Multisystem Trauma: Considerations for Pediatric, Geriatric, and Pregnant Patients, Exams of Medicine

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EMT - Chapter 36 Exam Questions and Complete Solutions Graded A+ [Document subtitle] Denning [Date] [Course title]

abruption placentae - Answer: separation of the placenta from the uterine wall multisystem trauma - Answer: trauma in which more than one major body system is involved

1. Traumatic forces are more widely distributed in children than adults and makes them more prone to multisystem trauma
2. Body surface area is greater and they can lose heat faster
3. Heavy heads and weak neck muscles increase risk of head and c-spine injuries
4. Internal organ placement makes them more susceptible to spleen and liver injuries
5. Greater chest wall flexibility than adults allowing for injuries with fewer external signs of trauma
6. Growth plates not fully developed so trauma can severely impact normal growth
7. Higher energy requirements and fatigue faster than adults - Answer: Summarize anatomical and physiological changes in children that create special considerations in assessing and managing, and transporting pediatric trauma patients 1-3; higher; nine times; uterine contractions that progress into labor - Answer: In regards to the relationship of maternal injuries to fetal distress and death: ____% of minor traumas involving pregnant women result in fetal loss; the more severe the injury to the mother, the _____ the chances of fetal injury; fetal death rates are __________ higher than maternal death rates following trauma; and the most common problem caused by maternal trauma is _____________________.
8. Primary goal is to identify and manage life-threatening injuries
9. Scene size-up 2a. ook for possible MOI and maintain high index of suspicion that more than one major body system is affected 2b. if patient belongs to a special population, use your knowledge about that throughout your assessment
10. primary assessment 3a. suspect c-spine injury 3b. assess mental status using the AVPU, Glasgow Coma Scale and pediatric assessment triangle to provide additional info 3c. establish airway

3d. maintain airway and assess breathing rate and quality and provide O2 and ventilation as necessary 3e. assess circulatory status and check pulse; look for major bleeding and control it with direct pressure; use pad in a pregnant patient

4. rapid secondary assessment 4a. rapid physical exam 4b. vital signs 4c. history 4d. signs and symptoms
5. transport immediately, contact receiving facility and note specifically the type of trau - Answer: Discuss the assessment-based approach to multisystem trauma and trauma in special patient populations
6. Circulation changes can lead to the inability to maintain vital signs during hemorrhage
7. The brain shrinks, which can lead to higher risk of cerebral bleeding following head trauma
8. Skeletal changes can cause curvature of the upper spine that may require padding during supine spinal immobilization
9. More susceptible to injury from fractures due to osteoporosis
10. Minor chest trauma can cause lung injury
11. Thinner skin results in more easily inflicted soft tissue injuries - Answer: Summarize anatomical and physiological changes assessing and managing, and transporting geriatric trauma patients
12. Spinal immobilization is required for suspected spinal injuries and should be maintained throughout care; add padding around the spaces in the back if necessary
13. Open and maintain a clear airway; suctioning is important in the elderly due to a decreased cough reflex
14. Provide and support ventilation as needed; administer high-concentration O2 and use Pulseox to monitor O2 saturation
15. Prevent hypothermia
16. Splint fractures; remember that traction splints are not used for hip fractures
17. Provide rapid transport; American College of Surgeons recommends that all trauma patients older than 55 be taken to trauma centers - Answer: Discuss special considerations in assessing, managing, and transporting older trauma patients.

1. high incidence of morbidity and mortality
2. leading cause of death for young people 1-37 years of age
3. patients are at a greater risk of developing shock than one-system trauma patients - Answer: Discuss the increased morbidity and mortality associated with multisystem trauma
4. ensure safety of the rescue personnel and the patient
5. determine additional resources needed
6. understand kinematics
7. identify and manage life threats
8. manage the airway while maintaining c-spine
9. support ventilation and oxygenation
10. control external hemorrhage and treat for shock
11. perform a secondary assessment and obtain a medical history
12. splint musculoskeletal injuries and maintain spinal immobilization on a long spine board
13. make transport decisions (on-scene time should be <10 minutes) - Answer: list the golden principles of prehospital multisystem trauma care, to keep in mind when treating such a patient
14. increase in total blood volume of about 50%
15. 10-15 bpm increase in heart rate during 3rd trimester
16. uterus becomes more vascular and helps to supply the increased O2 demand
17. diaphragm elevates, making tension pneumothorax a bigger risk
18. abdominal viscera pushed up, potentially altering perception of abdominal pain
19. risk of vomiting and aspiration goes up due to decreased gastric motility
20. bladder displaced into abdominal cavity making it at greater risk for traumatic injury
21. increased renal blood flow
22. loosened pelvic joints and change to center of gravity - Answer: summarize anatomical and physiological changes of pregnancy that create special considerations in pregnant trauma patients
23. abruptio placentae can result from traumatic injury

2. motor vehicle crashes account for a large number of maternal and traumatic injuries
3. potential fetal distress caused by hypoxia or hypovolemic shock - Answer: summarize special considerations in assessing pregnant trauma patients
4. tilt spine board to the left
5. ABCs are critical
6. check for major bleeding
7. consider ALS - Answer: summarize special considerations in managing and transporting pregnant trauma patients
8. need special care
9. often need to involve the patient's care givers in emergency treatment
10. patients may be more cooperative in presence of care giver
11. care givers may provide important health information
12. err on the side of caution and manage the patient as if he has a head injury - Answer: discuss special considerations in assessing managing, and transporting cognitively impaired trauma patients