Trauma Assessment and Kinematics Quiz
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Questions and Answers

What percentage of cases may be absent of hematuria following blunt trauma?

  • 35%
  • 55%
  • 25%
  • 45% (correct)

    • In pediatric trauma, what factor increases the risk of head trauma?

  • Poor balance and coordination
  • Weak neck muscles
  • Proportionally large heads (correct)
  • High activity levels

    • What is the minimum systolic blood pressure (SBP) for a pediatric patient based on their age?

  • 70 + (2 x age in years) (correct)
  • (2 x age in years) + 50
  • 70 + age in years
  • 80 + (age in years)

    • What is the most common major trauma associated with pregnancy?

    <p>Motor vehicle accidents (MVAs)</p> Signup and view all the answers

    What complication arises from maternal shock during trauma in pregnancy?

    <p>80% fetal mortality rate</p> Signup and view all the answers

    What condition is characterized by organ dysfunction due to crush injuries?

    <p>Crush syndrome</p> Signup and view all the answers

    What is a classic symptom of traumatic asphyxia?

    <p>Cervicofacial cyanosis</p> Signup and view all the answers

    What is NOT recommended for treating a crush injury with entrapment for over 24 hours?

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

    Which condition is associated with significant increases in thoracic pressure?

    <p>Traumatic asphyxia</p> Signup and view all the answers

    What target SpO2 level should be aimed for during aggressive resuscitation in pregnancy trauma?

    <p>Above 95%</p> Signup and view all the answers

    What is the highest score on the Injury Severity Scale (ISS)?

    <p>75</p> Signup and view all the answers

    What refers to the downward and upward pathways of motor vehicle accidents (MVA)?

    <p>Down and Under pathway and Up and Over pathway</p> Signup and view all the answers

    Which type of shock is associated with inflammation and toxin release?

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

    What is the primary goal of damage control resuscitation?

    <p>Minimize shock burden and restore homeostasis</p> Signup and view all the answers

    Which of the following is a symptom of Pericardial Tamponade?

    <p>Electrical alternans</p> Signup and view all the answers

    What is the minimum Shock Index value indicating critical shock?

    <p>1.0</p> Signup and view all the answers

    Which blood product is most effective in treating hemorrhagic shock?

    <p>Low Titer O Whole Blood</p> Signup and view all the answers

    What does the acronym 6 P’s stand for in relation to compartment syndrome?

    <p>Pain, Paresthesia, Poikilothermia, Pallor, Paralysis, Pulselessness</p> Signup and view all the answers

    What is the main risk associated with pelvic trauma?

    <p>High potential for shock</p> Signup and view all the answers

    Which type of injury is most commonly associated with renal trauma?

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

    What is the maximum score on the Injury Severity Scale (ISS)?

    <p>75</p> Signup and view all the answers

    What should be the minimum systolic blood pressure (SBP) target for permissive hypotension to perfuse vital organs?

    <p>90-100 mmHg</p> Signup and view all the answers

    What is one of the common types of shock that results from coagulopathy and microvascular thrombosis?

    <p>Disseminated Intravascular Coagulation (DIC)</p> Signup and view all the answers

    Which condition is characterized by pain, paresthesia, and pulselessness, often referred to as the '6 P's'?

    <p>Compartment Syndrome</p> Signup and view all the answers

    In the context of trauma, what does TXA stand for and its primary function?

    <p>Tranexamic Acid, stabilizes fibrin matrix</p> Signup and view all the answers

    What is a common sign of diaphragmatic hernia, particularly after penetrating trauma?

    <p>Shortness of breath on one side</p> Signup and view all the answers

    What is the recommended initial treatment for a patient experiencing penetrating cardiac injury?

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

    In the context of trauma, which situation describes the 'Down and Under' pathway in a frontal motor vehicle accident (MVA)?

    <p>Lower extremity and abdominal trauma</p> Signup and view all the answers

    What intervention is critical in managing traumatic shock to prevent coagulopathy?

    <p>Transfusion of low titer O whole blood</p> Signup and view all the answers

    Which type of impact is notably associated with a high likelihood of c-spine injury during motor vehicle accidents?

    <p>Rear impact</p> Signup and view all the answers

    What is a significant risk factor in pediatric trauma related to head injuries?

    <p>Proportionally larger heads</p> Signup and view all the answers

    What is a commonly observed complication associated with placental abruption in trauma during pregnancy?

    <p>Maternal shock leading to high fetal mortality</p> Signup and view all the answers

    What indicates a critical concern following crush injuries with entrapment exceeding 24 hours?

    <p>Mortality risk increases</p> Signup and view all the answers

    What is a characteristic clinical presentation of traumatic asphyxia?

    <p>Cervicofacial cyanosis and petechiae</p> Signup and view all the answers

    In the context of resolute treatment for trauma during pregnancy, what target SpO2 level is recommended?

    <p>95%</p> Signup and view all the answers

    Which type of shock has a strong association with inflammation and toxin release?

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

    How does the magnitude of hematuria correlate with the degree of injury after blunt trauma?

    <p>No correlation</p> Signup and view all the answers

    What is a common non-fatal consequence of a significant increase in thoracic pressure?

    <p>Traumatic asphyxia</p> Signup and view all the answers

    Which of the following factors does NOT play a role in crush syndrome?

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

    What condition is primarily linked to the long-term effects of crush injuries?

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

    Study Notes

    Trauma Scoring

    • Injury Severity Score (ISS) ranges from 1 to 75
    • Scores correlate with injury severity (1: minor, 2: moderate, 3: serious, 4: severe, 5: critical, 6: maximum)

    Kinematics of Trauma

    • An object in motion stays in motion
    • Force = Mass x Acceleration
    • Momentum = Mass x Velocity
    • Forward axis of impact is well tolerated
    • Vertical axis impact is moderately tolerated
    • Lateral axis impact is poorly tolerated

    Motor Vehicle Accidents

    • Frontal impact:
      • Down and Under Pathway: Lower extremity and abdominal trauma
      • Up and Over: Chest hits steering wheel, head hits windshield
    • Lateral Impacts: Lateral forces on body, shearing forces
    • Rear Impact: High likelihood for c-spine injury
    • Rollovers: Unpredictable injury patterns, low mortality with seatbelt use

    Falls

    • Kinetic energy related to height is a primary factor
    • Type of surface impacted is important
    • Body part that struck the ground first is crucial for understanding the injury

    Penetrating Trauma

    • Cavitation: The temporary cavity (a void) created when a high-speed projectile enters a body
    • Fragmenting: Projectile breaking into multiple pieces upon entering the body

    Traumatic Shock

    • Types:
      • Hemorrhagic shock: Shock caused by blood loss
      • Inflammation: Inflammatory response leading to shock
      • Toxin release: Shock caused by toxins released from trauma
      • Coagulopathies: Shock due to clotting disorders
    • Critical Shock:
      • SBP < 100 mmHg
      • HR > 100 bpm
      • HCT < 32%
      • pH < 7.25

    Hemorrhage Control

    • Early tourniquet application
    • Direct pressure
    • Elevation
    • Pressure point

    Thromboelastography (TEG)

    • Measures the viscoelastic properties of blood
    • Helps assess clotting ability

    Disseminated Intravascular Coagulation (DIC)

    • Coagulopathy with microvascular thrombosis
    • Characterized by thrombocytopenia, abnormal coagulation tests, elevated D-dimer, and continuous bleeding

    The Lethal Triad

    • Hypothermia
    • Acidosis
    • Coagulopathy

    Hypothermia Management

    • Heating fluids
    • Heated blankets
    • Cabin temperature

    Calcium

    • Critical for clotting
    • Ionized calcium (free calcium) is important for clotting
    • Bound by citrate in PRBC administration

    TXA (Tranexamic Acid)

    • Prevents plasmin from stabilizing the fibrin matrix
    • Must be given within 3 hours of injury
    • Administration: IV, TXA-soaked gauze, nebulized

    Isotonic Crystalloid

    • 0.9% NSS (pH 5.5)
    • Lactated Ringer’s (pH 6.5)
    • Not first line for traumatic shock

    Blood Products

    • PRBC: Increases oxygen carrying capacity
    • Plasma: For clotting deficiency
    • Platelets: Form clots
    • Low Titer O Whole Blood:
      • Best for hemorrhagic shock
      • Reduces citrate delivery
      • Short shelf life, expensive

    Damage Control Resuscitation

    • Goal: Minimize shock burden, restore homeostasis, prevent hypoxia, reduce oxygen debt, mitigate coagulopathy
    • Uses: Low Titer O Whole Blood or 1:1:1 Ratio of PRBC:Plasma:Plt

    Permissive Hypotension

    • Goal: Perfuse vital organs without disrupting clot formation
    • SBP Minimum Goal: 90-100 mmHg (110 mmHg if CNS involvement)
    • Note: Not applicable to isolated head trauma

    Transfusion Reactions

    • Hemolytic: Fever, chills, flank pain
    • Febrile Non-hemolytic: Managed with acetaminophen
    • TACO: Circulatory overload
    • TRALI: Acute lung injury, similar to ARDS

    Head-to-Toe Trauma

    • Facial Trauma: LeFort Fractures
    • Eye Trauma:
      • Often concomitant with head injury
      • Avoid straining or squeezing eyelids shut
      • Post-traumatic floaters and visual field defect suggest retinal detachment
      • Ocular compartment syndrome managed with lateral canthotomy

    Extremity Trauma

    • Re-align if possible
    • Femur may conceal large amounts of bleeding
    • Signs of Vascular Injury:
      • Active or pulsatile hemorrhage
      • Clinical signs of limb ischemia
      • Pulsatile or expanding hematoma
      • Diminished or absent pulses
      • Bruit or thrill suggesting AV fistula

    Compartment Syndrome

    • 6 P’s:
      • Pain
      • Paresthesia
      • Poikilothermia
      • Pallor
      • Paralysis
      • Pulselessness

    POCUS: eFAST Exam

    • RUQ
    • Pelvis
    • LUQ
    • Cardiac
    • Lungs

    Chest Trauma

    • Aortic Injury:
      • High mortality, shearing forces, lateral impact
      • Presentation: Hypotension, AMS, tearing of the aorta
      • Chest X-ray: Widened mediastinum, enlarged aortic knob, large left-hemothorax, trachea deviation
      • Treatment: Anti-impulse therapy, SBP goal < 100 mmHg, beta blockers (Esmolol)

    Rib Fractures

    • Pneumothorax:
      • Size Matters: 14 gauge, 3.25”
      • Sites: Anterior (2nd ICS midclavicular), Axillary (5th ICS anterior axillary)
      • SpO2 Goal: >90%

    Needle Thoracostomy

    • Hemothorax:
      • Should be drained, can resuscitate with autotransfusion, retained hemothorax is harmful

    Pulmonary Contusion

    • Associated with MVA, respiratory distress over time
    • Supportive treatment, avoid over fluid resuscitation, encourage coughing and deep breathing, supplemental oxygen PRN

    Penetrating Cardiac Injury

    • Statistics: 52% stabbings, 42% GSW
    • Risk: Ventricles due to positioning
    • Injuries: Simple lacerations
    • Pericardial Tamponade:
      • Fluid accumulation in pericardial sack, obstructive shock
      • EKG: Electrical alternans
      • Beck’s Triad
      • Treatment: Pericardiocentesis, fluid bolus, pericardial window

    Blunt Cardiac Injury

    • Presentation: Tamponade, hemorrhage, severe cardiac dysfunction
    • Potential Issues: Septal rupture, valvular dysfunction, delayed heart failure

    Tracheobronchial Injury

    • Signs: Subcutaneous air, pneumothorax not responsive to evacuation, air leakage through chest tube, persistent recurrent pneumothorax
    • Intubation: Insert deep right mainstem

    Diaphragmatic Hernia

    • Usually on left side, commonly from penetrating trauma, symptoms vary

    Abdominal Trauma

    • Liver Injury:
      • Common due to size, extremely vascular, different grades of injury
    • Splenic Trauma:
      • Common, causes referred shoulder pain (Kehr’s sign), high index of suspicion, children susceptible, can hold large amount of blood
    • Bowel and Stomach:
      • Common injury due to seat belts, low risk of peritonitis if stomach ruptures, high risk if bowel ruptures
    • Pelvic Trauma:
      • Highly vascular, high potential for shock, mortality up to 40%, POCUS ineffective, perform stabilization in presence of mechanism for pelvic fracture and signs of shock

    REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta)

    • Zones:
      • Zone 1: Thoracic trauma
      • Zone 2: Abdominal trauma
      • Zone 3: Pelvic trauma
    • Not for: Thoracic aortic injury
    • Success: Combat environments, postpartum hemorrhage

    Genitourinary Trauma

    • 10% of abdominal trauma patients have GU injury, 90% are renal injuries from blunt trauma, hematuria important but may be absent in 45% of cases, magnitude of hematuria does not correlate with degree of injury

    Special Situations

    Pediatric Trauma

    • Head trauma common due to proportionally large heads, less thoracic and abdominal protection, delayed signs of shock
    • Minimum SBP: 70 + (2 x age in years)

    Trauma in Pregnancy

    • MVA most common major trauma, placental abruption most common injury, maternal shock = 80% fetal mortality rate, supine hypotensive syndrome, aggressive resuscitation, target SpO2 >95%

    Crush Injuries

    • Entrapment >24 hours: high mortality, tourniquets not recommended, crush syndrome: organ dysfunction (AKI), myoglobinemia, rhabdomyolysis, hyperkalemia

    Traumatic Asphyxia

    • Significant increase in thoracic pressure, often not fatal, classic presentation: cervicofacial cyanosis, subconjunctival hemorrhage, petechia on face, neck, and chest

    Blast Injuries

    • Overpressure: Shock wave that can cause damage
    • Blast Wind: High velocity wind that can cause injuries
    • Fragments: Debris propelled by the blast
    • Thermal Effects: Burns from the explosion
    • Secondary Injuries: Injuries caused by being thrown or falling
    • Tertiary Injuries: Injuries caused by the body striking an object

    Trauma Scoring

    • Injury Severity Scale (ISS): Ranges from 1 to 75, higher scores represent increased severity. - 1: Minor - 2: Moderate - 3: Serious - 4: Severe - 5: Critical - 6: Maximum

    Kinematics of Trauma

    • Force = Mass x Acceleration
    • Momentum = Mass x Velocity
    • Axis of Impact:
      • Forward: Well tolerated
      • Vertical: Moderately tolerated
      • Lateral: Poorly tolerated

    MVA Impacts

    • Frontal Impact:
      • Down and Under: Lower extremity and abdominal trauma
      • Up and Over: Chest hits steering wheel, head hits windshield
    • Lateral Impacts: Lateral forces on the body, shearing forces
    • Rear Impact: High likelihood of cervical spine injury
    • Rollovers: Unpredictable injury patterns, low mortality with seatbelt use

    Falls

    • Factors:
      • Kinetic energy related to height
      • Type of surface
      • Body part that struck the ground first

    Penetrating Trauma

    • Cavitation: A temporary cavity formed by the projectile's energy.
    • Fragmenting: Projectiles break apart within the body, causing significant damage.

    Traumatic Shock

    • Types:
      • Hemorrhagic shock
      • Inflammation
      • Toxin Release
      • Coagulopathies

    Shock Index

    • Critical Shock:
      • SBP < 100 mmHg
      • HR > 100 bpm
      • HCT < 32%
      • pH < 7.25

    Stop the Bleeding

    • Early tourniquet application
    • Direct pressure
    • Elevation
    • Pressure point

    Thromboelastography (TEG)

    • Used to assess coagulation function, helps determine the presence of DIC.

    Disseminated Intravascular Coagulation (DIC)

    • Coagulopathy with microvascular thrombosis
    • Symptoms: Thrombocytopenia, abnormal coagulation tests, elevated D-dimer, continuous bleeding

    The Lethal Triad

    • Hypothermia
      • Treatment: Heated fluids, heated blankets, cabin temperature control.
    • Calcium
      • Critical for clotting
      • Ionized calcium is "free calcium"
      • Bound by citrate in PRBC administration
    • TXA (Tranexamic Acid)
      • Prevents plasmin from stabilizing the fibrin matrix
      • Must be given within 3 hours of injury
      • Administration: IV, TXA-soaked gauze, nebulized

    Isotonic Crystalloid

    • 0.9% NSS (pH 5.5)
    • Lactated Ringer’s (pH 6.5)
    • Not first line for traumatic shock

    Blood Products

    • PRBCs: Increase oxygen-carrying capacity
    • Plasma: Used for clotting deficiency
    • Platelets: Help form clots
    • Low Titer O Whole Blood
      • Best for hemorrhagic shock
      • Reduces citrate delivery
      • Short shelf life, expensive

    Damage Control Resuscitation

    • Goal: Minimize shock burden, restore homeostasis, prevent hypoxia, reduce oxygen debt, mitigate coagulopathy
    • Use: Low Titer O Whole Blood or a 1:1:1 ratio of PRBCs:Plasma:Platelets

    Permissive Hypotension

    • Goal: Perfuse vital organs without disrupting clot formation
    • SBP Minimum Goal: 90-100 mmHg (110 mmHg if CNS involvement)
    • Note: Does not apply to isolated head trauma

    Transfusion Reactions

    • Hemolytic: Fever, chills, flank pain
    • Febrile Non-Hemolytic: Managed with acetaminophen
    • TACO: Circulatory overload
    • TRALI: Acute lung injury, similar to ARDS

    Head-to-Toe Trauma

    • Facial Trauma: LeFort Fractures
    • Eye Trauma:
      • Often concomitant with head trauma
      • Avoid straining or squeezing eyelids shut
      • Post-traumatic floaters and visual field defect suggest retinal detachment
      • Ocular compartment syndrome managed with lateral canthotomy

    Extremity Trauma

    • Re-align if possible
    • Femur fractures can conceal significant bleeding
    • Signs of Vascular Injury:
      • Active or pulsatile hemorrhage
      • Clinical signs of limb ischemia
      • Pulsatile or expanding hematoma
      • Diminished or absent pulses
      • Bruit or thrill suggesting AV fistula
    • Compartment Syndrome: The 6 P's
      • Pain
      • Paresthesia
      • Poikilothermia
      • Pallor
      • Paralysis
      • Pulselessness

    POCUS: eFAST Exam

    • RUQ
    • Pelvis
    • LUQ
    • Cardiac
    • Lungs

    Chest Trauma

    • Aortic Injury: High mortality, shearing forces, lateral impact
      • Presentation: Hypotension, AMS, tearing of the aorta
      • Chest X-ray: Widened mediastinum, enlarged aortic knob, large left-hemothorax, trachea deviation
      • Treatment: Anti-impulse therapy, SBP goal < 100 mmHg, beta blockers (Esmolol)
    • Rib Fractures
    • Pneumothorax: Size matters: 14 gauge, 3.25”
      • Sites: Anterior (2nd ICS midclavicular), Axillary (5th ICS anterior axillary)
      • SpO2 Goal: >90%
    • Needle Thoracostomy
    • Hemothorax: Should be drained, can resuscitate with autotransfusion, retained hemothorax is harmful.
    • Pulmonary Contusion: Associated with MVA, respiratory distress over time.
      • Supportive treatment, avoid over fluid resuscitation, encourage coughing and deep breathing, supplemental oxygen PRN.

    Penetrating Cardiac Injury

    • Statistics: 52% stabbings, 42% GSW.
    • Risk: Ventricles due to positioning, injuries, simple lacerations.

    Pericardial Tamponade

    • Fluid accumulation in pericardial sac, obstructive shock.
    • EKG: Electrical alternans
    • Beck’s Triad:
      • Hypotension, muffled heart sounds, distended neck veins
    • Treatment: Pericardiocentesis, fluid bolus, pericardial window

    Blunt Cardiac Injury

    • Presentation: Tamponade, hemorrhage, severe cardiac dysfunction
    • Potential Issues: Septal rupture, valvular dysfunction, delayed heart failure

    Tracheobronchial Injury

    • Signs: Subcutaneous air, pneumothorax not responsive to evacuation, air leakage through chest tube, persistent recurrent pneumothorax.
    • Intubation: Insert deep right mainstem

    Diaphragmatic Hernia

    • Usually on the left side, commonly from penetrating trauma, symptoms vary.

    Abdominal Trauma

    • Liver Injury: Common due to size, extremely vascular, different grades of injury.
    • Splenic Trauma: Common, causes referred shoulder pain (Kehr’s sign), high index of suspicion, children susceptible, can hold large amounts of blood
    • Bowel and Stomach: Common injury due to seat belts, low risk of peritonitis if stomach ruptures, high risk if bowel ruptures.
    • Pelvic Trauma: Highly vascular, high potential for shock, mortality up to 40%, POCUS ineffective, perform stabilization in presence of mechanism for pelvic fracture and signs of shock.

    REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta)

    • Zones:
      • Zone 1: Thoracic trauma
      • Zone 2: Abdominal trauma
      • Zone 3: Pelvic trauma
    • Not for: Thoracic aortic injury
    • Success: Used in combat environments, postpartum hemorrhage

    Genitourinary Trauma

    • 10% of abdominal trauma patients have GU injury, 90% are renal injuries from blunt trauma, hematuria important but may be absent in 45% of cases, magnitude of hematuria does not correlate with degree of injury.

    Special Situations

    • Pediatric Trauma: Head trauma common due to proportionally large heads, less thoracic and abdominal protection, delayed signs of shock.
      • Minimum SBP: 70 + (2 x age in years)
    • Trauma in Pregnancy: MVA most common major trauma, placental abruption most common injury, maternal shock = 80% fetal mortality rate, supine hypotensive syndrome, aggressive resuscitation, target SpO2 >95%
    • Crush Injuries: Entrapment >24 hours: high mortality, tourniquets not recommended, crush syndrome: organ dysfunction (AKI), myoglobinemia, rhabdomyolysis, hyperkalemia.
    • Traumatic Asphyxia: Significant increase in thoracic pressure, often not fatal, classic presentation: cervicofacial cyanosis, subconjunctival hemorrhage, petechia on face, neck, and chest.
    • Blast Injuries:

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    Test your knowledge on trauma scoring, kinematics of trauma, and the impact of vehicle accidents. This quiz covers essential concepts related to injury severity and the mechanics of different types of trauma. Ideal for medical students and professionals in emergency medicine.

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