Trauma Practical Exam Prep

Question 1

List the stages of the decision-making algorithm for trauma destination guidelines

Answer 1

1. Failed airway?
2. Blunt traumatic arrest?
3. Penetrating traumatic arrest?
4. Physiological criteria
5. Anatomical criteria
6. Mechanism criteria
7. Special Considerations

Question 2

In general, when should one bypass a local facility to access a lead trauma hospital?

Answer 2

If there is physiological, anatomical, mechanism, or special criteria for trauma bypass and the time to the LTH is under 30 minutes (60 minutes in fraser)

Question 3

list physiological criteria for major trauma

Answer 3

1. SBP less than 90
2. RR greater than 30 or less than 10
3. GCS 13 or less

Question 4

list anatomical criteria for major trauma

Answer 4

1. Open or depressed skull fracture
2. New paralysis or neurological deficits
3. Major penetrating injury
4. Facial injury with potential airway compromise
5. Two or more proximal long bone fractures
6. Crushed , degloved, mangled, or pulseless extremity
7. Amputation proximal to wrist or ankle
8. Chest wall instability or deformity
9. Major burns
10. Unstable pelvis

Question 5

list mechanism criteria for major trauma

Answer 5

1. Falls over 6m
2. MVA; intrustion, ejection, death in vehicle
3. Pedestrian or cyclist struck at 30kph or more, thrown, or run over
4. motorcycle collision at 30kph or more

Question 6

list special criteria for major trauma

Answer 6

1. Elderly
2. SBP under 110 in pts. over 65
3. Anticoagulation
4. Pregnancy over 20 wks.

Question 7

What is the preferred order of primary assessment in major trauma?

Answer 7

CABCDE

Question 8

What are the indications for tourniquet placement?

Answer 8

Bleeding from an extremity that cannot be controlled through direct pressure or wound packing

Question 9

List critical steps in tourniquet placement to control bleeding

Answer 9

1. Attempt direct pressure or wound packing first
2. Apply Tq 2-3in. above the wound and directly on skin
3. Tighten until bleeding stops
4. Note the TIME OF APPLICATION
5. Reassess at each point of reassessment

Question 10

What are indications for pelvic binding?

Answer 10

Major mechanism suggestive of pelvic fracture with any of the following:

• Hemodynamic instability (heart rate > 100 or systolic blood pressure < 90 mmHg)
• Pelvic pain on exam
• Pelvic instability
• Decreased level of consciousness
• Major injury distracting from pelvic exam

Question 11

Describe oxygen administration in trauma patients

Answer 11

• Apply high-flow oxygen early if any signs of shock, dyspnea, or need for resuscitation are present. Do not delay to obtain a room-air sat. Target 100% SpO2 and then titrate down.

Question 12

Describe fluid resuscitation targets in the following populations;
1. General resuscitation
2. Bleeding
2. TBI/SCI
3. Burns
4. Electrocution (high voltage)

Answer 12

1. Target SBP of 90mmHg or more, or MAP of 65 or more. 500mL aliquots to a MAX of 2000mL
2. Consider permissive hypotension (SBP=70-90mmHg) only if mentation and distal pulses are intact
3. Target SBP of 120mmHg or greater, or MAP of 85-90
4. Target SBP over 120mmHg
5. Initial 5mL/kg bolus, followed by 100mL/hr

Question 13

Describe general management of a patient with an active crush injury

Answer 13

• Apply tourniquets above the entrapped limb prior to release of crush
• Provide up to 2L IV N/S prior to release of crush
• Consider continuous ventolin
• Prepare for cardiac arrest
• Once crush is released, identify and treat bleeding
• Consider calcium and bicarb post release

Question 14

Describe BP targets in TBI

Answer 14

MAP of 85-90 or SBP more than 120 (conflicting data in CPG)

Question 15

List specific management priorities in TBI

Answer 15

• elevate head to 30 degrees
• loosen tube ties, C-collars, or other restrictive items around neck
• avoid hypotension, hypothermia and hypoxia at all costs
• Target a MAP of 85-90 or SBP of 120
• Target end tidal CO2 of 35-40. Do not hyperventilate

Question 16

What kinds of injuries may be assessed with the NEXUS tool?

Answer 16

C-spine injuries ONLY (NOT thoracolumbar!)

Question 17

What are the 5 components of NEXUS?

Answer 17

1. Midline Tenderness?
2. Altered LOC?
3. New Focal Deficits?
4. Intoxicated?
5. Major distracting injury?

If “no” to all, no SMR is necessary.

Question 18

When should a clamshell be used in SMR?

Answer 18

Only in multi-trauma!

Question 19

When should epinephrine be used in management of shock?

Answer 19

Only if the pt. is refractory to fluid resuscitation

Question 20

What is the preferred insertion site for needle thoracentesis?

Answer 20

5th intercostal space at mid-axillary line

Question 21

should a chest seal be placed over a needle thoracentesis site?

Answer 21

no

Question 22

Describe steps for managing blunt traumatic arrest

Answer 22

• control all bleeding
• decompress chest bilaterally
• apply pelvic binder
• Administer 2L of fluid
• Secure airway and optimize oxygenation
• If none of these obtain ROSC, call for discontinuation

Question 23

Describe evisceration management

Answer 23

cover with moist sterile dressings followed by occlusive dressings

Question 24

What constitutes major burns according to trauma services BC?

Answer 24

• > 20% BSA
• > 10% in peds and Gerrys
• > 5% full thickness BSA
• Burns to hands, feet, genitalia, or joints
• Electrical/chemical burns
• Inhalation injuries
• Burns associated with major trauma