CSTR STUDY GUIDE (LATEST 2023 – 2024) VERIFIED ANSWERS, Exams of Health sciences

Download CSTR STUDY GUIDE (LATEST 2023 – 2024) VERIFIED ANSWERS and more Exams Health sciences in PDF only on Docsity! CSTR STUDY GUIDE (LATEST 2023 – 2024) VERIFIED ANSWERS AIS Components for ISS Scaling-Body Region - 1. Head/Neck 2. Face 3. Chest 4. Abdominal/Pelvic Contents 5. Extremities/Pelvic Girdle Severe 6. External- Skin and Burns Types of head injuries - scalp wounds, skull fractures, brain injuries The adult skeletal system - 206 bones Skull base fractures - orbital roof, ethmoid, basilar process of occipital bone, petrous and squamous process of temporal bone (mastoid or petrous) Skull Vault fractures - frontal, parietal, occipital, temporal bones (specifies squamous) Brain Hematomas - EPH, SAH, SDH, IPH, ICH uncal herniation, transtentorial - (cerebellum) - code ICD-10 - cord contusion = AIS code of 140202.5 = 5 squared = 25 ISS score. Meninges - three protective membranes that surround the brain and spinal cord dura mater, arachnoid, and pia mater Intracranial Injuries-Focal injuries - picked up on CT scan. Contusion, epidural hematoma, subdural hematoma, subarachnoid hematoma, intracerebral/intraparenchymal hemorrhage Intracranial Injuries-Nonfocal Head Injuries - concussions, shear injury, diffuse axonal injury (DAI), anoxic brain injury (ABI) - these go down to the cellular level. Cranial Nerves and Functions - I. Olfactory- smell II. Optic - Vision III. oculomotor - Pupil, some extraocular movement IV. Troclear - extraocular movements V. Trigeminal - some movements of the jaw, sensation VI. Abducens- lateral extraocular movement VII. Facial - facial muscle movement, taste VIII. Acoustic- hearing, balance IX. Glossopharyngeal - pharynx-motor, ear/pharynx, tongue- movement X. Vagus - palate, larynx, pharynx, involuntary muscles XI. Accessory - sternocleidomastoid/trapezius muscles XII. Hypoglossal - tongue Facial Bones - • Orbits • Nasal bones • Maxillae • Mandible • Palatine • Vomer Facial Mechanisms of Injury - deep lacerations, deformity, difficulty speaking, visual changes, entrapment of muscles, rhinorrhea, otorrhea, trismus LeFort Fractures - Type I: maxilla dissociated from skull base - nasal aperture; "floating palate" Type II: central midface dissociation - inferior orbital rim, orbital floor; "pyramidal" Type III: complete midface dissociation - lateral orbital wall, zygomatic arch; "floating face" • If spinal cord injured at c1-C2- typically quadriplegic Cervical Vertebra Injuries - • Atlanto-occipital Dissociation - C 1 is associated. • Jefferson's fracture of C1 • Hangman's fracture of C-2 • Axis or Odontoid-dens Fracture of C-2 Thoracic Spine - • Contains 12 vertebrae • If spinal cord injured here, typically Paraplegia Lumbar Spine - • Contains 5 vertebrae • Spinal cord ends L1 to L2 level Sacral Spine - • 5 fused vertebrae • Joins with the pelvic bones coccyx - • 3-5 very small fused bones • Tail bone Spinal Cord Syndromes-Incomplete - • Central cord - affects extremities • Anterior cord • Posterior cord • Brown-sequard Thoracic Bone Structures - • Spinal column • Ribs • Clavicles • Scapulae - if this bone is fractured, be suspicious for lung contusion. • Sternum • Xiphoid process - tip of the sternum Rib fracture documentation - very important to know the number of ribs fractured on each side. Segmental - flail Thoracic Muscular Structures - Diaphragm - muscle separating the chest and its contents from abdomen and its contents Intercostal - assists in breathing Thoracic Organs - lungs, heart, esophagus, trachea, thymus glands Thoracic Injury Descriptors - • Shortness of breath • Cyanotic- bluish • Deviated Trachea • Subcutaneous Emphysema • Abdominal Breathing • Paradoxical Movement - also known as flail chest, the ribs seem to be floating or moving. • Pale and clammy Thoracic Trauma diagnostics - • FAST exam • Pericardiocentesis • CT scan • Ct angiography - uses dyes • Aortography • Needle Thoracentesis Thoracic Trauma Procedures - chest tube/thoracostomy thoracotomy cardiac massage defibrillation pericardial window median sternotomy cross- clamp aorta Thoracic Injuries - • Tension Pneumothorax - usually results from a blunt injury • Rib Fractures • Flail Chest - be careful when looking at the medical record as segmental indicates flail. • Sucking Chest Wounds • Pneumothorax - chest tube is inserted. • Hemothorax- chest tube is inserted • Pulmonary contusions • Blunt cardiac injury • Aortic transection- aortography is used to detect this. • Pseudoaneurysm • Cardiac tamponade is pressure on the heart muscle, which occurs when the pericardial space fills up with fluid faster than the pericardial sac can stretch. It is detected by an angiography and usually is treated by pericardiocentesis-- a needle is inserted into pericardial sac. • Diaphragmatic rupture • Aortic rupture - aortography is used to detect this. Rib Fractures - common in older pts; can lacerate the surface of the lung and can cause pneumothorax or hemothorax; can cause crepitus; pts breathe rapidly and shallowly Rib Fractures-Flail Chest - be careful when looking at the medical record as segmental indicates detachment a life-threatening medical condition that occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall cardiac tamponade - pressure on the heart caused by fluid in the pericardial space Aortic rupture - Dx in which the arterial wall breaks open as could happen in aortic dissection, ruptured aortic aneurysm trauma,aortography is used to detect this • Mesentery Arteries - Superior and Inferior - help feed the GI contents. • Renal Arteries • Iliac Arteries - external and internal • Vena Cava - iliac, renal, hepatic • Portal System - Mesenteric, Splenic. Abdominal Trauma Mechanisms of Injury - • MCC • MVC • GSW • Stab Wounds • Falls • Assaults • Sports • Seat Belts • Equestrian • Pedestrian hit by MV • Machinery Abdominal Injury Indicators - • Distended Abdomen • Rigidity • Guarding • Rebound • Short of Breath • Bruising • Seatbelt Sign • Quadrant pain • Dehiscence • Evisceration - bowel is exposed to the outside world. • Umbilical Bruising • Tenderness • Absence of Bowel Sounds • Nausea/Vomiting Abdominal trauma Diagnostics & Procedures - • FAST exam • Ct Scan • X Ray • Diagnostic Peritoneal Lavage (DPL) - to rule out intra-abdominal bleeding using a needle. • Foley Catheter • Suprapubic Catheter • IVP - intravenous pyelogram • Cystotomy • RUG - retrograde urethrogram- contrast dye is inserted through the urethra • Laparoscopy- viewing the abdomen through a scope • Exploratory laparotomy - making an incision into the abdomen surgically and exploring. • Resection- for example of the colon. Abdominal Injuries - • Contusions/Lacerations involving the liver, spleen, bowel, renal, bladder, urethra • Fractures - lumbar, pelvic • Blood Vessels Classification of Splenic Injuries - Grade 1 - sub capsular hematoma- nonexpanding Grade 2 - Split- capsular tears Grade 3 - Deep parenchyma laceration Grade 4 - artery injured, devascularized parenchyma Grade 5 - Avulsion of splenic artery, vein. Transhilar injury Pelvic Bones - • Ilium • Ischium • Pubis • Acetabulum • Symphysis Pubis • Sacroiliac Joint Upper Extremity Bones - • Humerus • Radius/Ulna • Carpals/Metacarpals/ Phalanges Upper Extremity Joints - • Sternoclavicular • Acromioclavicular • Glenohumeral • Elbow • Wrist • Hand Upper Extremity Arteries - • Subclavian • Axillary • Brachial • Radial • Ulna Upper Extremity Nerves - • Brachial Plexus • Median • Radial • Ulnar Lower Extremity Bones - • Femur • Patella • Simple • Spiral • Elevated • Green-stick • Slipped Epiphysis Skin and Soft Tissue Anatomy - • Skin- epidermis, dermis, subcutaneous tissue • Muscle • Tendon External Trauma Mechanisms of Injury - • Burns • Stabbings • Falls • Most any other type of event Contusions - a type of relatively minor hematoma of tissue in which capillaries and sometimes venules are damaged by trauma, allowing blood to seep into the surrounding interstitial tissues Ecchymosis - bluish discoloration of an area of skin or mucous membrane caused by the extravasation of blood into the subcutaneous tissues as a result of trauma to the underlying blood vessels or fragility of the vessel walls Abrasion - a wound caused by superficial damage to the skin, no deeper than the epidermis. Laceration - a tear in the skin which results from an injury Degloving injury - An avulsion-type injury in which the skin and subcutaneous tissue of the hand are torn off in a glove-like fashion, leaving the musculofascial plane intact Avulsion - an injury in which a body structure is forcibly detached. It most commonly refers to a surface trauma where all layers of the skin have been torn away; exposing the underlying structures (e.g. subcutaneous tissue, muscle, tendons). This is similar to an abrasion but more severe, as body parts such as an eyelid or an ear can be partially or fully detached from the body Debridement - the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue Irrigation - cleaning a wound or body organ by flushing or washing out with water or a medicated solution Grafting - refers to a surgical procedure to move tissue from one site to another on the body, or from another person, without bringing its own blood supply with it. Tangential excision (burns) - Tangential excision - involves surgical removal of successive layers of the burn wound down to viable dermis. Sutures/Staples - medical device used to hold body tissues together after an injury or surgery Escarotomy - a surgical incision into necrotic (or devitalized dead tissue) tissue resulting from a severe burn. Burns Depth and Degree - • First Degree - involves the outer layer of the skin. Dry, red, blanches, tender. • Second Degree - Hyperemic, moist, blister, painful. Superficial partial thickness - upper dermis, Deep partial thickness - deeper dermis. • Third Degree - Dry, leather appearance, eschar. Color varies from to red to brown to black. Not painful. ICD-10 Coding - a classification system that groups health related conditions and procedures for statistical and billing purposes. Types of ICD-10 Codes - There are 3 primary sections in PCS (Primary Coding System). • Medical and Surgical (Largest Section in PCS) • Medical and Surgical Related • Ancillary ICD-10 Format of a PCS Code: - Section - Body System - Root Operation - Body Part - Approach - Device - Qualifier ICD-10 Medical and Surgical Section: - • All Codes n Medical and Surgical Section begin with 0 (a zero) • The first character in a PCS Code represents the section • There are 31 body systems in Medical and Surgical Section ICD-10 Body System: - Anatomical Region procedures are performed on multiple body parts and through various types of structures ICD-10-Body Part - Indicates site of the body on which the procedure was performed (Example: liver, upper lung, skin of back, etc.) ICD-10-Device Characters: - • Used only to specify the devices that remain after the procedure is completed o Four General Types 1. Grafts and Prostheses 2. Implants 3. Simple or Mechanical Appliance 4. Electronic appliance (Drainage device, monitoring device, etc ICD 10 - CM - • 3-7 characters in length • No procedure codes • Alphanumerical • 1st character is letter • Use of decimal after 3rd character • X & A (New in ICD 10 - used as placeholders) 9-Unknown ISS Calculations - the sum of the squares of the highest AIS from the three (3) most severely injured ISS body regions. A2 +B2+C2 = ISS AIS components- ( ) - contains synonyms for a specific type of injury/provide a definition for the injury description AIS components- { } - contain inclusionary or exclusionary information/ contain organ injury scale grade AIS components-Boxed Bold Type - contains directives AIS components- ; semicolon - separate injury descriptors that are comparable in severity AIS components-Italics - used for proper name anatomical structures or injuries, and for OIS grades ISS Range - 1-75 ISS Purpose - to reflect severity of multi-organ injury in the same body region. TRISS - determines the probability of survival from the ISS, RTS, and the patient's age. >0.50 = probability of Survival <0.50 = Probability of Death PS Components - • Age • Mechanism (Blunt vs. Penetrating) • RTS (Evaluation) • ISS TRISS Chart - • PRE Chart • Utilizes a Scatter plot • Used to demonstrate expected and unexpected outcomes • Threshold is 0.50 or 50% M Score - Characterizes case mix Based on ISS compared to the MTOS Score Ranges: 0.0-0.87 = Dissimilarity to MTOS .88-1.0 = Similarity to MTOS Z score - Clinical Significance Describes Provider's performance Values between -1.96 to +1.96 allow national comparison Score ranges: Values exceeding +1.96 are significantly BETTER Values exceeding -1.96 are significantly WORSE W Score - Describes the # of unexpected survivors (+) or deaths (-) per 100 patients Formula: W = A - B C/100 A= Total # of pts with Ps (probability of survival)- those that died B = Sum of the Ps C = Total # of pts with Ps W Score Example: - Total patients = 784, those with POS (probability of survival) 693 Total deaths = 24 Sum of POS = 634.531 (Total # pts with POS - deaths) - (POS sum) (Total # pts with POS)/100 (693-24)- (634.531) (693)/100 =669 - 634.531 6.93 = 34.469 divided by 6.93 = 4.97 unexpected survivors /100 patients Data validation - is the process of ensuring that a program operates on clean, correct, and useful data. • A routine check for correctness, meaningfulness, and security of data that are input to the system database. • A process to prove or disprove accuracy. • Elimination of erroneous values. • Identify y suspicious or invalid cases, variables, and data values. IRR registry frequency and percent - The data in the registry should be evaluated monthly and not all data elements need to be validated each time. The ACS suggests 5- 10% of records The Trauma Registrar's Role - • Daily review of all trauma charts- new and in-house patients. • Being knowledgeable of reimbursement issues, what documentation to look for. • Work hand in hand with physicians as a respected team member related to documentation issues • Leave prompters on the chart for needed documentation. • Face to face meetings to discuss documentation needs on a weekly basis. • Educational presentations for residents • Coding validations with medical records for reimbursement comparisons. • Reliable, validated data within the Trauma Registry. • Concurrent trauma Registry. • Dedicated person for the Trauma Registry. Medial - Toward the mid line of the body Lateral - Away from the mid line of the body supine - lying on the back prone - lying face down Burn Scoring - the rule of nines intertrochanteric fracture - Fracture at the proximal end of the femur ICD-10-CM Solid Organ Injury, 5th digit represents - Organ Injured (Body Part Injured) ICD-10-CM Code Structure - 3-7 Characters: 1st Character: Always alpha (A-Z, except u). 2nd Character: Always numeric. 3rd-7th Characters: Alpha or numeric. First 3 characters: Category. 4th- 6th Characters: Describe etiology, anatomic site, severity, and such. 7th Character: Added information for obstetrics, injuries, external causes or injury and such. duodenum - first part of the small intestine LOC assigned an AIS code must be corroborated by? - EMS hyoid bone - U-shaped bone at the base of the tongue that supports the tongue and its muscles. xiphoid process - lower, narrow portion of the sternum AIS Injury Scale-How many body regions? - 6 ACS recommendations what % of patients for data validation? - 5%-10% subluxation - partial dislocation of a joint comminuted fracture - fracture in which the bone is splintered or crushed Pt with AIS value of 6 has an ISS of? - 75 cystic duct - carries bile to and from the gallbladder ICD-10-CM classification - arranges dx and injuries into groups pie chart - a chart that shows the relationship of a part to a whole bar graph - a graph that uses vertical or horizontal bars to show comparisons among two or more items Scattergram - Used to plot correlations where each pair of values is plotted against each other to see if there is a relationship between them. line graph - A graph that uses line segments to show changes that occur over time histogram - a bar graph depicting a frequency distribution lumbar vertebrae - L1-L5 cervical vertebrae - 7, C1-C7, first set of seven bones, forming the neck Thoracic Vertebrae (T1-T12) - the 12 bones of the vertebral column (midspine) sacral spine - S1-S5 (back wall of the pelvis) Coccyx Vertebrae - 4 vertebrae that make up the tail bone M score - Characterizes case mix Based on ISS compared to the MTOS Score Ranges: 0.0-0.87 = Dissimilarity to MTOS .88-1.0 = Similarity to MTOS Mode - The value that occurs most frequently in a given data set. Rate - A ratio that compares two quantities measured in different units Median - the middle score in a distribution; half the scores are above it and half are below it average - mean Where is the inferior vena cava primarily located? - Abdomen cytostomy - incision into the urinary bladder colostomy - creation of an artificial opening into the colon crainotomy - incision of the skull celiotomy - incision into the abdominal cavity Y92.0 - Non institutional (private) residence Y92.1 - Institutional (Non-private) residence