FISDAP Trauma

53 yo F hit by car. Unresponsive w/ deformity to the left femur and pelvic instability. Diminished lung sounds on L side. You should?

Immobilize long backboard

28 yo M, blunt trauma to R anterior chest. Pale, cool, diaphoretic and responsive to verbal. R 38 and shallow with paradoxical movement. What should you do?

02 with positive pressure ventilations

What is the most likely cause of periorbital echymosis?

Basilar skull fracture

30 yo M shot in mid thigh. Bleeding continues after partner applies direct pressure. You should?

Tourniqet

28 yo PT driver motorcycle traveling 45 mph hit parked car. Not wearing a helmet. Supine with copious amount of blood around face. Gurgling and R 4 per min. ANOTHER most appropriate action?

Jaw thrust without head tilt

M fell while water skiing. Unconsciouse. Suspect?

Head and spine injury

Appropriate care for amputated extremity?

Wrap in dry gauze, seal in plastic bag, and place in cool water

28 yo pt driving motorcycle traveling 45 mph hit parked car. Not wearing a helmet. Supine with copious amount of blood around face. Gurgling and R 4 per min. Most appropriate?

Control bleeding

18 yo M holding right shin after sports related injury. Deformity and swelling; pedal pulse present. You should?

Apply board splint in position found

Pedestrian hit by car. Pale, cool, and diaphoretic. Oriented to name only and has difficulty breathing. BP 80/40, P 120, R 28 and shallow. 90% SP02. You should?

BVM

81 yo F helthcare facility fell out of bed. Nurse suspects hip fracture. Which medication should concern you the most?

Coumadin

You are treating a patient with agonal respirations and gunshot wound to the chest. You notice an open skull fracture leaking brain matter. There is no radial pulse, you should?

Asses a carotid pulse and assist ventilations

a 45 year old male fell asleep outisde while doing yard work. His face and lower legs are bright red with blisters and painful on examination. You should suspect

Both superficial and partial thickness burns

a 35 year old patient has fallen and has a deformed right lower leg. The distal extremity is pulsless and the skin is cool and cyanotic. You should

Realign the injured extremity

You arrive on scene of a car crash. The driver is alert and complaining of severe chest and abdominal pain. His radial is weak and rapid. Skin is cool, pale, and moist. The patient has a history of cardiac problems. You should?

Rapidly extricate onto a long spinal board and transport

47 male shot in back has cool and clammy skin with arm weakness. BP 130/90, P 76, R 24. You should suspect

Spinal cord injury

Injury that is most likely to require routine assessment and transport

Deformed Wrist Injury

After securing pt on long board, you should immediately assess

PMS

23 yo soccer player was kicked in the chest. He is alert with rapid, shallow R and complains of chest pain. Pale, cool, and wet. You should?

Non Rebreather

25 yo in R distress after being stabbed in the chest. Blood is bubbling from 2 cm laceration to L chest wall. Lung sounds diminished on L side. You should?

Apply occlusive dressing

Early signs of decompensated shock?

Low blood pressure

Pt stabbed in RUQ. What organ is injured?

Liver

Pt with chemical burn on eye and is wearing contact lenses. You should?

Remove contact lenses and administer irrigation solutions

A baseball player was hit by a baseball in the left eye and complains for double vision. What should you do?

Restrict spinal movement

First concern with conscious pt who received partial thick burns to the face is treating?

airway problems

22 yo F had an accident on moped. She is lying on ground; breathing well. Still wearing helmet. You should?

Leave helmet in place while she is stabilized

32 yo M is unconscious after being struck in the head by a baseball bat. Has pulse but breathing is slow. Minor bleeding from a laceration at the left temple. Partner is maintaining manual C-spine stabilization. You should?

Measure and apply a rigid c collar

28 yo M is fleeing from police and sustained 1 cm laceration shallow on forearm while climbing a rusted chain link fence. Refusing transport. What should you be concerned with?

Infection

Which is an open wound?

abrasion

Woman struck in face with softball bat. Unconscious. BP 74/50, P 60, R 8. What do you do?

Insert an oral airway and admin 02 via BVM

21 yo football player hit from the side and landed head first onto the ground. Was ambulatory on scene and oriented to name only. Refusing transport and care. What should you do?

Ask the team coach for assistance

Pt is bruising around the eyes and behind ears. What should you suspect?

Brasilar skull fracture

Pt cut wrist. Wound is bleeding rapidly and is spurting with each heartbeat. Pt most likely severed?

Artery

Pt presents with pain and bruising to RUQ following motor vehicle collision. You should suspect injury to the?

Liver

50 yo M has obvious deformed right lower leg after falling from the roof. You notice a tear in the skin over the deformity. What should you do?

Realign and splint the leg

35 yo driver collided into telephone pole and is unconscious and unresponsive with severe bleeding in the mouth. You should?

rapid extrication to long spine board

Most important factor with person struck in chest with baseball

Speed of the ball

75 yo is involved in motor vehicle collision and can't feel legs. BP is 80/40, P 60, R 24, you should suspect?

Neurogenic Shock

Pt was stabbed in chest and knife was removed prior to arrival. You notice blood and bubbles leaking from the wound. You cannot find occlusive dressing. You should?

Cover wound with plastic wrapper sealed on 3 sides

Chest wound, crackling sensation produced by air blowing into surrounding tissues is called subcutaneous ______?

Emphysema

40 yo M crashed snowmobile, skin cold and pale, BP 198/96, P 48, respiration is slow and irregular. What should you suspect?

Traumatic Brain Injury

Arrive at motor vehicle collision, pt extricated herself from vehicle and is walking around complaining of neck pain. You should?

Immobilize on a backboard

42 yo M has metal impaled in lower right leg. Obvious open fracture and no pulse in R foot, what should you do?

Stabilize with bulky dressing prior to transport

16 yo M complains of extreme pain to chest. You notice his shirt is splashed with battery acid. BP 150/100, P weak, R 24. You should?

Remove shirt and flush with saline water

38 yo M large bruise LUQ, following motorcycle collision. What should you suspect?

Injury to spleen

Unresponsive 18 yo F supine, bleeding in mouth from the nose, R20. What should you do?

Suction oropharynx

Snowmobile rider is thrown 15 ft from vehicle. His finger is deformed and sternum is tender to palpation. Pt states "I think I'll be okay" and refuses trans. What should you do?

Ask if you're able to assess the pt

Treating abdominal evisceration

Cover with moist sterile dressing

30 yo F was in minor motor vehicle accident. She is standing outside of the vehicle and complains of lower back pain. You should immobilize her using a?

Long spine board

23 yo M received burns to feet while stomping fire. He is still wearing the shoes. The rubber soles and laces melted together. What do you do?

Cut shoe laces and remove shoes

40 yo M fell off ladder has a broken leg, and the left knee now bends the wrong way. You should?

Check for PMS in the leg

24 yo F is unconscious after being struck by a car. She has ineffective breathing and bloody secretions in mouth. You should?

Immediate suction oropharynx

24 yo M has burns to the eyes, nose and mouth when the radiator cap on his car blew off. Treat for?

Respiratory swelling

Patient was found dead at the scene. GCS scale?

3

22 yo M is ejected from the vehicle. He complains of numbness and tingling in his extremities. What should you do?

Stabilize cervical spine

Appropriate management for an avulsion of the ear

Bandage in correct anatomical position

32 yo M has sustained facial trauma after falling off the roof. He has snoring respirations. What should you do?

Modified jaw thrust

4 yo M, arm amputated from farming accident, how should you manage the amputated limb?

Seal in plastic bag and place in container of cool water

Adult was pinned between 2 vehicles. Pt is conscious but confused and unable to follow directions. Has bruising on both sides of anterior chest, weak carotid pulse, no peripheral pulse, clear breath sounds, distended neck vein. What should you suspect?

Pericardial tamponade

59 yo M is trapped in the car by broken gas pedal through his foot. He's gone into cardiac arrest. You should

Pull out of car

Knife impaled at 4th intercostal space, left sternal border, pulseless and not breathing. You should?

Remove knife from chest

Pt is bleeding profusely from scalp. You should?

apply direct pressure with sterile gauze

Pt with JVD, muffled heart sounds, clear breath sounds. You should suspect:

Pericardial tamponade

Pt suffering from most severe brain injury

Unconscious 34 yo with decerebrate posture

Cause of bilateral periorbital ecchymosis

Basilar skull fracture

Pt with 4in stick in their eye. You should?

Stabilize with gauze, place paper cup over affected eye, put dressing over the unaffected eye

Pt with severe steam burns to the hand and wrist. You should?

Remove the watch

62 yo M is unresponsive next to a ladder. BP 80/48, P 60, R 24. What should you suspect?

Neurogenic shock

Pt with several wounds oozing blood. After scene size up, you should?

Ensure adequate airway

Pt with diminished breath sounds on one side. Chest rise is unequal. You should suspect?

Pneumothorax

18 yo M fell off skateboard. He struck his head on the concrete and immediately started screaming. Alert and oriented to name only. You should?

Immobilize and expedited transport

25 yo assault victim is spitting up light pink sputum. Has bright red blood spurting from 2in laceration to L forearm. What should you do?

Apply direct pressure to wound

An early indicator of shock indicates?

Tachycardia

Patient has a 3 cm laceration above his left eye. It is bleeding profusely you should?

Apply several 4x4 dressing to the wound using pressure to hold

An altered 24 yr M. stabbed in the abdomen. Sitting, holding contents and complaining of dizziness. He does not want to be touched. Vitals BP 70/40, P 120, R 20 you should?

Lay him down and apply a moist dressing

What is external hemorrhage?

Bleeding

A 16 year old male complains of severe pain in his upper left quadrant after being hit in the stomach while playing football. What should you suspect?

a. Lacerated liver

b. Ruptured spleen

c. Pulmonary contusion

d. Bruised ribs

b. Ruptured spleen

The spleen is located in the upper left quadrant. It is a solid organ with two arteries that supply blood flow. The spleen is dense with blood and the injury has the ability to be life-threatening.

A 46 year old male is only responsive to verbal stimuli after being stabbed. He has an open, bubbling chest wound. What should you do?

a. Assist ventilations with a bag-valve mask.

b. Apply sterile gauze over the wound.

c. Cover the wound with a gloved hand.

d. Perform pleural chest decompression.

c. Cover the wound with a gloved hand.

You should first cover the open chest wound with a gloved hand to prevent any more air leakage into the thoracic cavity.

A 43 year old male is unresponsive after being kicked in the chest by a horse. On inhalation a segment of his chest moves inward. Vital signs are P 130, R 24 and shallow. What should you do?

a. Stabilize the segment with a bulky dressing.

b. Assist ventilations with a bag-valve mask.

c. Apply high-flow oxygen by non-rebreather mask.

d. Obtain intravascular access.

b. Assist ventilations with a bag-valve mask.

The initial treatment for a flail segment is providing positive pressure ventilations (PPV). The chest wall structure has been compromised and they need help breathing to prevent them from tiring out. Continuous waveform capnography will help assess their ventilations. Analgesics my help reduce their pain and allow them to breathe easier (follow local protocol).

what are primary blast injury's?

Primary blast injury is caused by the blast wave moving through the body.

what are secondary blast injury's?

Secondary blast injuries are caused by debris that is displaced by the blast wind of the explosion.

What are tertiary blast injurys?

Tertiary blast injuries are caused when the person in displaced through the air and impacts on another object by the blast wind, or when a structure collapses and causes injury to the person.

Why are circumferential full thickness burns of an extremity considered so serious?

a. The extremity will begin to utilize anabolic metabolism proximal to the burn site.

b. Blood flow to underlying and distal tissue may become restricted.

c. The patient becomes more susceptible to systemic infection.

d. Even if the extremity heals, it will lose most of its functional ability.

b. Blood flow to underlying and distal tissue may become restricted.

Circumferential full thickness burns can inhibit blood flow and muscle movement. These injuries need to be monitored for the need of an escharotomy. This surgical procedure allows for tissue expansion in order to restore local perfusion.

What chemical do muscle cells release after being damaged?

a. Calcium

b. Magnesium

c. Potassium

d. Sodium

c. Potassium

Potassium is the predominated intercellular ion. When muscle cells die they release potassium, which may lead to rhabdomyolysis.

An 18 year old male screams in pain and has a large volume of bright, red blood spurting from his right wrist. What should you do?

a. Apply direct pressure.

b. Apply a tourniquet.

c. Ensure an adequate airway.

d. Apply high-flow oxygen.

a. Apply direct pressure.

Since he is screaming in pain, you know he has a patent airway. Bright, red blood spurting from his wrist is a life-threatening injury. The first step in bleeding and shock management is to apply direct pressure.

An altered 24 year old male has an evisceration. In which position should the patient be transported?

a. Reverse Trendelenburg

b. Supine with knees flexed

c. Left lateral

d. Trendelenburg

b. Supine with knees flexed

Transporting a patient in a supine position with their knees flexed (bent) will help relieve pressure on the abdomen

A 39 year old female was stabbed with a broken bottle in her left lower quadrant. Her bowels are protruding from the wound. What should you do?

a. Push the bowels back into the abdomen.

b. Place her supine with her legs elevated.

c. Apply a moist sterile dressing.

d. Cover with a dry bulky dressing.

c. Apply a moist sterile dressing.

You should apply a moist sterile dressing for a bowel evisceration. This will help prevent the bowels from drying out and being exposed to an unsterile environment.

An unresponsive 31 year old female was found at the bottom of a stairwell. She has blood draining from her ears and nose and dry vomit on her face. Emergency Medical Responders are unsure how long she has been there. Vital signs are BP 202/122, P 54, R 10 and irregular, SpO2 81%. What should you do?

a. Obtain IV access.

b. Perform endotracheal intubation.

c. Assist ventilations with a bag-valve mask.

d. Apply high-flow oxygen by non-rebreather mask.

c. Assist ventilations with a bag-valve mask.

You should assist her ventilations with a bag-valve mask because she is breathing at of rate of 10 and irregular. Her pulse oximetry is low and her vital signs indicate that she has a traumatic brain injury. Assisting ventilations can help increase her SpO2 and reduce brain swelling

A 25 year old male is unconscious after a car crash. His car struck a tree head-on at highway speeds. He has abdominal guarding upon palpation and bruising around the umbilicus. Vitals signs are BP 50/30, P 120 and weak, R 28. What should you suspect?

a. Gallbladder rupture

b. Ruptured diaphragm

c. Bilateral kidney contusions

d. Abdominal hemorrhage

d. Abdominal hemorrhage

You should suspect bleeding into the abdomen with a trauma patient who is hypotensive without any other signs of injury. The guarding and umbilicus bruising is a sign that there has been significant bleeding into the abdomen.

A 20 year old female complains of shortness of breath after being physically assaulted with a tennis racket. She has bruises on the midclavicular line of her chest. Vital signs are BP 120/80, P 80, R 22. What should you suspect?

a. Simple pneumothorax

b. Cardiac contusion

c. Tension pneumothorax

d. Pulmonary embolism

a. Simple pneumothorax

You should suspect a simple pneumothorax with stable vital signs and the symptom of shortness of breath. A tension pneumothorax is something you should monitor for because a simple pneumothorax can develop into a more serious condition. Non-invasive continuous waveform capnography would be useful to monitor patient ventilations.

A 31 year old male was in a car crash at highway speeds. He has a contusion above his left breast and left lateral torso. Vital signs are BP 90/76, P 118 with diminished heart tones, R 24. What should you suspect?

a. Cardiac contusion

b. Pulmonary contusion

c. Tension pneumothorax

d. Cardiac tamponade

d. Cardiac tamponade

You should suspect a cardiac tamponade. The key information is the diminished heart tones and a very narrow pulse pressure. As the pericardial sac fills with blood, the heart has less and less space to expand. The pulse pressure narrows from the inability to expand and contract properly and heart tones become diminished because the blood muffled the sound.

A confused 76 year old female complains of upper leg pain after falling on the sidewalk. She has a mid-shaft femur deformity and crepitus of the pelvis. She has a history of osteoporosis and kyphosis. What should you do?

a. Wrap her pelvis in a sheet.

b. Stabilize her femur with long bone splints.

c. Apply a traction splint and administer pain medication.

d. Stabilize her c-spine and secure her to a long back board.

You should stabilize her c-spine and secure her to a long backboard. Although her leg may hurt, it is a distracting injury. She has osteoporosis (fragile bones) and will be prone to fractures. She has crepitus in her pelvis and you should suspect the mechanism of injury was significant enough to fracture her c-spine as well.

A 22 year old female was thrown from a horse. She complains of back pain and dizziness. Her skin is warm and dry. Vital signs are BP 74/50, P 84 and R 20. What should you suspect?

a. Hypovolemic shock

b. Neurogenic shock

c. Cerebral contusion

d. Anterior cord syndrome

b. Neurogenic shock

Equestrian (horse riding) injury patterns often involve spinal injuries. She is hypotensive because her vasculature below the level of the injury has dilated and created a state of distributive shock.

What is the body's initial response to hemorrhage?

a. Vasoconstriction

b. Platelet aggregation

c. Catecholamine release

d. Fibrin formation

a. Vasoconstriction

The first thing that happens after hemorrhage is vasoconstriction. The vessel clamps down to reduce blood loss.

A 45 year old female was stabbed in the upper right chest. Her breath sounds are diminished on the right side. Vital signs are BP 70/48, P 150, R 32 and shallow. What should you do?

a. Apply high-flow oxygen.

b. Assist ventilations with a Bag-valve mask.

c. Initiate rapid transport.

d. Perform a needle decompression.

d. Perform a needle decompression.

She is hypotensive with diminished breath sounds on the affected side. You should suspect a tension pneumothorax which is treated with a needle decompression or pleural decompression.

An alert 19 year old female has a midshaft deformity to her right femur. Vital signs are BP 130/78, P 108, R 18. What should you do?

a. Stabilize her leg with long bone splints.

b. Apply a traction splint.

c. Immobilize her to a padded back board.

d. Move her with a scoop stretcher.

b. Apply a traction splint.

A midshaft deformity is a sign of a femur fracture. The best way to split an isolated femur fracture is with a traction splint. A traction splint will stabilize the injury and apply traction, which can reduce the pain from the fracture.

A 51 year old female has a 4 inch laceration to her right leg. Bright, red blood is rapidly soaking through the initial dressings. What should you do?

a. Apply an additional dressing.

b. Administer high-flow oxygen.

c. Warm her with a blanket.

d. Apply a tourniquet.

d. Apply a tourniquet.

You should apply a tourniquet if the laceration continues to bleed after initial treatment. The bright, red blood is a sign of an arterial bleed.

A 20 year old male was involved in a fight. Bystanders report he was struck in the head and went unconscious. During the primary survey he was awake and complained of head pain. He loses consciousness while you obtain vital signs. What should you suspect?

a. Subdural hematoma

b. Concussion

c. Epidural hematoma

d. Alcohol intoxication

c. Epidural hematoma

Patients with epidural hematomas will typically lose consciousness at the moment of impact then regain consciousness. This moment of alertness is called the lucid interval. A headache followed by a rapid decline is classical presentation; it may be accompanied by vomiting and early unilateral pupil dilation.

A 29 year old male has a traumatic amputation of the left arm. Vital signs are BP 66/22, P 128, R 18. At what rate should you administer IV fluids?

a. Until his BP reaches 120/80

b. 20 mL/kg

c. 500 mL

d. Keep open rate (KVO)

b. 20 mL/kg

For a hypotensive patient, the initial fluid bolus should be 20 mL/kg. Ideally, you should attempt to restore the systolic pressure to around 90 mm Hg. This blood pressure will help perfuse vital organs (heart/brain/kidney), and, in theory, prevent blood clots from washing away.

How does Neurogenic shock present?

Neurogenic shock (also called vasomotor shock) results from the loss of normal sympathetic nervous system tone; it is commonly caused by a spinal injury. In neurogenic shock, there is no release of the catecholamines epinephrine and norepinephrine. This causes widespread vasodilation and hypotension (relative hypovolemia); pink, dry skin below the level of the injury; and relative bradycardia.