Trauma and its Impact
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Questions and Answers

What is the number one cause of death for Americans between age 1 and 44 years?

  • Infectious diseases
  • Trauma (correct)
  • Cardiovascular diseases
  • Cancer

    • What are the major causes of death following trauma?

  • Muscle strains, ligament sprains, minor burns
  • Abdominal injury, skin lacerations, minor fractures
  • Concussion, contusion, minor cuts
  • Head injury, chest injury, and major vascular injury (correct)

    • What is the impact of poverty on the incidence of death from injury?

  • It has no significant impact on the incidence of death from injury
  • It increases the incidence of death from injury more than threefold (correct)
  • It doubles the incidence of death from injury
  • It reduces the incidence of death from injury

    • What is the number one cause of death for Americans between age 1 and 44 years?

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

    How does the incidence of death from injury correlate with poverty?

    <p>It increases more than threefold with increasing poverty</p> Signup and view all the answers

    What should trauma care be organized according to?

    <p>Rapid assessment, triage, resuscitation, diagnosis, and therapeutic intervention</p> Signup and view all the answers

    What is the purpose of the Trauma Care Systems Planning and Development Act of 1990?

    <p>To establish a system for rapid triage of injured patients and promote collaboration among emergency medicine, trauma surgery, and trauma care subspecialists</p> Signup and view all the answers

    How are trauma centers certified?

    <p>Based on the institution's commitment of personnel and resources to maintain readiness for the treatment of critically injured patients</p> Signup and view all the answers

    What is the role of a well-run trauma center?

    <p>To conduct multidisciplinary evaluation and perform diagnostic and therapeutic interventions with smooth transitions between different medical settings</p> Signup and view all the answers

    What does each state need to determine in creating its own trauma care system?

    <p>The appropriate facility for treatment of various types of injuries</p> Signup and view all the answers

    What is the purpose of the Trauma Care Systems Planning and Development Act of 1990?

    <p>To establish a system to triage injured patients rapidly to the most appropriate setting</p> Signup and view all the answers

    What is the role of a well-run trauma center?

    <p>Perform multidisciplinary evaluation and diagnostic interventions</p> Signup and view all the answers

    How are trauma centers certified?

    <p>Through a verification process offered by the American College of Surgeons</p> Signup and view all the answers

    What did the Trauma Care Systems Planning and Development Act of 1990 provide for?

    <p>Development of a model trauma care system plan for each state</p> Signup and view all the answers

    What should ED staff do in preparation for a trauma patient's arrival?

    <p>Assign tasks to team members and prepare resuscitation equipment</p> Signup and view all the answers

    What information can a focused history obtained from the patient or others provide?

    <p>Important details about circumstances of the injury, intoxicant ingestion, and preexisting medical conditions</p> Signup and view all the answers

    What is the primary purpose of a primary survey in trauma care?

    <p>To identify and treat immediately life-threatening conditions</p> Signup and view all the answers

    For patients transported to non-trauma center EDs, what should be considered immediately?

    <p>Whether transfer to a trauma center is appropriate and what resuscitation or stabilization can or should be performed prior to transfer</p> Signup and view all the answers

    What is the primary purpose of a primary survey in trauma care?

    <p>Identify and treat immediately life-threatening conditions</p> Signup and view all the answers

    What should ED staff do in preparation for a trauma patient's arrival?

    <p>Assign tasks to team members and prepare resuscitation equipment</p> Signup and view all the answers

    What information can a focused history obtained from the patient or others provide?

    <p>Circumstances of the injury, intoxicant ingestion, preexisting medical conditions, medication use</p> Signup and view all the answers

    For patients transported to non-trauma center EDs, what should be considered immediately?

    <p>Whether transfer to a trauma center is appropriate and what resuscitation or stabilization can or should be performed prior to transfer</p> Signup and view all the answers

    What is the preferred initial imaging modality for the cervical spine?

    <p>CT scan</p> Signup and view all the answers

    When should spinal immobilization be maintained during resuscitation?

    <p>Throughout the resuscitation process</p> Signup and view all the answers

    What is the recommended approach if a patient is obtunded?

    <p>Assume a cervical spine injury until proven otherwise</p> Signup and view all the answers

    When are the NEXUS and Canadian criteria useful in assessing cervical spine injury?

    <p>Only in awake and alert patients</p> Signup and view all the answers

    What maneuver should be performed simultaneously with in-line stabilization of the head and neck for a patient with inadequate respiratory effort?

    <p>Jaw thrust maneuver</p> Signup and view all the answers

    When is insertion of an oral airway difficult?

    <p>In patients with a strong gag reflex</p> Signup and view all the answers

    What should be avoided in patients with suspected basilar skull fractures?

    <p>Nasal airway insertion</p> Signup and view all the answers

    What technique should be used to maintain in-line immobilization of the cervical spine while managing the airway?

    <p>Two-person spinal stabilization technique</p> Signup and view all the answers

    What maneuver should be performed simultaneously with in-line stabilization of the head and neck for a patient with inadequate respiratory effort?

    <p>Jaw thrust maneuver</p> Signup and view all the answers

    When is insertion of an oral airway difficult?

    <p>In patients with an active gag reflex</p> Signup and view all the answers

    What should be avoided in patients with suspected basilar skull fractures?

    <p>Nasal airway insertion</p> Signup and view all the answers

    Why are video laryngoscopy devices beneficial in trauma patients?

    <p>They aid in vocal cord visualization while minimizing cervical spine manipulation</p> Signup and view all the answers

    What is the preferred initial imaging modality for the cervical spine?

    <p>CT scan</p> Signup and view all the answers

    When should spinal immobilization be maintained during resuscitation?

    <p>Even when plain radiographs or CT images show normal findings</p> Signup and view all the answers

    What should be used for intubation if anatomy or severe maxillofacial injury precludes endotracheal intubation?

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

    When are the NEXUS and Canadian criteria useful in assessing cervical spine injury?

    <p>Only in awake and alert patients</p> Signup and view all the answers

    What intervention is warranted for a patient with paradoxical movement of a chest wall segment?

    <p>Insertion of large-bore chest tubes (36-F)</p> Signup and view all the answers

    What should be done if no breath sounds are heard and massive hemothorax or vascular injury is suspected?

    <p>Thoracotomy or video-assisted thoracic surgery</p> Signup and view all the answers

    What is the immediate intervention warranted for a sucking chest wound?

    <p>Application of an occlusive dressing to a sucking chest wound</p> Signup and view all the answers

    For asymmetric or absent breath sounds in an intubated patient, what action should be taken?

    <p>Partially withdraw the endotracheal tube from the right mainstem bronchus</p> Signup and view all the answers

    What is the immediate intervention warranted for a patient with crepitus in the thorax?

    <p>Insertion of large-bore chest tubes (36-F)</p> Signup and view all the answers

    What should be done for asymmetric or absent breath sounds in an intubated patient?

    <p>Partially withdraw the endotracheal tube from the right mainstem bronchus</p> Signup and view all the answers

    What indicates the need for thoracotomy or video-assisted thoracic surgery?

    <p>Initial chest tube output of &gt;1000 mL</p> Signup and view all the answers

    What intervention is warranted for paradoxical movement of a chest wall segment?

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

    What should be applied to control active external bleeding?

    <p>Direct pressure</p> Signup and view all the answers

    What is the purpose of QuikClot Combat Gauze?

    <p>To control arterial or venous bleeding</p> Signup and view all the answers

    What was the impact of aggressive tourniquet use in Iraq?

    <p>Reduced death rates from isolated limb exsanguination</p> Signup and view all the answers

    What should be done for exsanguinating extremity injury?

    <p>Apply a tourniquet</p> Signup and view all the answers

    What is the recommended intervention for exsanguinating extremity injury?

    <p>Apply a tourniquet</p> Signup and view all the answers

    What is the primary purpose of assessing the patient's overall hemodynamic status?

    <p>Evaluate level of consciousness</p> Signup and view all the answers

    What is the composition of QuikClot Combat Gauze, a recommended hemostatic dressing?

    <p>Kaolin-impregnated rayon and polyester</p> Signup and view all the answers

    What contributed to a significant decrease in death rates from isolated limb exsanguination in Iraq?

    <p>Aggressive tourniquet use</p> Signup and view all the answers

    What is a common cause of post injury death in hypotensive trauma patients?

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

    What can mask early hemodynamic indicators of shock?

    <p>β-blockers</p> Signup and view all the answers

    What is the recommended fluid for infusion in hypovolemic trauma patients?

    <p>Lactated Ringer’s or normal saline</p> Signup and view all the answers

    What is an alternative technique for providing rapid vascular access in difficult clinical situations?

    <p>Intraosseous access</p> Signup and view all the answers

    What is the fluid of choice for initial resuscitation?

    <p>Balanced salt crystalloid</p> Signup and view all the answers

    What is the theoretical advantage of lactated Ringer’s over saline?

    <p>Reduced risk of hyperchloremic acidosis</p> Signup and view all the answers

    When should hypotensive patients be reassessed after rapid infusion of crystalloid solution?

    <p>After 2 L of crystalloid solution</p> Signup and view all the answers

    What is the immediate intervention warranted for paradoxical movement of a chest wall segment?

    <p>Needle decompression</p> Signup and view all the answers

    What contributes to the coagulopathy in major trauma patients?

    <p>Acidosis and hypothermia</p> Signup and view all the answers

    What ratio of packed red blood cells to fresh frozen plasma showed decreased mortality in patients receiving >10 units of packed red blood cells?

    <p>2:1</p> Signup and view all the answers

    What is the recommended fluid for initial resuscitation of hypotensive trauma patients?

    <p>Lactated Ringer’s</p> Signup and view all the answers

    What is the alternative technique for providing rapid vascular access in difficult clinical situations?

    <p>Interosseous access</p> Signup and view all the answers

    What can mask early hemodynamic indicators of shock?

    <p>β-blockers</p> Signup and view all the answers

    When should central venous access be established in trauma patients?

    <p>Only if upper extremity peripheral veins are not easily cannulated</p> Signup and view all the answers

    What is the recommended fluid for initial resuscitation in hypovolemic trauma patients?

    <p>Lactated Ringer’s or normal saline</p> Signup and view all the answers

    What should be done if there is no marked improvement in hypotensive patients after rapid infusion of 2 L of crystalloid solution?

    <p>Transfuse type O blood</p> Signup and view all the answers

    What contributes to defective clotting and platelet function in major trauma patients?

    <p>Acidosis and hypothermia</p> Signup and view all the answers

    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?

    <p>1:1</p> Signup and view all the answers

    What is the purpose of immobilizing open pelvic fractures in a pelvic wrap or sling?

    <p>To provide stability and prevent further displacement</p> Signup and view all the answers

    What is the primary effect of tranexamic acid?

    <p>Prevents cleavage of plasmin and degradation of fibrin</p> Signup and view all the answers

    When is the administration of tranexamic acid reported to decrease the relative risk of death from bleeding by 32%?

    <p>Within 1 hour of injury</p> Signup and view all the answers

    What was a criticism of the CRASH-2 study regarding tranexamic acid?

    <p>Heterogeneous patient populations studied</p> Signup and view all the answers

    Why have major Western nation trauma centers been hesitant to adopt the use of tranexamic acid in trauma management algorithms?

    <p>Concerns about potential harmful effects after 3 hours post-injury</p> Signup and view all the answers

    What is the reported risk reduction of death from bleeding with the use of tranexamic acid?

    <p>10% to 15%</p> Signup and view all the answers

    When is administration of tranexamic acid reported to decrease the relative risk of death from bleeding by 32%?

    <p>Within 1 hour of injury</p> Signup and view all the answers

    What was a criticism of the CRASH-2 study regarding tranexamic acid?

    <p>Heterogeneous patient populations studied</p> Signup and view all the answers

    When must tranexamic acid be given in order to meet the time requirement of early administration?

    <p>Before transfer/arrival to a trauma center</p> Signup and view all the answers

    What should be included in the search for the cause of depressed level of consciousness in trauma patients?

    <p>Measurement of capillary blood glucose level</p> Signup and view all the answers

    How should altered mental status in the setting of trauma be approached?

    <p>Do not simply attribute it to intoxication</p> Signup and view all the answers

    What should be assessed as part of a focused neurologic evaluation in trauma patients?

    <p>Level of consciousness, pupillary size, and reactivity</p> Signup and view all the answers

    What should be included in the search for the cause of depressed level of consciousness in trauma patients?

    <p>Measurement of capillary blood glucose level and consideration of possible intoxicants</p> Signup and view all the answers

    What is recommended when assessing a patient with an appropriate mechanism for head trauma and altered mental status?

    <p>Do not simply attribute altered mental status to intoxication</p> Signup and view all the answers

    What should be assessed during a focused neurologic evaluation in trauma patients?

    <p>Level of consciousness, pupillary size and reactivity, and motor function</p> Signup and view all the answers

    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.

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    Description

    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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