Tauma Exam 4

life, limb or eye

What is triage kinda basing their care off of?

• very word of mouth type thing

most critical are seen first

• needs are greater than available resources 

• prioritization of care based on illness/injury, severity, prognosis, and resource avilability 

Explain disaster triage.

• walking wounded

• can walk, talk, good LOC, A&O x4

• minor injury 

What classifies as green pts in disaster triage?

need to be seen, extremity injury, broken arm

• assess for pulse in affected area

• can still follow directions and understand commands 

What classifies as Yellow pts in disaster triage?

if no quick action is taken they will die or a limb will be lost

• thready pulse 

• active hemorrhaging

• txtment ASAP!

What classifies as red pts in disaster triage?

• unsalvageable 

  • not breathing even after airway positioning 

  • no pulse

  • not breathing 

  • exposed brains 

What classifies as black pts in disaster triage?

• Red #!

  • life threatening 

• Yellow #2

  • 2o mins - 2hrs 

• Green #3

  • hours-days 

• Black #0

  • dead

Rank the priority of the classification for disaster triage.

blunt injury

• MVC

• falls

• assaults and contact sports

• combo of forces like acceleration, declaration, shearing, crushing and compressive restiance 

penetrating injury

• forgein objects penetrating the tissue 

• GS, stab wound 

What are the most common mechanism of injury for trauma?

• maintain airway!!!!

• ensure adequate ventilation 

• control external bleeding

• prevent shock 

• maintain spine immobilization 

• transport to appropriate facility

What is done for pre-hospital management of trauma pts?

Secondary 

• once primary survey is completed, more detailed secondary survey is imitated. starts at head and works down to feet. non-life-threatening injuries are revealed during this survey. 

•A detailed head-to-toe assessment is done during which survey?

A. Primary

B. Secondary

C. Tertiary

• airway

• breathing

• ventilation

• life-threatening injuries all identified 

Explain primary survey.

detailed heat to toe survey, plan for appropriate diagnostic test

Explain secondary sdurvey.

on admission to ICU, another head to toe exam, assess response to interventions , labs, and all imaging reviewed 

Explain tertiary survey.

• crystalloids

• colloids

• Blood products

• blood substitutes

What are the type of fluids used in fluid resuscitation in trauma events?

• expand volume status

  • Iso, hypo, hypertonic 

• typically at least 2L of isotonic

• NS, LR

Why would we used crystalloid fluids?

rapid volume expander

• albumin

• dextran

• hetastarch  

Why would we used colloid fluids?

• hemodynamically unstable or are showing signs of tissue hypoxia despite crystalloid infusion 

Why would we used blood products?

they don’t require cross-matching

Why would we use blood substitutes?

3

How many steps to damage control?

stop hemorrhage, control contamination and closure methods to close wounds temporailarly

Step one to damage control?

correct physiological abnormalities in the ICU by warming and ensuring adequate resuscitation as well as correcting coagulopathy 

Step two to damage control?

Definitive operative management 

Step 3 to damage control?

minor abrasions to life-threatening

What is the range of damage (severity) in thoracic trauma?

• chest tubes

• mechanical ventilation

• aggressive pain control

• supportive care 

How is thoracic trauma managed?

great vessel injuries or disruption to heart 

In thoracic trauma, what causes immediate death?

• airway obstruction 

• tension pneumothorax

• cardiac tamponade 

• open penumothorax

• massive hemothorax 

• fail chest  

What requires immediate treatment in thoracic trauma? 

airway

• cyanosis is a late sign of airway injury

What is the priority management in thoracic trauma?

• tongue

• avulsed teeth 

• dentures

• secretions

• blood 

What is the common cause of airway obstruction?

What is usually injured in thoracic trauma?

B

•What is the most common cause of abdominal trauma?

A. Falls

B. MVC

C. Sports

D. Assault

includes:

• diaphragm

• liver

• spleen

• stomach

• transverse colon

• portion covered by the bony thorax

The periotoneal area includes all of what?

includes

• aorta 

• vena cava

• pancrease 

• kidney

• ureters and parts of the duodenum and colon

The retroperitoneal area includes all of what?

• rectum

• bladder

• uterus

• iliac vessels 

The pelvis includes all of what?

MVC

• assaults

• falls

• pedestrian-motor vehicle collisions

• industrial accidents 

What is the most common cause of abdominal truams?

What are other causes?

• OG/NG tube

• foley cath 

• local wound exploration 

• laparoscrtomy 

• chest xray

• abdominal CT

What are some managements of abdominal traumas? 

false

• important to cont. assess pt for hypovolemia, traumatic amputation and major pelvic ring fractures are known for their extensive blood lost 

T/F

Pelvic fractures are low priority in pts with trauma?

traumatic amputation or pelvic fracture

When are musculoskeletal injuries considered life-threatening?

in secondary survey after hemodynamic stabilization

When is assessment done for musculoskeletal injuries?

• MVC

• falls

• assaults

• industrial farming 

• home accidents 

What are major causes of musculoskeletal injuries? 

swelling, ecchymosis, or deformity 

should be immobilized 

When an extremity shows _____, we need to _________ that extremity.

cap re-fil

pulse 

crepitus

muscle spasm 

movement

sensation 

pain 

• lets use know if the area is receiving blood flow 

What should we test extremality of trauma for? Why is this important?

vascular or neurologic compromise

What should we monitor for in musculoskeletal injuries? 

Infections

What is common with open wounds? 

• infection 

• compartment syndrome 

• DVT

• PE

• fat embolism syndrome 

What are complications of musculoskeletal injuries? 

• directly r/t the force of impact

• ABCs

Degree of meiofaunal trauma is r/t what?

What are the priorities in this type of trauma?

• soft tissue as well as bony structures 

• CN 

• Neuro assess. 

What needs to be assessed in macillofacial trauma?

• operation 

• washout to debride the tissue and clean area

What may be needed for this maxillofacial trauma?

• tetanus if soft tissue is injuried 

What vaccination is needed for maxillofacial truma?

What qualifies a pt of this trauma for this vaccination? 

severe head injury

hemorrhage

Early complications of multiple trauma?

• hypovolemic shock

• infection

• septic shock

• ARDS

• SIRS

• MODS

Late complications of multiple trauma?