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Trauma Principles and Pelvic Trauma
Principles of Trauma
Evaluation Principles
Primary Survey
| 1. | What are the two purposes of the primary survey? | 1. | Find causes of hemodynamic instability and respiratory impairment Restore cardiorespiratory function |
| 2. | What are the five components of the primary survey? | 2. | A-airway B-breathing C-circulation D-disability E-environmental exposure |
Secondary Survey
| 3. | What is the secondary survey? | 3. | Traditional history and physical examination after initial resuscitation |
Routine Imaging
| 4. | What is the most common reason for missed fractures in polytrauma patients? | 4. | Inadequately imaged extremities |
| 5. | With polytrauma, what two radiographs are obtained during the primary survey? | 5. | Anteroposterior (AP) chest AP pelvis |
| 6. | What radiographs are usually obtained during the secondary survey? | 6. | Cervical spine films: lateral view including the superior endplate of T1, AP cervical spine, and AP odontoid view |
Calculations and Prognostic Indicators
| 7. | How is the Injury Severity Scale (ISS) score calculated? In what situation is it not prognostic? | 7. | (AIS)2 + (AIS)2 + (AIS)2 for the three most severely injured systems Not prognostic for severely affected single system |
| 8. | What are the mortality rates for an ISS score >16? >40? | 8. | ISS >16: 10% mortality ISS >40: 50% mortality |
| 9. | Increased ISS is associated with what three outcomes? | 9. | Greater disability Higher rate of unemployment Lower quality of life |
| 10. | Increased short-term mortality rates are associated with what two factors? | 10. | Advanced age Increased severity of injury |
| 11. | What are the components of the Glasgow Coma Scale (GCS)? | 11. | Eye opening Verbal response Motor response |
| 12. | How is eye opening scored? | 12. | 1, no eye opening |
| 2, eye opening to pain | |||
| 3, eye opening to verbal command | |||
| 4, eyes open spontaneously | |||
| 13. | How is verbal response scored? | 13. | 1, no verbal response |
| 2, incomprehensible sounds | |||
| 3, inappropriate words | |||
| 4, confused | |||
| 5, orientated | |||
| 14. | How is motor response scored? | 14. | 1, no motor response |
| 2, extension to pain | |||
| 3, flexion to pain | |||
| 4, withdrawal from pain | |||
| 5, localizing pain | |||
| 6, obeys commands | |||
| 15. | How is the GCS score arrived at? What is the definition of coma? | 15. | Score is the sum of all three sections A GCS score <8 indicates coma |
| 16. | The GCS score is prognostic of what outcome? | 16. | Future neurologic function |
Shock, Resuscitation, and Systemic Inflammatory Response Syndrome
| 17. | With hypovolemic shock, what happens to cardiac output (CO) and peripheral venous resistance (PVR)? Do veins constrict or dilate? What is the preferred treatment? | 17. | CO decreases PVR increases Veins constrict Treatment: resuscitation with crystalloid and colloid, control of ongoing losses |
| 18. | What is the effect of cardiogenic shock on CO, PVR, and the venous system? | 18. | CO decreases PVR increases Venous dilation |
| 19. | What is the effect of vasogenic shock on arteries and veins? | 19. | Arteries constrict Veins dilate |
| 20. | What is the effect of neurogenic shock on arteries and veins? What is the treatment? | 20. | Arteries dilate Veins dilate Treatment: restore intravascular volume and vasopressors after hypovolemia excluded |
| 21. | What is the effect of septic shock on CO, PVR, and heart rate (HR)? | 21. | CO increases PVR decreases HR increases Also fever and leukocytosis |
Stages of Hemorrhagic Shock
| 22. | Class I: What percentage of blood volume is lost? How are HR and blood pressure (BP) affected? | 22. | <15% lost HR <100 Normal BP |
| 23. | Class II: What percentage of blood volume is lost? How are HR and BP affected? | 23. | 15 to 30% lost HR >100 Normal BP |
| 24. | Class III: What percentage of blood volume is lost? How are HR and BP affected? Are there other changes? | 24. | 30 to 40% lost HR >100 Low BP Decreased urine output, slight mental status changes |
| 25. | Class IV: What percentage of blood volume is lost? How are HR and BP affected? Are there other changes? | 25. | >40% lost HR >100 Low BP No urine output, lethargy, confusion |
Resuscitation Pearls
| 26. | What are the seven criteria for adequate resuscitation of the polytrauma patient? | 26. | Hemodynamically stable Stable oxygen saturation Lactate level <2 mmol/L International normalized ratio (INR) <1.25 Normal body temperature Adequate urine output Not requiring inotropic support |
| 27. | What are the adult and pediatric goals for urine output after resuscitation? | 27. | Adult: 0.5 mL/kg/hour Pediatric: 1 mL/kg/hour |
| 28. | At what level should thrombocytopenia be treated in the setting of polytrauma? | 28. | <50,000/mL |
Common Calculations
| 29. | How is pO2 expected (exp) calculated? | 29. | 7 * FiO2 – pCO2 |
| 30. | If expected (exp) pO2 is less than observed (obs), then calculate what? How? | 30. | Calculate Aa gradient = pO2 (exp) – pO2 (obs) |
| 31. | Aa gradient/20 = ? | 31. | Percent physiologic shunt |
Systemic Inflammatory Response Syndrome (SIRS)
| 32. |
