Trauma Assessment and Management, Exams of Nursing

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PHTLS BLOCK 3 – TRAUMA EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS PHTLS BLOCK 3 – TRAUMA EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS What factor has the greatest influence on the kinetic energy in a Motor Vehicle Crash (MVC)? - Precise Answer ✔✔The speed of the vehicle What is your first concern when arriving to the scene of a call? - Precise Answer ✔✔Body Substance Isolation (BSI) and Scene Safety What is the best indicator of adequate breathing? - Precise Answer ✔✔Minute Volume What are the vitals signs associated with Class I shock? - Precise Answer ✔✔Blood Loss: <750 mL (15%) Systolic Blood Pressure - No Change Heart Rate - No Change/Slightly Elevated Respiratory Rate - No Change What are the vital signs associated with Class II (Compensated) shock? - Precise Answer ✔✔Blood Loss: 750-1500 mL (15%-30%) Systolic Blood Pressure - No Change Heart Rate - >100 Respiratory Rate - 20-30 5 - Localizes Pain 4 - Withdraws to Pain 3 - Decorticate Posturing 2 - Decerebrate Posturing 1 - No Reaction What is the Rule of Nines? - Precise Answer ✔✔System to assess Total Body Surface Area (TBSA) of Burn Patients. What is the Parkland Burn Formula? What is it used for? - Precise Answer ✔✔Used to calculator fluid resuscitation for a burn patient over the first 24 hours, half in the first 8, and half in the second 16. Formula = 4 x Weight (kg) x Total Body Surface Area (TBSA) What is the normal range of vital signs for pediatric patients? - Precise Answer ✔✔ What type of injuries are associated with a Lateral Impact? - Precise Answer ✔✔Injuries to the Clavicle, Arms, Ribs, Pelvis, Femur, Cervical spine, Chest, and Head What type of injuries are associated with a Up and Over Impact? - Precise Answer ✔✔Injuries to the Head, Face, Airway, Chest, Tracheal Fracture, Diaphragmatic Rupture, Abdomen, and Pelvis What types of injuries are associated with a Down and Under Impact? - Precise Answer ✔✔Injuries to the Pelvis, Femur, Knees, Lower Extremities What type of injuries are associated with a Rear Impact? - Precise Answer ✔✔Whiplash Injuries (Cervical spine, Anterior Neck Ligaments) What type of injuries are associated with Rotational Impact? - Precise Answer ✔✔Shearing Injuries (Heart off aorta, Liver/Kidneys off renal artery/vein) What type of injuries are associated with Roll Over Impacts? - Precise Answer ✔✔Everything. How many times more likely are you to die in a roll over vs other impacts? - Precise Answer ✔✔You are six (6) times more likely to die in a roll over. What is the mortality rate for ejected patients in MVCs? - Precise Answer ✔✔75% What should you do simultaneously while assessing the airway in a trauma patient? - Precise Answer ✔✔Manually Stabilize their head and neck What is the purpose of supplemental oxygen for a trauma patient? - Precise Answer ✔✔Increases the concentration of oxygen at the alveolar level What is the minimum pulse oximetry reading wanted in any patient? - Precise Answer ✔✔95% or Greater When do you utilized a Bag-Valve-Mask (BVM) Device on a Trauma Patient? - Precise Answer ✔✔Respirations <10 or >29/30 How long can you go without providing ventilation for a patient with inadequate respirations? - Precise Answer ✔✔30 Seconds What part of the spine is most commonly injured in Trauma? - Precise Answer ✔✔Cervical Spine What are the indications for the Pneumatic Anti-Shock Garment (PASG)? - Precise Answer ✔✔Belly, Pelvis, Retroperitoneal Bleeds with a Systolic BP less than 90 mmHg OR Widespread Hemorrhage with Systolic BP less than 60 mmhG What are the contraindications for the Pneumatic Anti-Shock Garment (PASG)? - Precise Answer ✔✔Pulmonary Edema, Penetrating Chest/Abdominal (Thoracic) Trauma What type of brain injury is a Laceration? - Precise Answer ✔✔Hemorrhage into cord tissue causing swelling, and disruption of impulses What are the symptoms of a complete cord transection? - Precise Answer ✔✔If in the cervical spine it can cause Quadriplegia, Incontinence, and Respiratory paralysis If it is below T-1 it can cause Incontinence, and Paraplegia What causes Anterior Cord Syndrome? What are the symptoms? - Precise Answer ✔✔A flexion injury (partial transection), frequently caused by bone fragments or interrupted blood supply Causes decreased sensation of pain, light touch, and temp below the lesion but maintain intact light touch, proprioception, vibration sensation What causes Central Cord Syndrome? - Precise Answer ✔✔A cervical hyperextension injury Causes greater motor impairment in the upper than in the lower extremities because fibers run centrally, and can cause bladder dysfunction and sacral sparing What causes Brown Sequard Syndrome? - Precise Answer ✔✔A hemi-transection of the cord secondary to a penetrating injury that affects one side of the cord, typically by a ruptured disk or penetrating trauma Will cause ipsilateral sensory and motor loss and contralateral pain and temperature sensation loss What is the criteria for rapid extrication of a trauma patient? - Precise Answer ✔✔A patient with the presence of a life threat or a scene hazard. What are the kinematics of a Blast Injury? - Precise Answer ✔✔Primary - Blast Injury to Hollow Organs Secondary - Flying Debris/Shrapnel Tertiary - Victim Displacement Quaternary - Burns Quinary - CBRN Exposure When are trauma patients with penetrating trauma fully immobilized? - Precise Answer ✔✔When there is the presence of a neurological deficit upon examination. What gauge catheter is used in Trauma Patients? - Precise Answer ✔✔Large Bore - 14 Gauge is ideal, but as large as is possible What type of IV set is used in Trauma Patients? - Precise Answer ✔✔Macro Drip Sets (10 gtts is ideal) What is the maximum amount of pre-hospital fluid resuscitation allowed? - Precise Answer ✔✔3 L What is the preferred pre-hospital fluid resuscitation fluid? - Precise Answer ✔✔Lactated Ringer's (LR) What is the formula for calculating Pediatric fluid resuscitation? - Precise Answer ✔✔20 mL/kg How many IV attempts before IO? - Precise Answer ✔✔For Pediatrics 2 max For Adults, depends on necessity for access What is the purpose of the Primary Assessment? - Precise Answer ✔✔To identify and correct any life threats A - Airway B - Breathing C - Circulation D - Disability What organs are most susceptible to shearing injuries? - Precise Answer ✔✔Heart, Kidneys, and Liver What is the order for controlling external hemorrhage? - Precise Answer ✔✔Direct Pressure, if unsuccessful or source appears arterial utilize a tourniquet, 2-3 inches above the wound, fastened until the blood stops and/or there is no distal pulse, and notate the time of application. What is the threat from a Hemothorax? - Precise Answer ✔✔Massive Blood Loss What are the layers of the Meninges? - Precise Answer ✔✔Dura Mater Arachnoid Layer Subarachnoid Space Pia Mater What are the three factors that determine the severity of a radiation injury? - Precise Answer ✔✔Time Exposed Distance from the Source Shielding Used What is Commotio Cordis? What is its cause? What is the treatment? - Precise Answer ✔✔Lethal disruption of the heart by direct blunt trauma causing the heart to most commonly go in to Ventricular Fibrillation Cause - Direct Blunt Trauma to Sternal Region during Repolarization (T Wave) of the Heart Treatment - Defibrillation What drugs may be used to treat a Traumatic Brain Injury (TBI)? - Precise Answer ✔✔Decadron/Dexamethasone (Steroid) - Decreases swelling Mannitol/Osmitrol - Diuretic, used to pull fluid / reduce swelling What are the differences between Trauma Center levels? - Precise Answer ✔✔Level I - Regional Trauma Center with all types of Specialty Surgical Care available 24/7, Open Surgical Suite, Staffed CT/X-Ray, Blood Bank Level II - Area Trauma Center, Able to receive the most common trauma patients, have most surgical capabilities Level III - Community Trauma Center, Specialized ED with some surgical capabilities Level IV - Community Hospital, Able to stabilize and then must transfer What are the four E's of Prevention? - Precise Answer ✔✔Engineering - Safer Roads, Airbags Education - Driver's Safety, Child Seat Installation Enforcement - Speeding Tickets, Seat Belt Tickets Economics - Grants for Helmets, Grants for Car Seats What are the three impacts in a Motor Vehicle Collision (MVC) - Precise Answer ✔✔I - Object Collides with Something II - Occupant Collides with the vehicle's interior III - Organs Collide with the interior of the Occupant How do you prevent Supine Hypotensive Syndrome? - Precise Answer ✔✔Push the mother's belly in order to push the baby, just enough, to relieve the pressure on the Vena Cava What is the appropriate treatment of an evisceration? - Precise Answer ✔✔Irrigate to remove debris Cover with a Moist Dressing to Keep Wet Cover with a Dry Dressing to Keep Warm Cover with an Occlusive Dressing to Protect NEVER push back in, Keep patient from moving What are the three types of burns? - Precise Answer ✔✔1st Degree (Superficial) - No Blisters, Only Effects the Epidermis, Characterized by Redness, Tenderness, Blanching (Turns Pale Under Pressure) 2nd Degree (Partial Thickness) - Blisters, Effects Epidermis and Some of the Dermis, Moist Appearance, Tactile/Pain Receptors intact, Fluid Shift to affected area 3rd Degree (Full Thickness) - Entire Dermis Effected, Hair Shaft, Nerves, Blood Vessels, Glands, and Lymph nodes destroyed What is Pulsus Paradoxus? What does it indicate? - Precise Answer ✔✔An abnormally large drop in the systolic blood pressure during inspiration, and it is an indicaiton of Pericardial Tamponade. What are the four types of Trauma Center Criteria? What is the reference in LA County? - Precise Answer ✔✔Physiological Criteria - Vital Signs, Level of Conciousness Anatomical Criteria - Injury Type Mechanical Criteria - Mechanism of Injury (MOI) Trauma Guidelines or Special Considerations - Age, History LA County Reference 506 What percentage of pediatric deaths are preventable? - Precise Answer ✔✔80% What is the best way to save a Fetus? - Precise Answer ✔✔Save the mother. Are patients in traumatic full arrest with blunt chest trauma worked up? - Precise Answer ✔✔No. Are patients in traumatic full arrest with penetrating chest trauma worked up? - Precise Answer ✔✔Yes, IF they have organized electrical activity above the ventricles, indicative of the tank just needing filling. How much blood can be lost with a single rib fracture? - Precise Answer ✔✔125 mL How much blood can be lost with a Pelvis fracture? - Precise Answer ✔✔Substantial Amount (1500-2000 mL) How much blood can be lost with a Femur fracture? - Precise Answer ✔✔1000 mL How much blood can be lost with a Tibia or Fibula fracture? - Precise Answer ✔✔500 mL How much blood can be lost with a Humerus fracture? - Precise Answer ✔✔750 mL How much blood can be lost with a Radius or Ulna fracture? - Precise Answer ✔✔250 mL Do patients with an isolated extremity injury required spinal immobilization? What should they be given if possible? - Precise Answer ✔✔Do not require c-spine, should be splinted and given pain medication if possible What is the appropriate treatment for a laceration of neck vessels? - Precise Answer ✔✔An occlusive dressing taped on all four sides What are the three classes of LeForte fractures? - Precise Answer ✔✔LeForte I - floating palate LeForte II - floating maxilla LeForte III - floating face What is MAP? - Precise Answer ✔✔The Mean Arterial Pressure, Calculated by adding the Systolic Blood Pressure to the Diastolic Blood Pressure multiplied by 2 and dividing that entire sum by 3 (MAP = (1x Systolic BP) + (2 x Diastolic BP) / 3 Must be at least 50 mmHg for perfusion What is CPP? - Precise Answer ✔✔The Cerebral Perfusion Pressure or the pressure required to perfuse the brain, calculated by subtracting the ICP from the MAP (CPP = MAP - ICP) Must be at least 60-70 mmHg What does the Monroe-Kelly Doctrine state? - Precise Answer ✔✔There is a fixed relation within your ICP between the mass of your brain, the amount of blood and the amount of Cerebral Spinal Fluid (CSF) surrounding your brain, and if the space is decreased or any of the above increase, then the others must decrease Normally = 80% Brain, 10% Blood, 10% CSF - ICP = 10 mmHg Autoregulation: Compensated = 80% Brain, 5% Blood, 5% CSF - ICP = 15 Uncompensated = 80% Brain, 4% Blood, 4% CSF - ICP = 30