Trauma

TEST TAKING TIPS

INITIAL MANAGEMENT

When does the first mortality peak for trauma occur?

• Within seconds to minutes after injury

The trauma system and acute patient care has the greatest impact on patients in which mortality peak for trauma?

• Second mortality peak (golden hour)

Most of the deaths during the second mortality peak for trauma occur from?

• Hemorrhage, central nervous system injuries

When does the third mortality peak for trauma occur?

• 24 hours after injury, from multisystem organ failure and sepsis

How long should the primary survey in the initial evaluation of a trauma patient take?

• No more than 5 minutes, unless an intervention is needed.

What mnemonic is used to conduct the primary survey?

• ABCDE: Airway, Breathing, Circulation, Disability, Exposure

What are the goals during airway assessment?

• Secure the airway, protect the spinal cord

What is required for spinal immobilization?

• A rigid cervical collar, use of a full backboard

Contraindications to nasotracheal intubation:

• Apnea, maxillofacial fracture

What is the quickest way to test for an adequate airway in an awake, alert patient?

• Ask a question, if the patient is able to speak the airway is intact.

Indications for a surgical airway:

• Anatomic distortion as a result of neck injury, massive maxillofacial trauma, inability to visualize the vocal cords (blood, secretions, airway edema)

What are the goals during the breathing assessment?

• Secure oxygenation and ventilation; treat life-threatening thoracic injuries

What should be done on physical examination to adequately assess breathing?

• Inspection (air movement, cyanosis, tracheal shift, JVD, respiratory rate, asymmetric chest expansion, open chest wounds, use of accessory muscles of respiration)

• Auscultation/ percussion (hyperresonance or dullness over lung fields)

• Palpation (flail segments, subcutaneous emphysema)

What life-threatening conditions must be treated during the breathing assessment if encountered?

• Open pneumothorax, tension pneumothorax, massive hemothorax

What is the most common cause for upper airway obstruction?

• The tongue

What is the preferred emergency airway procedure?

• Cricothyroidotomy

In a patient with poor peripheral upper extremity access, what alternative routes can be considered for intravenous access?