platinum trauma exam study guide

What treatments do we do for patients who have been in a residential fire that has a hoarse voice and singed nasal hairs?

Give O2, monitor airway closely.

What types of injuries would you use head-tilt, chin-lift on? What about jaw-thrust?

→ Head-tilt/chin-lift = no spinal injury.

→ Jaw-thrust = suspected spinal injury.

You have an unresponsive patient and have treated the life-threats, what do you do next assessment wise?

Rapid head-to-toe trauma assessment.

You need to do a reassessment of your trauma patient but they are worried you think something is wrong - how do you explain WHY you're doing it?

"I'm checking again to make sure you're improving and nothing new develops."

What is the general reason you would request additional resources during your scene size-up?

When scene hazards, multiple patients, or special equipment are present.

What types of injuries would you expect to find if a person is wearing his seatbelt in a MVA?

Chest/abdominal bruising (seatbelt sign), neck strain, lacerations, possible internal injuries

What is the difference between a structural cause versus a toxic cause of AMS? What are some examples of each? Be able to list a few since this is a multi-select question.

→ Structural: brain injury, stroke, tumor.

→ Toxic: drugs, alcohol, hypoxia, hypoglycemia.

What type of MVA would an ejection of your patient be the worst suspect for injury and death?

Rotational Crash

Your trauma patient was ejected from a vehicle and you notice asymmetrical chest wall movement (paradoxical) - what will this do to their ventilations pathophysiologically?

Impaired ventilation, poor gas exchange

What are the most common emotions that trauma patients feel?

Fear, anxiety, confusion, anger.

What types of scene hazards would present themselves in a multi-car accident?

Fuel leaks, traffic, debris, fire, electricity.

What are some s/s that would make you think your MVA patient needs to be immediately transported?

AMS, airway issues, shock, severe bleeding, chest/abdominal trauma.

What is the law of inertia?

Object in motion stays in motion until acted on by another force.

What are the 3 collisions that happen in MVAs?

A) vehicle X obstacle

B) Occupant X Vehicle

C) Occupant X internal organs

How far away do we park our rescue unit from a MVA scene with no apparent hazards?

100 feet away, uphill/upwind.

In general - why would you do a rapid trauma assessment versus a focused assessment?

→ Rapid: significant MOI, unresponsive, multisystem trauma.

→ Focused: isolated injury, stable pt.

What are the steps to manage chest trauma in general?

Airway, O2, expose, seal open wounds, stabilize, rapid transport.

What is a sucking chest wound? How do you treat it? What if their airway is partially obstructed - which one is the priority?

→ Open chest wound w/ bubbling air.

→ Treat w/ occlusive dressing (3 sides taped).

→ Airway always priority.

When it comes to oxygen delivery devices - what do we use to treat inadequate breathing?

BVM with O2

S/S of hemothorax?

Decreased or absent breath sounds on that side, shock without any obvious external bleeding or apparent reason for shock

S/S of tension pneumothorax?

Absent lung sounds on affected side, JVD/tracheal deviation (late sign), tachycardia, chest pain, respiratory distress, low or rapidly dropping spO2

What rate and depth is considered inadequate breathing?

<8 or >24 bpm, shallow, labored, irregular.

Abdominal quadrants? Organs within?

→ RUQ: liver, gallbladder.

→ LUQ: spleen, stomach, pancreas.

→ RLQ: appendix, kidney.

→ LLQ: descending colon, kidney.

How would you bandage an abdominal evisceration?

→ Cover w/ moist sterile dressing, then occlusive dressing tape 4 sides.

→ NEVER push organs back in.

What is an avulsion? How would you describe it?

Flap of skin torn loose, may hang or detach.

What are the various soft-tissue injuries? How would you describe each of them? Are they open or closed?

Abrasion (scrape) closed, laceration (cut) open, avulsion (flap) open, puncture (stab) open, contusion (bruise) closed.

What is the difference between a hematoma and a contusion?

→ Hematoma: deeper, larger blood collection.

→ Contusion: minor bruise.

What are the 3 levels of burns? What layers of the skin do they go into - how would you describe them?

→ 1st: red, painful (epidermis).

→ 2nd: blisters (dermis).

→ 3rd: white/charred, no pain (full thickness).

How do we treat chemical burns?

Brush off dry, flush with water 15+ min (as long as not H2O reactive), remove contaminated clothing.

You have a fall victim who is complaining of neck pain - what are the assessment and management steps?

Manual stabilization, airway, C-collar, backboard, rapid transport.

Your head injury patient was initially unconscious, but is now coming around but is walking around unsteadily - what is your treatment? How do you get them to the stretcher safely?

Sit, support, c-spine, assist to stretcher safely.

What are the steps to safely remove a helmet?

Two rescuers: stabilize head, remove gently keeping spine aligned.

You have someone who is under the influence, jumped from a building and landed on their feet - what is your main treatment concern and injury suspected?

Suspect spinal compression (axial load), stabilize spine.

What is a special consideration you must do for pediatric patients if you suspect a spinal injury?

Pad under shoulders to keep airway neutral.

What s/s would you look for to indicate the ABSENCE of a spinal injury?

No pain, no tenderness, normal sensation & movement.

You have an unresponsive head injury patient and their vital signs are dropping - what type of injury is causing this besides the head trauma?

Likely brain herniation or internal bleeding

What is ICP? What are the s/s?

Headache, vomiting, unequal pupils, AMS, Cushing's triad (↑BP, ↓HR, irregular resp).

What is the most common cause of spinal cord injuries?

MVAs and falls.

Why is it so important to constantly reassess spinal cord injury patients?

Detect neuro decline or airway compromise.

What type of nervous system injury would be the greatest concern for you? Why?

High spinal cord (C3-C5) → respiratory failure.

What is epistaxis? How do you treat it? What becomes your priority if they have epistaxis AND a spinal injury that requires backboarding?

Epistaxis = bloody nose

→ Lean forward, pinch nose.

→ If spinal injury: maintain c-spine, control bleeding as best possible.

What type of situations would you leave a helmet on?

Fits well, no airway issues, no facial trauma, pt stable.

What is peripheral and circumoral cyanosis? What condition would you consider the patient to be experiencing if you see it?

→ Peripheral: blue coloring in fingers/toes.

→ Circumoral: blue tint around the mouth/lips.

- Indicates: Hypoxia (low oxygen levels) or poor circulation.

What are "best practices" versus "poor practices" when it comes to facial fracture treatments?

→ Best: control bleeding gently, maintain airway.

→ Poor: direct pressure to fractures or forceful manipulation

What is the medical terminology word for wrist bones?

Carpals

Where and why are certain fractures more serious?

- Femur, skull, ribs, pelvis

Risk of major bleeding, shock.

What is the treatment for suspected sprain/strain?

RICE (rest, ice, compress, elevate).

What body part connects bone to bone?

Ligament

Your patient had a deformed lower limb with a distal pulse in 1 foot, but pulseless in the other foot - what treatment do you do?

Realign once, then splint.

You splinted your patients limb and now it has no pulse - what is the most likely reason this occurred?

Splint too tight → loosen, realign.

What are the general rules of splinting?

Check PMS before/after, immobilize joints above/below, pad well.

Your patient has fractured all 4 limbs - how do you treat them? What type of splint do you use?

Long backboard or full-body vacuum splint.

What is the main reason we splint extremities?

Prevent movement, pain, further injury, bleeding.

If your splint caused the pulse to be lost - how do you fix that?

Loosen, realign limb, reassess PMS.

Why is an unstable pelvis almost always a critical, life-threat?

Massive internal bleeding, shock risk.

An object is impaled - after controlling bleeding, what do we do treatment wise?

Stabilize in place, control bleeding, do not remove.

What types of medical or life choices would lead someone to be more likely to become septic?

Elderly, immunocompromised, chronic illness, open wounds.

Your patient has a stab wound and has signs of shock - what are your immediate interventions?

Airway, O2, control bleed, keep warm, rapid transport.

You're at an event doing medical and the on-site nurse had bandaged a wound, but suggests you look at it - what do you do if the wound is already covered?

Do not remove, reinforce if needed.

What are s/s of decompensated shock?

Low BP, weak pulse, AMS, shallow resp.

What are s/s of shock in general?

Pale, cool, clammy, tachycardia, tachypnea.

In regards to vital signs, what signs would you see that would indicate improvement versus deterioration?

→ Improving: rising BP, steady HR.

→ Deteriorating: falling BP, weak pulse.

What are the steps for bleeding control in a laceration?

→ Direct pressure → pressure dressing → tourniquet (if direct pressure doesn't work).

What are the components (pieces) that make up blood? What are each of them responsible for?

Plasma (fluid), RBCs (O2), WBCs (immune), platelets (clotting).

What are the 3 things we do/treat when a patient is in shock?

O2, keep warm, position of comfort, rapid transport

What type of PPE should you be wearing with severely bleeding injuries?

Gloves, eye protection, gown, mask.

What is considered a normal cap refill rate? Is that true still in pediatrics and infants?

→ <2 sec (adults); slower in cold or elderly.

→ Infants/children: still <2 sec.

Why would you do a rapid secondary assessment versus a focused exam on a stabbing victim who complains of severe pain but has minor bleeding?

Rapid → significant pain/internal injury suspected.

What are the late signs of hemorrhagic shock?

HYPOTENSION, weak pulse, shallow breathing, LOC drop.