Initial Management & Assessment in Trauma Care

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Questions and Answers

What color code represents patients that require resuscitation in the triage system?

Red (correct)

Orange

Green

Yellow

Which component of trauma management emphasizes simultaneous procedures by a team?

Detailed secondary survey

Triage system

Primary survey

ABCDE approach (correct)

Which of the following represents a step in the initial management and assessment of trauma?

Resuscitation survey

Detailed secondary survey (correct)

Penetrating trauma evaluation

Definitive care

Which of the following is NOT part of the standard precautions for trauma management?

Face mask Signup and view all the answers

What is the primary purpose of the initial assessment in trauma management?

Immediate stabilization Signup and view all the answers

In ATLS, which phase follows the primary survey?

Detailed secondary survey Signup and view all the answers

Which group of patients is designated as 'walking wounded' in the triage system?

Green Signup and view all the answers

Which of these is the correct order of initial trauma assessment according to ATLS?

Primary Survey, Resuscitation, Detailed Secondary Survey Signup and view all the answers

What does a patient being able to answer questions about their name and incident indicate?

They have a patent airway and clear sensorium. Signup and view all the answers

What is a temporary airway management technique used in case of airway obstruction?

Chin lift or jaw thrust Signup and view all the answers

What is the main objective of the circulation assessment during a primary survey?

Control bleeding and restore volume Signup and view all the answers

Which procedure is considered the gold standard for definitive airway management in trauma?

Oral endotracheal intubation Signup and view all the answers

Which of the following methods is considered invasive for assisting breathing?

Mechanical ventilation Signup and view all the answers

What assessment can be used to gauge the adequacy of ventilation?

Arterial blood gas analysis (ABG) Signup and view all the answers

What is the initial approach to airway management that also protects the cervical spine?

Chin lift or jaw thrust Signup and view all the answers

Which method is considered non-invasive for assisting with breathing?

Facemask ventilation Signup and view all the answers

What is a common initial management step for tension pneumothorax?

Needle decompression Signup and view all the answers

Which of the following is NOT a clinical sign of tension pneumothorax?

Tracheal deviation to the unaffected side Signup and view all the answers

Which condition requires immediate surgical management in patients experiencing active bleeding in shock?

Uncontrollable bleeding Signup and view all the answers

What is the primary purpose of the FAST examination in trauma scenarios?

To assess abdominal organ injury and bleeding Signup and view all the answers

What is indicated if a chest radiograph shows a wide mediastinum in a stable patient?

CT angiography (CTA) Signup and view all the answers

In penetrating thoracic trauma, what is the typical treatment for an open pneumothorax?

Suturing followed by tube thoracostomy (ICD) insertion Signup and view all the answers

How long can conservative treatment for a persistent leak continue before considering surgery?

5-7 days Signup and view all the answers

Which of the following injuries are typically identified during the primary survey of penetrating thoracic trauma?

Airway obstruction and tension pneumothorax Signup and view all the answers

Which laboratory finding indicates the need for laparotomy in the presence of enteric content?

Amylase level > 1751 U Signup and view all the answers

What is the first step in the approach to a stable patient with suspected abdominal injury?

Primary survey Signup and view all the answers

A patient with abdominal distention and a seatbelt sign during an examination should raise suspicion for which condition?

Internal injury Signup and view all the answers

What finding is NOT associated with internal injury during an abdominal examination?

Regular bowel sounds Signup and view all the answers

Which of the following predictors increases the likelihood of blunt abdominal injury requiring a CT scan?

Hypotension Signup and view all the answers

For stable patients, which of the following criteria would guide the decision to perform a CT scan?

Positive FAST exam Signup and view all the answers

Which sign during an abdominal examination suggests an increased risk for pelvic fracture?

Abdominal rigidity Signup and view all the answers

What is the typical role of CT in unstable patients suspected of having abdominal injuries?

Not generally required if surgery is imminent Signup and view all the answers

What is the first step in managing an abdominal wall wound with entrapped bowel?

Extend the wound down to the sheath and muscle Signup and view all the answers

What is the gold standard investigation for patients with haematuria?

CT with IV contrast Signup and view all the answers

Which management approach is recommended if there are no immediate surgical indications for a patient with abdominal gunshot wounds?

CT scanning to determine missile trajectory Signup and view all the answers

In the case of left thoracoabdominal stab wounds, what is a significant complication to be avoided?

Diaphragmatic hernia Signup and view all the answers

What is the appropriate management for patients with blunt abdominal trauma who are not examinable?

CT scan to aid in diagnosis Signup and view all the answers

Which of the following is NOT a mechanism of injury associated with blunt abdominal trauma?

Burns Signup and view all the answers

When should diagnostic laparoscopy be used in cases of fresh blood per rectum?

If the patient has no signs of peritonism Signup and view all the answers

What is the recommended observation period for patients with abdominal injuries who do not require surgery?

24 hours Signup and view all the answers

Which abdominal organ is most frequently injured in blunt abdominal trauma?

Spleen Signup and view all the answers

What must be done if continued intra-abdominal bleeding is noted despite aggressive resuscitation efforts?

Proceed with exploratory surgery Signup and view all the answers

Study Notes

### Initial Management & Assessment

Standard precautions should be taken when assessing patients for trauma, including gown, gloves, shoe covers, goggle and face shield.
Triage is carried out based on the ABCDE principles and available resources.
Green: Walking wounded.
Yellow & Orange: Stretcher cases.
Red: Resuscitation.

Airway

Temporary airways: Initial manoeuvres (chin lift, jaw thrust) and oropharyngeal airway (i.e.Guedelle).
Definitive airway: Oral endotracheal intubation, followed by surgical cricothyroidotomy or laryngeal mask if necessary.
Tracheostomy is used for long-term ventilation.
C-spine protection is essential until cleared clinically or by CT scan.

Breathing

Non-invasive: Supplemental oxygen, CPAP, Optiflow.
Invasive: Mechanical ventilation.
ABG: Arterial blood gas is used to assess the adequacy of ventilation.

Circulation

Assessment: Level of consciousness, skin temperature and colour, pulse rate and character, blood pressure, urine output and ABG.
Bleeding Control: FAST (Focused Abdominal Sonogram in Trauma) and e(extended) FAST.
Fluids: Administer IV fluids as needed to address hypovolaemia.

Disability

GCS: Glasgow Coma Scale score is assessed.
Pupils: Size, reactivity, and equality are checked for intracranial pressure.
Sensory and Motor: Assess for any neurological deficits.

Exposure/Environment

Full Exposure: Remove the patient's clothing to inspect for injuries.
Warmth: Maintain the patient's core temperature.
Safety: Ensure a safe environment for both the patient and the medical team.

Penetrating Neck Injury (PNI)

Management: Focus on airway management, haemorrhage control, and prevention of compartment syndrome.
Airway: Immediate airway control is crucial.
Bleeding: Bleeding control is a high priority; apply direct pressure.
Surgical Exploration: Surgical intervention may be necessary to repair the PNI.
Angiography: If vascular injury is suspected, angiography is required.
Complications: Airway obstruction, haemorrhage, and infection.

Penetrating Thoracic Trauma

Significant Cause of Mortality: Penetrating Thoracic Trauma contributes significantly to mortalities during trauma.
Life-Threatening Injuries: Airway injury/obstruction, Tension pneumothorax, and Open pneumothorax require immediate management.
Tension Pneumothorax: Air trapped in the pleural cavity, compressing the lung and shifting mediastinum.
Open Pneumothorax: All pneumothoraxes following penetrating trauma are considered "open."
Treatment: Needle decompression followed by ICD (Intercostal Drainage) insertion.

Blunt Thoracic Trauma

Mechanisms of Injury: Road traffic accidents, falls from heights, assault, and sporting incidents.
Life-Threatening Injuries: Aortic dissection, pericardial tamponade, and pulmonary contusion.
Assessment: Thorough chest examination and investigation of haemodynamic status.
Radiological Investigation: Chest X-ray and CT scan are essential.

Penetrating Abdominal Trauma

Management: Involve a multidisciplinary approach with prompt surgical evaluation.
Airway: Secure airway if necessary.
Bleeding: Control bleeding; apply direct pressure.
Diagnostic Laparoscopy: Consider diagnostic laparoscopy to assess the severity of the injury.
Retained Objects: Evaluate and consider removal in a controlled environment.

Blunt Abdominal Trauma

Mechanisms of Injury: Road traffic accidents, falls from heights, assault, and sporting incidents.
Management: Involves careful assessment and timely intervention depending on the severity and stability of the patient.
Initial Assessment: Primary and secondary survey for life-threatening injuries and abdominal examination.
FAST: Focused Abdominal Sonogram in Trauma to assess for internal injuries and excessive fluid.
CT Scan: For stable patients with non-examinable characteristics or risk factors of BAI.

Vascular Trauma

Definition: Injury to major blood vessels resulting in significant blood loss and potential for shock.
Causes: Penetrating and blunt trauma.
Assessment: Clinical examination and radiological investigation.
Management: Control bleeding, stabilize the patient, prompt surgical intervention.

Head Injuries

Classifications: Mild, moderate, and severe head injuries.
Assessment: Glasgow Coma Scale (GCS) and neurological examination.
Management: Focus on maintaining airway, ventilation, and circulation (ABCs).
Complications: Intracranial haemorrhage, brain swelling, and infections.

Burns

Classification: Superficial, partial thickness, and full thickness burns.
Assessment: Fluid resuscitation and pain management.
Management: Focus on debridement, wound care, and infection prevention.
Special Considerations: Burns to the face, hands, or genitalia require particular attention.

Shock

Definition: A state of circulatory failure characterized by inadequate tissue perfusion.
Causes: Hypovolaemia, cardiogenic, septic, and anaphylactic shock.
Assessment: Signs and symptoms include hypotension, tachycardia, tachypnea, and altered mental status..
Management: Focus on identifying the underlying cause and addressing the appropriate therapies.

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Description

This quiz covers the essential principles of initial management and assessment for trauma patients, including triage protocols and airway management techniques. It also emphasizes the importance of circulation and breathing assessments in emergency situations. Test your knowledge on the practices necessary for effective trauma care.