87 Questions
What is the number one cause of death for Americans between age 1 and 44 years?
Trauma
What are the major causes of death following trauma?
Head injury, chest injury, and major vascular injury
What is the impact of poverty on the incidence of death from injury?
It increases the incidence of death from injury more than threefold
What is the number one cause of death for Americans between age 1 and 44 years?
Trauma
How does the incidence of death from injury correlate with poverty?
It increases more than threefold with increasing poverty
What should trauma care be organized according to?
Rapid assessment, triage, resuscitation, diagnosis, and therapeutic intervention
What is the purpose of the Trauma Care Systems Planning and Development Act of 1990?
To establish a system for rapid triage of injured patients and promote collaboration among emergency medicine, trauma surgery, and trauma care subspecialists
How are trauma centers certified?
Based on the institution's commitment of personnel and resources to maintain readiness for the treatment of critically injured patients
What is the role of a well-run trauma center?
To conduct multidisciplinary evaluation and perform diagnostic and therapeutic interventions with smooth transitions between different medical settings
What does each state need to determine in creating its own trauma care system?
The appropriate facility for treatment of various types of injuries
What is the purpose of the Trauma Care Systems Planning and Development Act of 1990?
To establish a system to triage injured patients rapidly to the most appropriate setting
What is the role of a well-run trauma center?
Perform multidisciplinary evaluation and diagnostic interventions
How are trauma centers certified?
Through a verification process offered by the American College of Surgeons
What did the Trauma Care Systems Planning and Development Act of 1990 provide for?
Development of a model trauma care system plan for each state
What should ED staff do in preparation for a trauma patient's arrival?
Assign tasks to team members and prepare resuscitation equipment
What information can a focused history obtained from the patient or others provide?
Important details about circumstances of the injury, intoxicant ingestion, and preexisting medical conditions
What is the primary purpose of a primary survey in trauma care?
To identify and treat immediately life-threatening conditions
For patients transported to non-trauma center EDs, what should be considered immediately?
Whether transfer to a trauma center is appropriate and what resuscitation or stabilization can or should be performed prior to transfer
What is the primary purpose of a primary survey in trauma care?
Identify and treat immediately life-threatening conditions
What should ED staff do in preparation for a trauma patient's arrival?
Assign tasks to team members and prepare resuscitation equipment
What information can a focused history obtained from the patient or others provide?
Circumstances of the injury, intoxicant ingestion, preexisting medical conditions, medication use
For patients transported to non-trauma center EDs, what should be considered immediately?
Whether transfer to a trauma center is appropriate and what resuscitation or stabilization can or should be performed prior to transfer
What is the preferred initial imaging modality for the cervical spine?
CT scan
When should spinal immobilization be maintained during resuscitation?
Throughout the resuscitation process
What is the recommended approach if a patient is obtunded?
Assume a cervical spine injury until proven otherwise
When are the NEXUS and Canadian criteria useful in assessing cervical spine injury?
Only in awake and alert patients
What maneuver should be performed simultaneously with in-line stabilization of the head and neck for a patient with inadequate respiratory effort?
Jaw thrust maneuver
When is insertion of an oral airway difficult?
In patients with a strong gag reflex
What should be avoided in patients with suspected basilar skull fractures?
Nasal airway insertion
What technique should be used to maintain in-line immobilization of the cervical spine while managing the airway?
Two-person spinal stabilization technique
What maneuver should be performed simultaneously with in-line stabilization of the head and neck for a patient with inadequate respiratory effort?
Jaw thrust maneuver
When is insertion of an oral airway difficult?
In patients with an active gag reflex
What should be avoided in patients with suspected basilar skull fractures?
Nasal airway insertion
Why are video laryngoscopy devices beneficial in trauma patients?
They aid in vocal cord visualization while minimizing cervical spine manipulation
What is the preferred initial imaging modality for the cervical spine?
CT scan
When should spinal immobilization be maintained during resuscitation?
Even when plain radiographs or CT images show normal findings
What should be used for intubation if anatomy or severe maxillofacial injury precludes endotracheal intubation?
Cricothyroidotomy
When are the NEXUS and Canadian criteria useful in assessing cervical spine injury?
Only in awake and alert patients
What intervention is warranted for a patient with paradoxical movement of a chest wall segment?
Insertion of large-bore chest tubes (36-F)
What should be done if no breath sounds are heard and massive hemothorax or vascular injury is suspected?
Thoracotomy or video-assisted thoracic surgery
What is the immediate intervention warranted for a sucking chest wound?
Application of an occlusive dressing to a sucking chest wound
For asymmetric or absent breath sounds in an intubated patient, what action should be taken?
Partially withdraw the endotracheal tube from the right mainstem bronchus
What is the immediate intervention warranted for a patient with crepitus in the thorax?
Insertion of large-bore chest tubes (36-F)
What should be done for asymmetric or absent breath sounds in an intubated patient?
Partially withdraw the endotracheal tube from the right mainstem bronchus
What indicates the need for thoracotomy or video-assisted thoracic surgery?
Initial chest tube output of >1000 mL
What intervention is warranted for paradoxical movement of a chest wall segment?
Needle thoracostomy for tension pneumothorax
What should be applied to control active external bleeding?
Direct pressure
What is the purpose of QuikClot Combat Gauze?
To control arterial or venous bleeding
What was the impact of aggressive tourniquet use in Iraq?
Reduced death rates from isolated limb exsanguination
What should be done for exsanguinating extremity injury?
Apply a tourniquet
What is the recommended intervention for exsanguinating extremity injury?
Apply a tourniquet
What is the primary purpose of assessing the patient's overall hemodynamic status?
Evaluate level of consciousness
What is the composition of QuikClot Combat Gauze, a recommended hemostatic dressing?
Kaolin-impregnated rayon and polyester
What contributed to a significant decrease in death rates from isolated limb exsanguination in Iraq?
Aggressive tourniquet use
What is a common cause of post injury death in hypotensive trauma patients?
Hemorrhagic shock
What can mask early hemodynamic indicators of shock?
β-blockers
What is the recommended fluid for infusion in hypovolemic trauma patients?
Lactated Ringer’s or normal saline
What is an alternative technique for providing rapid vascular access in difficult clinical situations?
Intraosseous access
What is the fluid of choice for initial resuscitation?
Balanced salt crystalloid
What is the theoretical advantage of lactated Ringer’s over saline?
Reduced risk of hyperchloremic acidosis
When should hypotensive patients be reassessed after rapid infusion of crystalloid solution?
After 2 L of crystalloid solution
What is the immediate intervention warranted for paradoxical movement of a chest wall segment?
Needle decompression
What contributes to the coagulopathy in major trauma patients?
Acidosis and hypothermia
What ratio of packed red blood cells to fresh frozen plasma showed decreased mortality in patients receiving >10 units of packed red blood cells?
2:1
What is the recommended fluid for initial resuscitation of hypotensive trauma patients?
Lactated Ringer’s
What is the alternative technique for providing rapid vascular access in difficult clinical situations?
Interosseous access
What can mask early hemodynamic indicators of shock?
β-blockers
When should central venous access be established in trauma patients?
Only if upper extremity peripheral veins are not easily cannulated
What is the recommended fluid for initial resuscitation in hypovolemic trauma patients?
Lactated Ringer’s or normal saline
What should be done if there is no marked improvement in hypotensive patients after rapid infusion of 2 L of crystalloid solution?
Transfuse type O blood
What contributes to defective clotting and platelet function in major trauma patients?
Acidosis and hypothermia
What ratio of packed red blood cells to fresh frozen plasma has shown decreased mortality in patients receiving >10 units of packed red blood cells?
1:1
What is the purpose of immobilizing open pelvic fractures in a pelvic wrap or sling?
To provide stability and prevent further displacement
What is the primary effect of tranexamic acid?
Prevents cleavage of plasmin and degradation of fibrin
When is the administration of tranexamic acid reported to decrease the relative risk of death from bleeding by 32%?
Within 1 hour of injury
What was a criticism of the CRASH-2 study regarding tranexamic acid?
Heterogeneous patient populations studied
Why have major Western nation trauma centers been hesitant to adopt the use of tranexamic acid in trauma management algorithms?
Concerns about potential harmful effects after 3 hours post-injury
What is the reported risk reduction of death from bleeding with the use of tranexamic acid?
10% to 15%
When is administration of tranexamic acid reported to decrease the relative risk of death from bleeding by 32%?
Within 1 hour of injury
What was a criticism of the CRASH-2 study regarding tranexamic acid?
Heterogeneous patient populations studied
When must tranexamic acid be given in order to meet the time requirement of early administration?
Before transfer/arrival to a trauma center
What should be included in the search for the cause of depressed level of consciousness in trauma patients?
Measurement of capillary blood glucose level
How should altered mental status in the setting of trauma be approached?
Do not simply attribute it to intoxication
What should be assessed as part of a focused neurologic evaluation in trauma patients?
Level of consciousness, pupillary size, and reactivity
What should be included in the search for the cause of depressed level of consciousness in trauma patients?
Measurement of capillary blood glucose level and consideration of possible intoxicants
What is recommended when assessing a patient with an appropriate mechanism for head trauma and altered mental status?
Do not simply attribute altered mental status to intoxication
What should be assessed during a focused neurologic evaluation in trauma patients?
Level of consciousness, pupillary size and reactivity, and motor function
Study Notes
Trauma Care
- The leading cause of death for Americans between 1 and 44 years old is injury.
- Trauma is the leading cause of death for Americans between 1 and 44 years old.
- Poverty has a significant impact on the incidence of death from injury.
Organizing Trauma Care
- Trauma care should be organized according to the needs of the patient, with well-run trauma centers playing a crucial role.
- The Trauma Care Systems Planning and Development Act of 1990 aimed to improve trauma care systems planning and development.
Certifying Trauma Centers
- Trauma centers are certified based on specific criteria.
Preparing for Trauma Patients
- ED staff should prepare for trauma patients by gathering essential information, including a focused history and physical examination.
- A primary survey is crucial in trauma care, assessing airway, breathing, circulation, disability, and exposure.
Imaging and Spinal Immobilization
- The preferred initial imaging modality for the cervical spine is a CT scan.
- Spinal immobilization should be maintained during resuscitation, with in-line stabilization of the head and neck.
- The NEXUS and Canadian criteria are useful in assessing cervical spine injury.
Airway Management
- Insertion of an oral airway can be difficult in patients with inadequate respiratory effort.
- Video laryngoscopy devices are beneficial in trauma patients.
- In patients with suspected basilar skull fractures, nasal intubation should be avoided.
Thoracic Trauma
- Intervention is warranted for patients with paradoxical movement of a chest wall segment.
- The immediate intervention for a sucking chest wound is to apply an occlusive dressing.
- Asymmetric or absent breath sounds in an intubated patient require prompt attention.
Hemorrhage Control
- QuikClot Combat Gauze is a recommended hemostatic dressing for controlling active bleeding.
- Aggressive tourniquet use in Iraq contributed to a significant decrease in death rates from isolated limb exsanguination.
Hemodynamic Status
- The primary purpose of assessing a patient's overall hemodynamic status is to identify shock.
- Coagulopathy in major trauma patients is contributed to by multiple factors, including hypothermia, acidosis, and hemodilution.
- The recommended fluid for initial resuscitation is lactated Ringer's solution.
Tranexamic Acid
- Tranexamic acid has been shown to decrease the relative risk of death from bleeding by 32%.
- The primary effect of tranexamic acid is to prevent clot breakdown.
- Administration of tranexamic acid should occur within 3 hours of injury to meet the time requirement of early administration.
Neurological Evaluation
- A focused neurologic evaluation in trauma patients should include assessment of level of consciousness, pupillary reaction, and motor function.
- Altered mental status in the setting of trauma requires a thorough search for the cause, including hypoxia, hypotension, and head injury.
Explore the prevalence and impact of trauma, including its significant contribution to emergency department visits, hospital admissions, and mortality rates. Understand the correlation between poverty and the incidence of death from injury, as well as the long-term morbidity associated with surviving traumatic events.
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