Questions and Answers
What is the trimodal distribution of death in trauma associated with?
Which of the following factors does NOT contribute to increased mortality risk in trauma patients?
In primary survey assessment, what is included in the 'B' of the ABCDEs?
What level of trauma center requires 24-hour in-house coverage of all specialty service lines?
Signup and view all the answers
Which assessment tool is specifically utilized during the airway management phase?
Signup and view all the answers
In the context of trauma care, what does MTP stand for?
Signup and view all the answers
Which Level of Trauma Center has standing agreements for transfer to higher-level centers?
Signup and view all the answers
What is the significance of achieving high patient volume in Level I Trauma Centers?
Signup and view all the answers
Which criteria must be assessed to determine the need for cervical spine precautions?
Signup and view all the answers
What does a GCS score assess in trauma patients?
Signup and view all the answers
Which factors should be assessed in a trauma patient during the initial evaluation?
Signup and view all the answers
In the event of altered mental status (AMS), what immediate blood test should be considered?
Signup and view all the answers
What is the primary purpose of the Extended Focused Assessment with Sonography for Trauma (EFAST)?
Signup and view all the answers
When is advanced imaging such as CT scans indicated in trauma care?
Signup and view all the answers
What complication should be monitored when using Foley catheters in trauma patients?
Signup and view all the answers
Which treatment shows the best reduction in mortality if administered within one hour after trauma?
Signup and view all the answers
What is a critical factor when deciding to employ Intubation for airway protection in trauma cases?
Signup and view all the answers
Which imaging type is more sensitive for pneumothorax than plain film but less sensitive for intra-abdominal injuries?
Signup and view all the answers
Study Notes
Trauma Overview
- Leading cause of death in the first four decades in the US and worldwide.
- Trauma accounts for permanent disability at three times the mortality rate.
- 30% of all ICU admissions are due to trauma.
Factors Influencing Outcomes
- Obesity and multiple comorbidities increase complication risks.
- Age impacts recovery and mortality.
- Anticoagulated patients have a 70% increased risk of mortality.
- Elevation of Injury Severity Score (ISS) treatment at Level I Trauma Center can reduce morbidity/mortality by 3.4%.
Death in Trauma
- Trimodal distribution of trauma deaths: immediate, early, and late.
Trauma Criteria
- Physiologic criteria include significant hypotension (SBP < 20), ejection from a vehicle, prolonged extrication (>20 min), motorcycle speed >20 mph, falls >20 ft, and vehicle versus pedestrian/bicycle incidents.
Community Hospitals
- Emergency Department (ED) physicians available for stabilizing care.
- Transfers to appropriate trauma centers are facilitated.
- No immediate obligation for OR or Trauma ICU services.
Trauma Center Levels
- Level I Trauma Center: 24/7 coverage by EM, anesthesia, trauma surgery, and specialty services; continuous education and quality assurance processes in place.
- Level II Trauma Center: 24/7 ED physician presence; availability of general surgery, anesthesia, orthopedics, neurosurgery, and radiology.
- Level III Trauma Center: Immediate ED care, general surgeon and anesthesia services available, must have transfer agreements to Level I/II.
Primary Survey
- Systematic assessment to identify life threats; the ABCDEs of trauma care:
- A: Airway/C-spine protection
- B: Breathing/Ventilation
- C: Circulation/Hemorrhage control
- D: Disability/Neurological status
- E: Exposure/Environmental control
- Simultaneous assessment and management are essential.
Airway Management
- Assess for patency, presence of foreign bodies, fluids, or malocclusion.
- Utilize the LEMON approach for airway evaluation.
- Manage via positioning, jaw thrust, suctioning, or advanced airway placement.
C-Spine Precautions
- Use NEXUS criteria for assessment.
- Canadian C-Spine Rules guide management decisions based on risk factors.
Breathing Assessment
- Evaluate respiratory rate, effort, and breath sounds.
- Identify signs of respiratory distress or airway compromise.
- Manage with oxygen therapy, chest tubes, or needle decompression if necessary.
Circulation Assessment
- Check for gross hemorrhage and assess volume status through skin color/turgor and capillary refill.
- Monitor vital signs, including pulse and blood pressure; manage hemorrhage with direct pressure, tourniquets, and IV fluids.
Disability Assessment
- Utilize Glasgow Coma Scale (GCS) for neurological status evaluation.
- Assess pupils, level of consciousness, and limb motor function.
- Administer Narcan or Flumazenil cautiously for substance-related issues.
Environmental/Exposure Management
- Conduct thorough disrobing for inspection and maintain normothermia with warmed IV fluids and blankets.
Secondary Survey
- Essential for identifying non-life-threatening injuries through a comprehensive head-to-toe examination.
- Perform ongoing reassessment of vital signs and injury status.
Imaging and Advanced Diagnostics
- Contact CT imaging is indicated after primary survey completion and stabilization.
- EFAST is used for rapid assessment of thoracic/abdominal trauma and is more sensitive for pneumothorax than plain films.
Special Situations
- Anticoagulated Patients: Require rapid reversal treatments; Tranexamic Acid can significantly reduce mortality when administered within the first few hours.
- Foley Catheters: Used for urine output monitoring but risky in pelvic fractures.
- Tourniquets: Gaining traction for limb trauma management following military guidelines.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
