Applied Bioscience for Health - Trauma
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Questions and Answers

What is the primary purpose of a cricothyrotomy in an emergent situation?

  • To lower the risk of spinal cord injury.
  • To facilitate quick access to the airway. (correct)
  • To ensure oxygenation while awaiting intubation.
  • To provide long-term airway management.

    • Which of the following conditions is NOT a characteristic of tension pneumothorax?

  • Distended neck veins.
  • Hyperinflation of the affected lung. (correct)
  • Absence of breath sounds on the affected side.
  • Air trapping in the pleural space.

    • What is the most critical first step in managing a patient presenting with signs of hemorrhagic shock?

  • Administer blood products immediately.
  • Perform an abdominal ultrasound.
  • Start intravenous fluid resuscitation. (correct)
  • Transport the patient to a surgical ward.

    • During a primary survey of a trauma patient, what is the primary focus concerning the cervical spine?

    <p>Ensure the head is returned to neutral position. (C)</p> Signup and view all the answers

    What is the recommended management for a patient with flail chest?

    <p>Intubation only if respiratory distress is present. (A)</p> Signup and view all the answers

    What primarily causes injuries sustained in blunt trauma?

    <p>Kinetic energy transfer (D)</p> Signup and view all the answers

    During which phase of trauma management is the patient's immediate medical needs assessed?

    <p>Primary survey (B)</p> Signup and view all the answers

    What is NOT a type of mechanism of injury?

    <p>Physical injury (B)</p> Signup and view all the answers

    In the context of trauma management, what is the primary goal of resuscitation?

    <p>Stabilize vital signs (A)</p> Signup and view all the answers

    Which condition is not commonly associated with trauma?

    <p>Asthma attack (B)</p> Signup and view all the answers

    What kind of injury would be characterized by the inhalation of smoke?

    <p>Oxygen deprivation (A)</p> Signup and view all the answers

    What type of vehicle collision is noted for providing the highest impact force to the occupants?

    <p>Frontal impact collisions (D)</p> Signup and view all the answers

    During the secondary survey, which aspect is NOT typically addressed?

    <p>Immediate life-threatening conditions (B)</p> Signup and view all the answers

    What is the primary purpose of the triage process in trauma management?

    <p>To sort patients according to their needs for immediate care (D)</p> Signup and view all the answers

    In trauma assessment, which step is performed immediately after the primary survey?

    <p>Resuscitation (D)</p> Signup and view all the answers

    What does the primary survey specifically assess in trauma patients?

    <p>Injuries that are immediately life-threatening (D)</p> Signup and view all the answers

    Which condition is characterized by the accumulation of air in the pleural space?

    <p>Pneumothorax (A)</p> Signup and view all the answers

    Which airway intervention involves creating an opening through the skin and into the airway?

    <p>Cricothyroidotomy (D)</p> Signup and view all the answers

    What is an early sign of inadequate perfusion due to airway obstruction?

    <p>Hoarse voice (C)</p> Signup and view all the answers

    What is the primary management strategy for hemorrhagic shock?

    <p>Fluid resuscitation with IV fluids (B)</p> Signup and view all the answers

    What does the secondary survey in trauma management typically include?

    <p>Comprehensive history and physical examination (A)</p> Signup and view all the answers

    Which of the following is a common indication for performing surgical interventions like cricothyroidotomy?

    <p>Obstructed airway not responding to conventional methods (D)</p> Signup and view all the answers

    Which of the following best describes the term ‘flail chest’?

    <p>Multiple rib fractures that result in a segment of the chest wall moving independently (D)</p> Signup and view all the answers

    What is the primary mechanism of injury in supine hypotensive syndrome during pregnancy?

    <p>Compression of the inferior vena cava (A)</p> Signup and view all the answers

    Which of the following is the first step in managing a trauma patient according to the primary survey?

    <p>Airway assessment (C)</p> Signup and view all the answers

    For paediatric trauma patients, what is the recommended initial fluid resuscitation dosage?

    <p>20ml/kg of 0.9% saline (C)</p> Signup and view all the answers

    Which of the following interventions is critical for treating raised intracranial pressure in injured patients?

    <p>20% mannitol or 3% saline (B)</p> Signup and view all the answers

    In case of hypoglycemia during trauma management, what is the correct intravenous glucose administration dosage for children?

    <p>2ml/kg of 10% glucose (B)</p> Signup and view all the answers

    What is the main purpose of the secondary survey in trauma assessment?

    <p>To identify non-life-threatening injuries (C)</p> Signup and view all the answers

    Which condition is characterized by the inability to maintain adequate oxygenation due to fluid in the chest cavity frequently associated with trauma?

    <p>Hemothorax (D)</p> Signup and view all the answers

    What is the most appropriate initial response for hemorrhagic shock management?

    <p>Fluid resuscitation (D)</p> Signup and view all the answers

    Which assessment method is crucial for concluding the presence of life-threatening injuries in trauma cases?

    <p>Primary survey followed by resuscitation (A)</p> Signup and view all the answers

    What feature characterizes flail chest in trauma patients?

    <p>Segmental chest wall movement (C)</p> Signup and view all the answers

    Flashcards

    Mechanism of Injury

    The exchange of forces leading to injury.

    Kinetic Energy

    Energy of motion that transfers to tissues and causes injury.

    Blunt Trauma

    Injury resulting from compression or shear force without penetration.

    Mechanical Energy

    Energy involved in blunt or penetrating injuries.

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    Thermal Energy

    Injury caused by extreme heat or cold exposure.

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    Chemical Energy

    Injury from exposure to acids or alkalis.

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    Haemorrhagic Shock

    A condition resulting from significant blood loss, leading to inadequate circulation.

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    Primary Survey

    Initial assessment to identify life-threatening conditions in trauma management.

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    Cricothyrotomy

    An emergency procedure to access the airway through the cricothyroid membrane.

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    Tracheostomy

    A procedure to create an opening in the trachea for long-term ventilation support.

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    Tension Pneumothorax

    A life-threatening condition where air trapped in the pleural space compresses lung.

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    Shock

    A state where tissue perfusion is inadequate, impacting oxygenation.

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    Beck’s Triad

    Signs of pericardial tamponade: distended neck veins, hypotension, muffled heart sounds.

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    Trauma Assessment

    A systematic approach to evaluating and managing trauma patients.

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    Airway Management

    Techniques to ensure a clear airway and prevent obstruction.

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    Cricothyrotomy vs. Tracheostomy

    Cricothyrotomy is an emergency procedure; tracheostomy is planned.

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    Resuscitation

    Immediate treatment actions based on findings from the primary survey.

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    Secondary Survey

    A comprehensive evaluation for all injuries after initial stabilization.

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    Airway Patency

    Ensuring that the airway is open and unobstructed.

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    Airway Interventions

    Actions taken to maintain or establish airway patency.

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    Triage

    Sorting patients based on the severity of their condition.

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    Monitoring and Evaluation

    Continuous assessment of patient status after initial care.

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    Supine Hypotensive Syndrome

    A condition in pregnant women where the enlarged uterus compresses the inferior vena cava, leading to decreased venous return and cardiac output after 20 weeks of gestation.

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    Left lateral decubitus position

    A recommended position for pregnant patients to prevent hypotension by avoiding inferior vena cava compression.

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    Fluid resuscitation in pediatrics

    Administering 20ml/kg of 0.9% saline for fluid replacement in seriously injured children.

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    Intracranial pressure treatment

    Management of increased pressure in the skull, often using 20% mannitol or 3% saline.

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    Fetal monitoring

    The assessment of fetal heart rate and well-being during maternal resuscitation to ensure optimal outcomes.

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    Pelvic Fracture Diagnosis

    Characterized by specific radiographic findings, often requiring imaging for confirmation.

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    Femur Fracture Diagnosis

    Identified through typical radiographical evidence in imaging studies.

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    Trauma Team Approach

    A collective method of managing severely injured children by activating resources quickly via a 'Trauma Call'.

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    Resuscitation Objectives

    The primary goal during trauma assessment, ensuring immediate response to life-threatening injuries.

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    Study Notes

    Applied Bioscience for Health Complexity 2 (GMED3009) - Trauma

    • Learning Outcomes:
      • Explain the mechanism of injury
      • Describe trauma management basics
      • Cover primary survey
      • Cover resuscitation
      • Discuss common trauma conditions (e.g., pneumothorax, haemothorax, flail chest) and their management
      • Discuss haemorrhagic shock and its management

    Mechanisms of Injury

    • Injury severity depends on the mechanism of injury
    • Mechanism of injury describes the exchange of forces between environment and person resulting in injury
    • Transfer of kinetic energy causes injury to tissues
    • Types of energy agents include:
      • Mechanical/kinetic energy (blunt or penetrating injury)
      • Thermal energy (injury from heat or cold)
      • Chemical energy (acid or alkaline exposure)
      • Radiant energy (exposure to radiation)
      • Electrical energy (electrocution)
      • Oxygen deprivation (smoke inhalation or drowning)
    • Mechanism details provide clues about the extent and type of injury

    Types of Traumatic Injury

    • Blunt Trauma:
      • Compression
      • Shear
      • Overpressure
      • Vehicle collisions (frontal, lateral, rear, offset/rotational, rollover)

    Initial Assessment and Management of Trauma Patients

    • Basics of Trauma Assessment:
      • Preparation (team assembly, equipment check)
      • Triage (sort patients by acuity)
      • Primary survey (identify and treat immediately life-threatening injuries)
      • Resuscitation (rapid procedures and treatment for primary survey injuries)
      • Secondary survey (full history and physical exam to find other traumatic injuries)
      • Monitoring and evaluation
      • Transfer to definitive care (e.g., ICU, ward, operating theatre)

    Primary Survey

    • Airway and protection of spinal cord
    • Breathing and ventilation
    • Circulation
    • Disability
    • Exposure and control of the environment

    Airway and Protection of Spinal Cord

    • Why first?: Loss of airway leads to death in < 3 minutes. Prolonged hypoxia results in end-organ damage.
    • Assessment: Vital signs (RR, O2 sat), mental status (agitation, somnolence, coma), airway patency (secretions, stridor, obstruction), ventilation status (accessory muscle use, retractions), clinical signs.
    • Interventions:
      • Airway patency maintenance (suction of secretions, chin lift/jaw thrust, nasopharyngeal airway)
      • Definitive airway support (oxygen, bag-valve mask, endotracheal intubation, in-line cervical stabilization, surgical cricothyroidotomy)

    Airway/Interventions (Cricothyrotomy vs. Tracheostomy)

    • Cricothyrotomy: Emergent procedure for immediate airway access when intubation is not possible. It is done through the cricothyroid membrane.
    • Tracheostomy: Procedure for long-term airway support, usually in an operating room or ICU. Done lower in the trachea, which allows for communication without discomfort.

    Protection of Spinal Cord

    • Protect the entire spinal cord until injury has been ruled out through radiography or physical exam
    • Immobilization (cervical collar, long rigid board) is key
    • Common causes of spinal cord injury (AUS): Road traffic accidents, high-energy falls
    • Treatment: Immobilization before the diagnosis, return the head to neutral position, avoid traction.

    Breathing and Ventilation

    • Adequate gas exchange is crucial for optimal patient oxygenation and CO2 elimination
    • Assessment: Exposure, general inspection, tracheal deviation, accessory muscle use, retractions, absence of spontaneous breathing, paradoxical chest wall movement, equality of breath sounds bilaterally using auscultation, palpate for deviations, broken ribs or injuries to chest wall.

    Breathing and Ventilation (Tension Pneumothorax, Haemothorax, Flail Chest, Open Pneumothorax)

    • Tension pneumothorax: Air trapping in the pleural space, leading to pressure buildup, compressing the lung and heart. Needle decompression, tube thoracostomy.
    • Hemothorax: Blood collection in the pleural space; common after chest trauma. Assessment includes physical examination (absent or diminished breath sounds, dullness to percussion, hemodynamic instability), treatment (chest tube, thoracostomy).
    • Flail chest: Unstable segment of the chest wall that moves independently during breathing; typically results from multiple rib fractures. Treatment includes improving gas exchange, early intubation for respiratory distress, avoiding over-aggressive fluid resuscitation.
    • Open Pneumothorax: Large wound in the chest wall allowing air to enter; treatment includes a three-sided occlusive dressing.

    Circulation

    • Shock: Impaired tissue perfusion due to inadequate oxygenation; leads to multi-organ failure and cell death.
    • Clinical signs: Altered mental status, tachycardia (>100 bpm), arterial hypotension (<120 mmHg systolic BP), pale, cool clammy skin, delayed cap refill (>3 seconds), altered LOC, decreased urine output (≤ 0.5 mL/kg/hr).
    • Types of shock: Hemorrhagic (internal/external bleeding), obstructive (cardiac tamponade, tension pneumothorax), neurogenic (spinal cord injury).
    • Emergency nursing treatment: Two large IV lines, cardiac monitor, blood pressure monitoring, treating the cause (stopping bleeding, appropriate pressure, temporarily fixing wounds or injuries).

    Circulation (Pericardial Tamponade, Emergency treatment)

    • Pericardial Tamponade: Blood accumulation around the heart, compressing it. Symptoms include distended jugular veins, hypotension, muffled heart sounds. treatment may include rapid pericardiocentesis.

    Disability

    • Baseline neurologic exam (GCS), pupillary exam (dilated pupil suggesting ipsilateral herniation), AVPU scale, gross neurological exam (extremity movement, equal and symmetric, normal sensation), Glasgow Coma Scale (3-15).
    • Cervical spine clearance: Ensure patient is alert, not intoxicated, tenderness-free spinous processes, no focal neurological deficit, painless range of motion.

    Exposure

    • Remove all clothing.
    • Examine for other signs of injury. Injuries aren't diagnosable until seen by a provider.
    • Logroll patient for back injury assessment.
    • Maintain cervical spinal immobilization.
    • Palpate along thoracic and lumbar spine. Minimum 3 people to ensure safety. Avoid hypothermia by keeping patient warm to prevent coagulopathy.

    Physical Exam

    • Seatbelt sign
    • Battle sign
    • Raccoon's eyes
    • Cullen's sign
    • Grey-Turner's sign

    Trauma in Special Populations (Pregnancy)

    • Supine Hypotensive Syndrome: Enlarged uterus compresses inferior vena cava after 20 weeks, decreasing venous return and cardiac output. Treat in left lateral decubitus position to avoid hypotension. Optimal maternal and fetal outcomes depend on adequate resuscitation and fetal monitoring.

    Classic Radiographical Findings

    • Pelvic fractures
    • Femur fractures

    Paediatric Focus

    • Background: Trauma is a leading cause of death in children
    • Early ABC interventions are crucial
    • Trauma Call system for major trauma patients
    • Primary survey involves assessments of Airway, Breathing, Circulation, Disability & Exposure, immediate treatment of life-threatening issues.
    • Specific pediatric interventions include fluid resuscitation, treatment for elevated intracranial pressure, and correcting hypoglycemia or hypoglycaemia.

    Conclusion

    • Trauma patient assessment follows a standard algorithm to avoid missing any life-threatening injuries.
    • Primary survey and resuscitation are essential steps involving airway, breathing, circulation, disability, and exposure.

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    Related Documents

    GMED3009 Trauma - Applied Bioscience for Health Complexity 2 - Curtin University - PDF

    Description

    Explore the fundamentals of trauma management in the Applied Bioscience for Health course (GMED3009). This quiz covers mechanisms of injury, the primary survey, resuscitation techniques, and common trauma conditions like pneumothorax and haemothorax along with their management strategies.

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