ABCDE's of Trauma Quiz
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Questions and Answers

Anyone who presents with decreased LOC should be considered to have _______.

TBI

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?

    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?

    <p>60 min</p> Signup and view all the answers

    What should occur if the patient in IR begins to decompensate?

    <p>Must proceed to the OR.</p> Signup and view all the answers

    What are the 4 mechanisms of traumatic brain injury?

    <p>Blast injury</p> Signup and view all the answers

    What is the highest cause of mortality in trauma (neuro)?

    <p>TBI</p> Signup and view all the answers

    What three things should you avoid with TBI patients? (Select all that apply)

    <p>Hypoxemia</p> Signup and view all the answers

    What are the 4 examples of primary TBI injuries? (Select all that apply)

    <p>Epidural hematoma</p> Signup and view all the answers

    What is the reason why TBI patients are more prone to trauma induced coagulopathy?

    <p>Injured neurons release tissue factor activating the protein C pathway.</p> Signup and view all the answers

    What is the treatment for TBI coagulopathy?

    <p>FFP (specifically factor V and VIII) and recombinant factor VIIa.</p> Signup and view all the answers

    What is the most common TBI that has the highest mortality?

    <p>Acute subdural hematoma.</p> Signup and view all the answers

    What main artery is disrupted with the epidural hematoma?

    <p>MCA.</p> Signup and view all the answers

    What is the volume that mandates immediate decompression of the epidural hematoma if supratentorial compression occurs?

    <blockquote> <p>30 ml</p> </blockquote> Signup and view all the answers

    What is the leading cause of mortality and morbidity for all age groups?

    <p>trauma</p> Signup and view all the answers

    What is the most important aspect in the treatment of trauma patients?

    <p>Must have a consistent approach to resuscitation</p> Signup and view all the answers

    What does the 'E' stand for in the 'ABCDE' approach to trauma assessment?

    <p>environment and exposure</p> Signup and view all the answers

    A shearing injury is considered to be a penetrating wound.

    <p>False</p> Signup and view all the answers

    What are the primary injuries associated with blast injury components?

    <p>head, organ or lung injuries from the blast wave</p> Signup and view all the answers

    What are the secondary injuries associated with blast injury components?

    <p>injuries from the flying debris</p> Signup and view all the answers

    What results from being thrown by the blast wave?

    <p>tertiary injuries</p> Signup and view all the answers

    What are quaternary injuries in the context of blast injuries?

    <p>exacerbation of pre-existing conditions</p> Signup and view all the answers

    What are some examples of thoracic injuries?

    <p>tension pneumothorax, pericardial tamponade, massive hemothorax, cardiac rupture, traumatic aortic rupture, tracheal injuries, commoto cordis</p> Signup and view all the answers

    How will you prepare to intubate a patient with respiratory distress and hoarseness?

    <p>RSI due to high risk with the hoarseness, stabilize the neck while intubating</p> Signup and view all the answers

    What percentage of progressive blood loss could be inferred for an 88-year-old patient with HR of 114 and decreased SBP?

    <p>40% or even greater than that</p> Signup and view all the answers

    What are the three important aspects of initial airway management?

    <ol> <li>Consider potential failed intubation, 2) presume cervical spine injury, 3) risk of aspiration</li> </ol> Signup and view all the answers

    What are the four trauma-related indications for airway management?

    <ol> <li>loss of airway reflexes, 2) decreased LOC with GCS &lt; 8, 3) need for pain management and sedation, 4) inadequate ventilation/oxygenation</li> </ol> Signup and view all the answers

    What are the five components to RSI?

    <ol> <li>pre-oxygenation, 2) cricoid pressure, 3) induction/muscle relaxation, 4) apneic ventilation, 5) DL</li> </ol> Signup and view all the answers

    What should you do if your patient has a grade III view worsened by cricoid pressure?

    <p>CP should be altered or removed if unable to intubate</p> Signup and view all the answers

    What is the RSI dose for Vecuronium?

    <p>2 mg/kg</p> Signup and view all the answers

    Why does Boyle's law apply to apneic ventilation?

    <p>Gas exchanges based on concentration gradient of gases in the alveoli</p> Signup and view all the answers

    Difficult intubation is the ______ most common respiratory-related event leading to death and brain damage.

    <p>third</p> Signup and view all the answers

    What are your main goals with airway management?

    <p>prevent hypoxia and hypercapnia, don't overinflate when ventilating, maintain c-spine precautions</p> Signup and view all the answers

    What should be presumed in any trauma patient complaining of neck pain?

    <p>cervical spine injury</p> Signup and view all the answers

    What percentage of trauma patients have cervical spine injuries?

    <p>2-4%</p> Signup and view all the answers

    What additional aspect should you assume for cervical spine injured patients until proven otherwise?

    <p>actively intoxicated with drugs or alcohol</p> Signup and view all the answers

    How do you maintain c-spine precautions during intubation?

    <p>remove only the front portion of the brace, use a second person to maintain position, do not pull up on the neck</p> Signup and view all the answers

    What are the two ways question makers can ask about the best airway technique for trauma patients?

    <p>emergent: RSI with inline stabilization, controlled: fiberoptic awake only if not bloody</p> Signup and view all the answers

    What is the name of the airway device that can block the esophagus and facilitates easy access to the trachea?

    <p>the Combi or King tube</p> Signup and view all the answers

    Which cuff blocks entry to the esophagus in the Combi or King tube?

    <p>the distal cuff</p> Signup and view all the answers

    Which cuff stabilizes the tube and seals the oropharynx in the Combi or King tube?

    <p>the proximal cuff</p> Signup and view all the answers

    Current evidence suggests that prehospital airway devices improve patient outcomes.

    <p>False</p> Signup and view all the answers

    What should you have in the room upon induction for a MVA patient with distorted facial anatomy?

    <p>cricothyrotomy or trach set</p> Signup and view all the answers

    Between what two cartilages should you place the cricothyrotomy incision?

    <p>between the thyroid cartilage and the cricoid cartilage</p> Signup and view all the answers

    Nasal intubation is contraindicated for a comatose patient with trauma near the zygoma.

    <p>True</p> Signup and view all the answers

    Describe the Le Fort fracture I.

    <p>fracture to maxilla</p> Signup and view all the answers

    Describe the Le Fort fracture II.

    <p>upper mouth and nose are separated</p> Signup and view all the answers

    Describe the Le Fort fracture III.

    <p>entire face</p> Signup and view all the answers

    What are the most common lung injuries present in 70% of blunt traumas?

    <p>lung contusions (the deadly blossom)</p> Signup and view all the answers

    With pulmonary contusions, which law should be considered when decreased gas exchange occurs?

    <p>Fick's</p> Signup and view all the answers

    What condition is indicated by multiple injuries, distended neck veins, decreased chest wall movement, and persistent hypotension despite IV fluid resuscitation?

    <p>tension pneumothorax</p> Signup and view all the answers

    In flail chest, when does lung compliance become decreased?

    <p>during inspiration</p> Signup and view all the answers

    What is the highest mortality injury related to unrestrained MVA?

    <p>torn thoracic injuries</p> Signup and view all the answers

    Why are trauma patients more at risk for ARDS?

    <p>due to pulmonary capillary leakage of high protein fluid</p> Signup and view all the answers

    What should you think about when assessing the 'D' for stability of the trauma patient?

    <p>hypoglycemia, drugs, ETOH, hypoperfusion, mechanism of injury, hypercarbia, LOC and spinal cord injury</p> Signup and view all the answers

    What is the cause of 40% of deaths within the first 24 hours of trauma?

    <p>hemorrhage</p> Signup and view all the answers

    What are the three stages of shock?

    <ol> <li>compensated, 2) progressive, 3) irreversible</li> </ol> Signup and view all the answers

    What fraction calculation is used to assess the blood loss and degree of shock?

    <p>shock index</p> Signup and view all the answers

    What is the normal shock index?

    <p>0.5 - 0.7</p> Signup and view all the answers

    What are the uses for the shock index?

    <p>triage, for prediction of the need for massive transfusion</p> Signup and view all the answers

    What does a shock index of 1.1 indicate?

    <p>acute hypovolemia, marker in severity &amp; mortality</p> Signup and view all the answers

    What population should the shock index be used with caution?

    <p>geriatrics</p> Signup and view all the answers

    The shock index will underestimate the degree of shock in the elderly due to a higher heart rate.

    <p>False</p> Signup and view all the answers

    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?

    <p>class III 1500-2000 ml lost</p> Signup and view all the answers

    After a patient in shock is stabilized, what is their metabolic and hemodynamic state?

    <p>successful resuscitation resulting in hypermetabolic/hyperdynamic state</p> Signup and view all the answers

    What is the triple threat of trauma patients?

    <p>acidosis, hypothermia, coagulopathy</p> Signup and view all the answers

    For every 1 ml of blood loss, how much crystalloid should be replenished?

    <p>3 ml</p> Signup and view all the answers

    What is hypotensive resuscitation?

    <p>when replenishing volume, goal of BP is lower to decrease excessive bleeding</p> Signup and view all the answers

    What are the SBP goals for the hemorrhaging patient?

    <p>SBP &gt; 100 (or 85-90 mmHg) and HR less than 100 BPM</p> Signup and view all the answers

    Name that class of blood loss that causes sympathetic response, increased DBP and HR.

    <p>class II (15-30%)</p> Signup and view all the answers

    Name that class of blood loss where compensatory mechanisms are not sufficient to maintain perfusion and meet metabolic demands.

    <p>class III (30-40% blood loss)</p> Signup and view all the answers

    Name that blood loss class that will develop trauma-induced coagulopathy and require 1:1:1 ratio transfusions.

    <p>class IV (greater than 40% blood loss)</p> Signup and view all the answers

    What can occur shortly after a traumatic injury before resuscitative efforts?

    <p>trauma-induced coagulopathy</p> Signup and view all the answers

    What are the three reasons why trauma-induced coagulopathy occurs in trauma patients?

    <ol> <li>dilution of factors, 2) hypothermia and acidosis combo, 3) hemorrhagic shock</li> </ol> Signup and view all the answers

    What is the role of activated protein C in trauma-induced coagulopathy?

    <p>activated protein C will consume plasminogen activator inhibitor, leading to hyperfibrinolysis</p> Signup and view all the answers

    What is the dose and timeframe TXA should be given for major trauma?

    <p>should be given within the first 3 hours of the injury; dose: 1 gm over 10 min and continuous infusion 125 mg/hour</p> Signup and view all the answers

    What is the result of activated protein C?

    <p>activated protein C will inhibit factors V and VIII</p> Signup and view all the answers

    How does FFP correct the activated protein C pathway?

    <p>it will improve clotting by overwhelming the thrombin-thrombomodulin complex</p> Signup and view all the answers

    Platelets and cryo are essential to the initial phase of hemostatic resuscitation.

    <p>False</p> Signup and view all the answers

    What are the contradictory points for hemostatic resuscitation?

    <p>most common cause of coagulopathy - dilutional thrombocytopenia</p> Signup and view all the answers

    What are the recommendations with lab values for managing coagulopathy?

    <ol> <li>INR &lt; 1.5, 2) platelet count &gt; 50,000; FFP dose 10-15 ml/kg for severe bleeding</li> </ol> Signup and view all the answers

    What is the potential risk associated with damage control resuscitation?

    <p>may be exposing patients to risks of blood products when not necessary</p> Signup and view all the answers

    What are the hazards associated with blood component transfusions?

    <p>infectious and non-infectious reactions</p> Signup and view all the answers

    What factors should you consider when deciding whether to transfuse?

    <p>should be based off labs, clinical evidence of bleeding, presence of cardiovascular disease</p> Signup and view all the answers

    What is an additional point for the need for MTP beyond SBP < 90, HR > 120, and the presence of penetrating mechanism?

    <p>positive for FAST</p> Signup and view all the answers

    In what situation is emergency thoracotomy indicated in pulseless or organized cardiac activity?

    <p>penetrating trauma; not recommended in pulseless blunt trauma</p> Signup and view all the answers

    How can you minimize the risks of exposure and heat loss?

    <p>keep temp greater than 35 C, do full examination in heated room, warm IVF, forced warm air device, cover the patient</p> Signup and view all the answers

    Renal, liver, and spleen injuries are managed with surgical intervention.

    <p>False</p> Signup and view all the answers

    What is the most common solid organ injured in trauma?

    <p>spleen (25%)</p> Signup and view all the answers

    Non-operative treatment for spleen laceration consists of what?

    <p>ensuring hemodynamic stability, normal abdominal exam, absence of clear indications for exp-lap</p> Signup and view all the answers

    What is the second most common solid organ injury but has the highest cause of death?

    <p>liver laceration</p> Signup and view all the answers

    During the intraoperative period, what is one consideration you should think prior to giving multiple units of blood?

    <p>If you give blood, you don't want it to go out of the patient.</p> Signup and view all the answers

    During the abbreviated interview prior to induction, what should be explained to the patient?

    <p>the possibility for intraoperative awareness</p> Signup and view all the answers

    This inhalational agent is contraindicated with bowel injury, pneumothorax, and closed head injuries.

    <p>N2O</p> Signup and view all the answers

    What two anatomical structures stent open the subclavian artery?

    <p>the first rib and the clavicle</p> Signup and view all the answers

    What is one essential component to apnea ventilation?

    <p>airway must be patent in order to perform</p> Signup and view all the answers

    How is apnea ventilation performed?

    <p>NC at 15 LPM, jaw thrust/NPA/DL</p> Signup and view all the answers

    What are the mechanics of apnea ventilation?

    <p>The pressure difference between O2 and CO2 creates a negative pressure gradient.</p> Signup and view all the answers

    What are the IV access considerations for patients with vena cava injuries?

    <p>should get IV access proximal to the vena cava injury</p> Signup and view all the answers

    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.

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    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.

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