Initial Trauma Assessment Em

Front 1

Explain what a,b,c,d,e stand for and the need to address these in order:

Back 1

A: airway maintenance with C-spine. B: breathing. C. Circulation with hemorrhage control D: Disability/neurologic E: Exposure (pt is completely undressed)

Front 2

Describe the evaluation and management of the airway component

Back 2

1. inspect FB or fx's 2. chinlift vs jaw thrust 3. GCS scor 3-8 intubate 4. logroll for vomiting 5. RSI for agitated, delirious etc. 6. Clear C-spine

Front 3

Describe what is evaluated during breathing and possible interventions that may be required

Back 3

1.inspect, auscultate and palpate thorax, neck for abnormalities. 2.Apply occlusive dressing to sucking chest 3.needle for tension pneumo 4.chest tube for hemothorax 5.note amount of blood loss.

Front 4

Describe how hemodynamic status is quickly assessed

Back 4

evaluate level of consciousness, skin color, peripheral pulses, heart rate, blood pulse pressure (systolic - diastolic)

Front 5

Identify when hemorrhagic shock should be assumed until proven otherwise

Back 5

any hypotensive pt

Front 6

Identify the type and # of IV lines which should be established:

Back 6

2 large bore lines (18+)

Front 7

Identify the types of IV intervention that should be provided for the unstable pt.

Back 7

2 liters of crystalloids - rapid infusion, warmed fluids; if still hypovolemic begin infusion of blood

Front 8

What is evaluated for dasability

Back 8

1. LOC using glascow coma scale 2. pupil size and reactivity 3. motor function

Front 9

Identify 3 components of glascow coma scale and know the hightest and lowest possible score that can be achieved

Back 9

1. eye opening (1-4) 2. verbal resp (1-5) 3. motor resp (1-6) 4. Total possible (3-15)

Front 10

Describe how to evaluate and manage the exposure component

Back 10

undress pt and examine entire surface for hidden bruises, lacerations, FB and fx's. If problems are found with any part of primary survey action is taken immediately

Front 11

Define components of secondary survey

Back 11

1. rapid head to toe exam 2. continue frequent BP, pulse and CVP measurement 3. Steps for head to toe

Front 12

What are the steps for a head to toe exam:

Back 12

scalp, TM's, pupils, lateral C-spine, CXR, A-P pelvic x-ray, gastric tube, urinary meatus, scrotum, perineum, rectal, prostate, ua cath, preg test, vag exam, peripheral pulses, logroll surfaces, extremities for fx's soft tissue injury, neuro exam

Front 13

List 3 standard radiographic images obtained for stable trauma pt

Back 13

1. lateral C-spine for fx's or sublux 2. CXR for hemorrhage of volumes to produce gross hypoTN 3. pelvic x-ray for hem of vol to pro gross hypTN

Front 14

Identify pt's who need to be admitted for observation and serial examinations and explain the reasoning

Back 14

1. closed head trauma who regained consciousness but require repeat neuro exams 2. penetrating abd wounds 3. penetrating chest trauma 4. blund abd trauma 5. documented blunt injuries to liver, pleen or kidney

Front 15

INITIAL TRAUMA ASSESSMENT

Back 15

INITIAL TRAUMA ASSESSMENT

Front 16

What are the categories used for triage

Back 16

Emergent or level 1, Urgent or level 2, non-urgent or level 3

Front 17

Define emergent or level 1 triage

Back 17

respiratory distress, cardiac/respiratory emergency, severe hypo, hyperglycemia, anaphylaxis, imminent childbirth, other shock

Front 18

Define urgent or level 2 triage

Back 18

pat can wait 20 minutes to 2 hours: abd px, elevated temp, persistent N/V

Front 19

Define non-urgent or level 3 triage

Back 19

pt could wait all day if necessary; simple fx's, vaginal discharge, URI's, UTI's, minor lecerations

Front 20

What does trimodal distribution of trauma mean

Back 20

patterns of mortality occuring secondary to trauma

Front 21

What is the 1st peak of trimodal distribution of trauma

Back 21

pre-hospital, death from devastating head injury and major vascular injury

Front 22

What is the 2nd peak of trimodal distribution of trauma

Back 22

within hours or minutes of hospital arrival; death from major chest, head, abd injuries

Front 23

What is the 3rd peak of trimodal distribution of trauma

Back 23

death from sequelae of organ hypoperfusion/failure or systemic inflammatory response syndromes; renal or liver failure, ARDS, post-op complications

Front 24

What does the Glasgow coma scale assess

Back 24

eye opening responses, verbal responses, and motor responses. Scale ranges from 3-15

Front 25

What are the scores for glasgo coma scale

Back 25

eye opening: 1-4, verbal: 1-5, motor: 1-6. Scores between 3-8 indicate coma.

Front 26

What assesments are done during the eye opening portion of the glascow coma scale

Back 26

Spontaneous 4 pts. Open to verbal 3 pts. open to px 2 pts. none 1 pt

Front 27

What assesments are done during the verbal portion of the glascow coma scale

Back 27

oriented 5 pts. confused but can answer 4 pts. Inappropriate 3 pts. incoprehensible 2 pts. None 1 pt

Front 28

What assesments are done during the motor portion of the glascow coma scale

Back 28

obeys commands 6 pts. purposeful movment to px 5 pts. withdraws from px 4 pts. abnormal flexion (decorticate) 3 pts. extensor response (decerebrate) 2 pts. none 1 pt

Front 29

What is meant by get an "AMPLE" hx from secondary survey

Back 29

Allergies, medications, PMH, last meal, and events (what happened?)

Front 30

What is important to remember about the secondary survey

Back 30

serial exams are necessary!