Trauma

Question 1

what is the impact of trauma

Answer 1

• Lost earning
• tax revenue
• burdern to society

Question 2

How do people get trauma

Answer 2

• Gravity
• Speed
• Deceleration
• Sharp
• Blunt
• Heat (and cold)
• Pressure (crush) • Energy transfer

Question 3

what is the leading cause of death in under 50s

Answer 3

Trauma

Question 4

How many deaths does trauma cause

Answer 4

• 18000 deaths/year

* 1/3 of deaths are preventable

Question 5

what is the golden hour

Answer 5

• time where you can save there life early on - important hour

Question 6

What are the basic managemnet procedures for trauma

Answer 6

• Safety (yours and pts)
• Primary Survey
• Secondary survey
• Concurrent management and investigation
• Life saving treatment

Question 7

What is the primary survey

Answer 7

- looking at things that will kill patient early on 
ABC
A = airways 
B = breathing 
C = circulation  - pulse and BP

• make sure they get oxygen and manage the C spine
• manage the haemorrhage - pressure and elevation

Question 8

How do you manage airways

Answer 8

• simple manoeuvres - lifiting the jaw up will open the airway
• adjuncts - oral pharygneal tube or naso airway into the nose
• COETT - endotracheal tube
• surgical airway - trachectomy

Question 9

How do you manage breathing

Answer 9

Look at the

• chest wall
• lung
• heart
• vessels
• rate
• effort
• air hunger

Question 10

How do you manage circulation

Answer 10

• Colour, sweaty
• HR, pulse strength
• BP
• Cap refill, distal perfusion
• AVPU

Question 11

How do you measure disability

Answer 11

• AVPU

• GCS (3-15/15)
– Eyes ( out of 4) - look for pinpoint pupils
– Verbal ( out of 5)
– Motor ( out of 6)

Question 12

What makes up the secondary survey

Answer 12

• Disability (GCS or AVPU)
• Exposure and Environment
• Radiographs
• CT

Question 13

What bloods do you carry out

Answer 13

• FBC
• U+E’s
• G&S, XM
• ABG 
– BD
– Lactate
– pH

Question 14

What do you have to say in handover from paramedics

Answer 14

ATMIST
- Age
• Time
• Mechanism
• Injuries
• Signs and symptoms 
• Treatment

Question 15

what is a coma

Answer 15

• unrousable unresponsiveness

Question 16

What are metabolic causes of coma

Answer 16

• drugs, poisoning (e.g. carbon monoxide, alcohol, TCA)
• Hypoglycaemia, hyperglycaemia
• hypoxia, carbon dioxide, narcosis
• septicaemia
• hypothermia
• myxoedema
• addisonian crisis
• hepatic encepahloapthy
• uraemia encephalopathy

Question 17

What are neurological causes of coma

Answer 17

• trauma
• infection - meningitis, encephalitis, malaria, typhoid, typhus, rabies
• tumour
• vascular - stroke, subdural/subarachnoid haemorrhage, hypertensive encephalopathy
• epilepsy - non convulsive status or post-ictal state

Question 18

list what makes up the Glasgow coma score

• best motor response
• best verbal response
• eye opening

Answer 18

Best motor response 
6 - obeying commands 
5 - localising to pain 
4 - Withdrawing to pain 
3 - Flexor response to pain 
2- extensor response to pain 
1 -  No response to pain

Best verbal response 
5 - oriented (time, place, person) 
4 - confused conservation 
3 - inappropriate speech 
2 - incomprehensible sounds 
1 - None

Eye Opening 
4 - spontaneous 
3 - In response to speech 
2 - in response to pain 
1 - None

Question 19

what is a decorticate posture and what does it mean

Answer 19

(arms bent inwards on chest, thumbs tucked in a clenched fist, legs extended) = implies damage above the level of the red nucleus in the midbrain

Question 20

What is a decelerate poster and what does it mean

Answer 20

decerebrate posture (adduction and internal rotation of shoulder, pronation of forearm)
= implies midbrain damage below the level of the red nucleus

Question 21

What is the AVPU score

Answer 21

A = Alert 
V = Voice response 
P = pain response 
U = unresponsive