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30 Cards in this Set

  • Front
  • Back
Explain what a,b,c,d,e stand for and the need to address these in order:
A: airway maintenance with C-spine. B: breathing. C. Circulation with hemorrhage control D: Disability/neurologic E: Exposure (pt is completely undressed)
Describe the evaluation and management of the airway component
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
Describe what is evaluated during breathing and possible interventions that may be required
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.
Describe how hemodynamic status is quickly assessed
evaluate level of consciousness, skin color, peripheral pulses, heart rate, blood pulse pressure (systolic - diastolic)
Identify when hemorrhagic shock should be assumed until proven otherwise
any hypotensive pt
Identify the type and # of IV lines which should be established:
2 large bore lines (18+)
Identify the types of IV intervention that should be provided for the unstable pt.
2 liters of crystalloids - rapid infusion, warmed fluids; if still hypovolemic begin infusion of blood
What is evaluated for dasability
1. LOC using glascow coma scale 2. pupil size and reactivity 3. motor function
Identify 3 components of glascow coma scale and know the hightest and lowest possible score that can be achieved
1. eye opening (1-4) 2. verbal resp (1-5) 3. motor resp (1-6) 4. Total possible (3-15)
Describe how to evaluate and manage the exposure component
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
Define components of secondary survey
1. rapid head to toe exam 2. continue frequent BP, pulse and CVP measurement 3. Steps for head to toe
What are the steps for a head to toe exam:
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
List 3 standard radiographic images obtained for stable trauma pt
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
Identify pt's who need to be admitted for observation and serial examinations and explain the reasoning
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
What are the categories used for triage
Emergent or level 1, Urgent or level 2, non-urgent or level 3
Define emergent or level 1 triage
respiratory distress, cardiac/respiratory emergency, severe hypo, hyperglycemia, anaphylaxis, imminent childbirth, other shock
Define urgent or level 2 triage
pat can wait 20 minutes to 2 hours: abd px, elevated temp, persistent N/V
Define non-urgent or level 3 triage
pt could wait all day if necessary; simple fx's, vaginal discharge, URI's, UTI's, minor lecerations
What does trimodal distribution of trauma mean
patterns of mortality occuring secondary to trauma
What is the 1st peak of trimodal distribution of trauma
pre-hospital, death from devastating head injury and major vascular injury
What is the 2nd peak of trimodal distribution of trauma
within hours or minutes of hospital arrival; death from major chest, head, abd injuries
What is the 3rd peak of trimodal distribution of trauma
death from sequelae of organ hypoperfusion/failure or systemic inflammatory response syndromes; renal or liver failure, ARDS, post-op complications
What does the Glasgow coma scale assess
eye opening responses, verbal responses, and motor responses. Scale ranges from 3-15
What are the scores for glasgo coma scale
eye opening: 1-4, verbal: 1-5, motor: 1-6. Scores between 3-8 indicate coma.
What assesments are done during the eye opening portion of the glascow coma scale
Spontaneous 4 pts. Open to verbal 3 pts. open to px 2 pts. none 1 pt
What assesments are done during the verbal portion of the glascow coma scale
oriented 5 pts. confused but can answer 4 pts. Inappropriate 3 pts. incoprehensible 2 pts. None 1 pt
What assesments are done during the motor portion of the glascow coma scale
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
What is meant by get an "AMPLE" hx from secondary survey
Allergies, medications, PMH, last meal, and events (what happened?)
What is important to remember about the secondary survey
serial exams are necessary!