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25 Cards in this Set
- Front
- Back
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1. The 23-year-old restrained driver involved in a high-speed motor vehicle crash. He presents with tachycardia, hypertension, and a GCS of 6. The patient's initial assessment suggests the following injuries: closed head injury, left pneumothorax, possible intra-abdominal injury, left femur fracture. The exact cause of the hypotension is undetermined at this time. Next step?
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a. Placement of a left chest tube (Tube thoracostomy) should be performed to treat the suspected left pneumothorax, which should improve his breathing and address a potential cause of hemodynamic instability.
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2. Responsible mechanisms for above scenario?
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a. The possible causes of the tachycardia, hypotension, and unresponsiveness in this patient include hemorrhagic shock and left tension pneumothorax.
b. Less likely causes are: 1. Spinal shock 2. Primary cardiac dysfunction 3. Severe closed head injury. |
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3. What does the evaluation of a person a severe MVA or other accident entail?
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a. 1st by learning the details of the collision to gain insight into the injury mechanism and severity.
b. With an initial GCS of 6, a severe closed head injury should be strongly suspected, and therefore earlier airway control is essential for oxygenation, ventilation, minimizing the effects of secondary brain injury. |
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4. What should the primary survey begin with?
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a. Reassessment of the airway to make certain the endotracheal tube has been secured in the correct position.
b. 1st treat pneumothorax c. Treatment should then be directed toward restoring intravascular volume, and simultaneous attempts should be made to identify the source of blood loss. |
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5. What features are highly suggestive of pneumothorax or possibly tension pneumothorax?
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a. Left chest wall crepitation
b. Decreased breath sounds c. Hypotension |
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6. Treatment of pneumothorax or tension pneumothorax?
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a. Placement of a chest to even prior to confirmation by CXR or U/S.
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7. What should hypotension in a polytrauma patient be presumed to be the result of?
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a. Hemorrhage until bleeding from all possible sources can be ruled out.
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8. What are the possible locations of major blood to be considered?
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a. External
b. Pleural space c. Intraperitoneal d. Retroperitoneal e. Pelvic f. Soft tissue. |
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9. Steps/test to run in the identification of blood loss?
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a. Survey patient's body for open wounds and clothing for blood to identify external blood loss
b. A CXR or bilateral chest tubes to locate pleural space blood loss. c. Intraperitoneal bleeding can be readily identified by focussed abdominal sonography for trauma (FAST) or diagnostic peritoneal lavage performed during the secondary survey of unstable patients. |
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10. What types of injuries can lead to neurogenic shock?
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a. Injuries of the cervical or upper thoracic spinal cord which can disrupt sympathetic functions.
b. The majority of spinal cord injuries occur in the presence of bone fractures and/or dislocations; therefore, plain radiographs of the spine can be used to screen for these injuries. |
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11. How is cardiac dysfunction from blunt trauma recognized/analyzed?
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a. ECG or elevated right heart filling pressure measured through central venous catheters for pulmonary artery catheters.
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12. Why is a CT scan contraindicated evaluation of hemodynamically unstable trauma patients?
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a. In hemodynamically unstable patients, it is important to identify life-threatening problems in a timely fashion without having to transport the patient to the radiology suite. Therefore, the use of a CT scan is not indicated in the evaluation of unstable, patients
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13. Focused Abdominal Sonography for Trauma (FAST)?
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a. The quick ultrasound examination performed during the secondary survey.
b. The 4 views examines are: 1. Subxiphoid 2. Right and left upper quadrant 3. Pelvic |
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14. What is the FAST procedure sensitive in identifying?
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a. Intraperitoneal fluid and pericardial fluid
b. It Is most useful for the rapid assessment of unstable patients |
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15. Diagnostic Peritoneal Lavage (DPL)?
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a. A bedside invasive diagnostic procedure performed during the secondary survey in unstable patients.
b. The study is highly sensitive in identifying intraperitoneal blood. |
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16. What are positive results of diagnostic peritoneal lavage defined as?
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a. 10 mL of gross blood
b. or c. enteric content aspirate d. or e. RBC count of more than 100,000/milliliter. f. Or g. WBC count of more than 500 per milliliter. |
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17. What is the primary limitation of DPL?
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a. This lack of specificity.
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18. Abdominal CT scans (value of)?
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a. A sensitive, specific diagnostic modality for:
1. Solid organ injuries 2. Retroperitoneal injuries 3. Peritoneal fluid b. In the blunt trauma setting. |
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19. Initial approach to a multiple?
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a. Primary survey consisting of: ABCs assessment and optimization.
b. The primary survey focuses on immediate life-threatening problems, which should be promptly treated. |
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20. Secondary survey (performed once the ABCs are addressed satisfactorily)?
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a. Conducted via a thorough head-to-toe examination and an inventory of all possible injuries.
b. It is important to remember that whenever a patient develops any significant change in clinical condition, a thorough re-evaluation beginning with the ABCs should be performed immediately! |
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21. Note: many hemodynamically stable patients with FEMA peritoneum, liver, spleen, or kidney injuries can be successfully managed non-operatively with close observation. Therefore, an initial nonoperative approach is appropriate.
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21. Note: many hemodynamically stable patients with FEMA peritoneum, liver, spleen, or kidney injuries can be successfully managed non-operatively with close observation. Therefore, an initial nonoperative approach is appropriate.
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22. Which of the following factors is likely to contribute to a worse outcome in a patient of them left some girl hematoma associated with the GCS and 9:
a. Blood pressure of 70/50 recorded for approximately 10 min. prior to arrival to the hospital b. Epidural hematoma c. Depressed skull fracture d. Pelvic fracture |
i. Answer: A- hypotension alone is associated with a 30 to 60% increased mortality associated with the brain injury, this is due to secondary brain injury that occurs as a result of reduced cerebral perfusion
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23. Note: a closed head injury is rarely the cause of hemodynamic instability in a trauma patient. Therefore, the evaluation should be directed towards identification of the bleeding source.
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23. Note: a closed head injury is rarely the cause of hemodynamic instability in a trauma patient. Therefore, the evaluation should be directed towards identification of the bleeding source.
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24. What may a low GCS score in a patient with profound shock result from?
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a. In adequate bring perfusion and the usual sequence of approach should not be altered.
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25. Complete
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25. Complete
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