Trauma

Question 1

What problem do you address first in a trauma case

Answer 1

greatest threat to life

Question 2

Age group with highest trauma rate

Answer 2

Young adults in late adolescence/early 20s (Males > females)

Question 3

Why were trauma teams developed

Answer 3

to address early/immediate deaths as as possible.

Question 4

When would you activate Full Trauma

Answer 4

• Airway distress or intubated
• RR 20 per min
• Circulation (Pulse > 120, SBP

Question 5

Full vs Limited trauma

Answer 5

Limited is activating the ER team

Question 6

Who comes to Full Trauma Team alert

Answer 6

• ED/MD doc at head
• Trauma surgeon
• 2 RNs
• resp therapy (2)
• ED Tech
• Pharmacy (pediatric alerts only, sometimes adults)
• Runners for blood bank
• Fluid RN
• OR Charge nurse
• Recorder- typically ICU nurse
• Charge RN

Question 7

Primary Survey in Trauma

Answer 7

C-ABCDE

• Catastrophic hemorrhage control
• Airway (and cervical spine control where appropriate)
• Breathing and Ventilation (with O2 where available)
• Circulation and Hemorrhage control
• Disability or Neuro deficit
• Extremity/Environment/Exposure

Meds/Allergies/ Past fam hx not important right now

Question 8

What happens to everyone with GCS

Answer 8

Put in airway

Question 9

Glascow Coma Scale

Answer 9

3-5 point scale
Best observed response
Modified for children
= 8 is a “coma” and requires intubation for airway protection

Question 10

Limitations to GCS

Answer 10

Peds
Motor deficits- well quantified but deficits not given priority
EtOH, Intoxication, language barriers

Question 11

2 most important vital signs in trauma

Answer 11

HR and BP

Question 12

How to assess Neuro status

Answer 12

Talk to pt/ask questions and do physical exam

GCS

Question 13

Adjuncts to primary survey

Answer 13

Chest Xray (tension pneumo, 
Pelvis Xray (fractures)
FAST exam (fluid; can also check for pneumothorax if no chest xray)
Diagnostic peritoneal lavage--not really done anymore

Question 14

Secondary survey

Answer 14

Look at pt head to toe

Question 15

Adjuncts to secondary survey

Answer 15

CTs
plain radiographs
blood tests

Question 16

Endpoints of Resuscitation

Answer 16

• HR
• Urine output
• BP
• Organ specific indicator of perfusion
• Global indicators of perfusion (Lactic acid, base, CO, oxygen delivery and consumption)

Question 17

What to include in trauma presentation to attending

Answer 17

ABC’s first then Head to toe

• Give actual numbers for BP and HR!
• Never “stable”

Question 18

Tertiary Exam

Answer 18

• Done 12-24 hours later
• Reassess basically everything including review of all xrays
• Rate of delayed dx as high as 10%