they pose the highest mortality risk.
General Management Considerations
- Temp regulation and minimizing exposure are critical in trauma care.
- Avoid nasal intubation in patients with facial trauma or signs of cerebrospinal fluid leakage.
Special Considerations: Traumatic Brain Injury (TBI)
- TBI is a leading cause of mortality in trauma patients; anyone with decreased LOC should be assumed to have TBI.
- Avoid hypocapnia, hypercarbia, and hypoxemia in TBI management.### Treatment for TBI Coagulopathy
- Fresh frozen plasma (FFP) targets specific clotting factors V and VIII.
- Recombinant factor VIIa is utilized for enhancing coagulation.
- Regular monitoring of prothrombin time (PT) and international normalized ratio (INR) is essential.
Most Common TBI with Highest Mortality
- Acute subdural hematoma resulting from deceleration or blunt force injuries.
- Involves vein rupture leading to severe brain compression.
- Surgical decompression may be necessary, especially in cases of midline shift.
Artery Disrupted in Epidural Hematoma
- Middle cerebral artery (MCA) is primarily affected.
- Represents less than 10% of traumatic brain injuries (TBI).
- Classified as a neurosurgical emergency due to ongoing arterial bleeding.
Volume for Immediate Decompression of Epidural Hematoma
- Any volume exceeding 30 ml warrants urgent surgical intervention to alleviate supratentorial compression.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Test your knowledge on the ABCDE approach to trauma assessment with this quiz. The questions cover essential concepts including trauma definitions, treatment strategies, and assessment techniques. Perfect for medical students and healthcare professionals looking to reinforce their understanding of trauma care.
