Trauma ppt

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Questions and Answers

What is the trimodal distribution of death in trauma associated with?

Critical Care, Community Hospitals, Trauma Centers

Prevention, Emergency Department, Intensive Care Unit (correct)

Outpatient, Surgical, Rehabilitation

Emergency Room, Surgical Ward, Discharge

Which of the following factors does NOT contribute to increased mortality risk in trauma patients?

Multiple comorbidities

Obesity

Anticoagulated status

Low age (correct)

In primary survey assessment, what is included in the 'B' of the ABCDEs?

Blood vessel stability

Blood pressure evaluation

Brain function assessment

Breathing and ventilation (correct)

What level of trauma center requires 24-hour in-house coverage of all specialty service lines?

Level I Trauma Center Signup and view all the answers

Which assessment tool is specifically utilized during the airway management phase?

LEMON Signup and view all the answers

In the context of trauma care, what does MTP stand for?

Massive Transfusion Protocol Signup and view all the answers

Which Level of Trauma Center has standing agreements for transfer to higher-level centers?

Level II Signup and view all the answers

What is the significance of achieving high patient volume in Level I Trauma Centers?

Required for accreditation Signup and view all the answers

Which criteria must be assessed to determine the need for cervical spine precautions?

Presence of focal neurologic deficits Signup and view all the answers

What does a GCS score assess in trauma patients?

Neurological status Signup and view all the answers

Which factors should be assessed in a trauma patient during the initial evaluation?

Pupil size/reactivity and alertness Signup and view all the answers

In the event of altered mental status (AMS), what immediate blood test should be considered?

POC Glucose Signup and view all the answers

What is the primary purpose of the Extended Focused Assessment with Sonography for Trauma (EFAST)?

To detect abdominal/thoracic trauma after initial evaluation Signup and view all the answers

When is advanced imaging such as CT scans indicated in trauma care?

After primary survey completion and life threats managed Signup and view all the answers

What complication should be monitored when using Foley catheters in trauma patients?

Hemorrhage from pelvic fractures Signup and view all the answers

Which treatment shows the best reduction in mortality if administered within one hour after trauma?

KCENTRA and Tranexamic Acid Signup and view all the answers

What is a critical factor when deciding to employ Intubation for airway protection in trauma cases?

The assessment of airway reflexes Signup and view all the answers

Which imaging type is more sensitive for pneumothorax than plain film but less sensitive for intra-abdominal injuries?

EFAST ultrasound 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.

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