Trauma Assessment and Management, Exams of Nursing

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Trauma Module Exam Questions With Complete Solutions Describe criteria to withhold resuscitation for the traumatic arrest patient Correct Answer Injury incompatible with life or traumatic arrest with extended downtime with asystole. Describe importance of a secondary assessment enroute to the hospital Correct Answer A secondary assessment is important because it allows providers to address non-life threatening injuries, repeat assessments on procedures already done in the primary assessment and make sure they are still working, gather information on the patient (if able to) and assess vital signs and begin a trend. Describe importance of personal safety and required PPE for trauma calls Correct Answer Personal safety and the safety of the crew should always be priority. If there is any threat to personal/crew safety, then you need to evacuate the premises, call for additional resources or issue a signal 25. PPE in trauma calls is important due to the risk of exposure via blood, saliva or in the eye. Describe the appropriate treatment for a blast injury Correct Answer • Follow Blast injury/incident protocol.

• Determine scene safety
• Immediate transport with assessment and treatment enroute,
• Manage airway
• Address and treat all traumatic injuries as they present
• Follow crush injury protocol if applicable
• Establish IV/IO access
• Monitor vitals

• Follow decontamination protocol if applicable and address and treat pain.
• Patients may suffer multi-system injuries including blunt and penetrating trauma, shrapnel, barotrauma, burns and toxic chemical exposures; consider airway burns which should prompt early and aggressive airway management, cover open chest wounds with semi-occlusive dressing, use lactated ringers for all critical or serious burns, minimize IV fluid resuscitation in patients with no signs of shock or poor perfusion.
• Cover and dress burns with dry sterile dressings. Describe the appropriate treatment for a burn Correct Answer • Stop the burning process (wet vs. dry chemical exposures)
• Be aware of possible inhalation burns and address and manage if present (Do not attempt an airway if you are not sure you will be able to appropriately establish placement of airway adjunct)
• Do not put ice on patient to prevent hypothermia
• Fluids
• Pain management (Morphine max of 50mg/Fentanyl max of 300 mcg)
• Immediate transport to appropriate facility.
• Know the metabolic response to burns (Release of catecholamine, cortisone, ADH, aldosterone and glucagon; Profound increase in the metabolic state recruiting excess nutrients and oxygen; Evaporation/fluid loss from wounds up to 300mL/m2/hr; and Heat loss up to 580 Kcal/hour) Describe the appropriate treatment for a crush syndrome Correct Answer • Control hemorrhage
• Consider topical hemostatic agent/dressing
• Tourniquet application

• Establish IV/IO
• Manage airway
• Fluid resuscitation
• Consider administration of Midazolam
• Administration of Sodium Bicarbonate, Calcium Gluconate, & Albuterol
• Rapid transport. Describe the appropriate treatment for a head injury Correct Answer • Determine mechanism of action
• Obtain and record GCS
• Provide supplemental oxygen and prevent oxygen desaturation events
• Obtain EtCO2 measurement (ideal range 35-45mmhg)
• Obtain a blood sugar reading
• Establish IV/IO access
• Monitor ECG and vital signs
• Follow protocol which has the altered mental status protocol, multiple trauma protocol, hypotension/shock protocol, seizure protocol, spinal restriction protocol & pain control protocol within the head injury protocol.
• Determine which subsections are needed and follow appropriately. Describe the appropriate treatment for a rhabdomyolysis Correct Answer • Fluid resuscitation
• EKG monitoring for hyperkalemia
• Rapid transport

Describe the appropriate treatment for a spinal injury Correct Answer • Apply C-Collar to patient with a suspected spinal cord injury

• Place on backboards and secure head via head straps
• Limit patient movement as much as possible to prevent further injury
• Monitor and reassess patient PMS after placement on board
• Establish IV/IO and follow pain and trauma protocol Describe the appropriate treatment for a traumatic cardiac arrest Correct Answer • If patient is pulseless after trauma criteria for death/no resuscitation or injury incompatible with life, do not attempt resuscitation.
• If blunt trauma and injury is compatible with life, place patient on monitor and determine if patient is asystole or is PEA with rate <40, determine if patient has an isolated chest injury or strong suspicion for recent, possibly reversible tension pneumothorax as the ONLY injury causing the arrest; if yes attempt resuscitation and transport to nearest trauma center. If no, do not attempt resuscitation.
• If blunt trauma and patient has a rhythm outside of PEA <40 or asystole, attempt resuscitation and transport to nearest trauma center.
• If patient has penetrating trauma and has injuries that are compatible with life, attempt resuscitation and transport to nearest trauma center. Describe the appropriate treatment for an acute respiratory distress syndrome Correct Answer • High flow oxygen
• CPAP may be needed if applicable
• Bronchodilators

• Fluid resuscitation if necessary Describe the appropriate treatment for an extremity trauma Correct Answer • Control all life threatening bleeding
• Apply tourniquet or hemostatic dressing
• Establish IV/IO access, address & treat pain
• If amputation, apply tourniquet, wrap part in sterile dressing soaked in normal saline and place in airtight container. Place container on ice if available.
• Treatment will depend on severity of trauma to the extremity. Describe the appropriate treatment for an eye injury Correct Answer • If complaint is pain or visual in nature; assess visual acuity, evaluate pupils, complete neuro exam, screen for unrecognized chemical/agent exposure, cover both eyes and follow pain protocol.
• If complaint is injury related and the eye is out of socket, cover with saline moistened gauze, cover unaffected eye and follow pain protocol.
• If complaint is injury related and the eye is in socket, determine if it is a burn/chemical nature or an injury to the eye.
• If it is a burn/chemical nature, immediately irrigate the eye with available saline or water, give tetracaine, irrigate with normal saline using Morgan lens, cover unaffected eye and follow pain protocol.
• If it is an injury, assess orbital stability, assess visual acuity (when feasible), Penetrating trauma or rupture of globe- secure object to insure no further movement and cover both eyes to prevent further movement by patient and follow pain protocol. ALWAYS remove contact lens and NEVER try to remove foreign object.

Describe the appropriate treatment for hemorrhagic shock Correct Answer Treatment in the field is limited due to the patient ultimately requiring a blood transfusion and surgery. Patients who are experiencing hemorrhagic shock need immediate transport to the appropriate and closest trauma center, IV/IO fluid, airway management (if unable to control their own airway), and bleeding control via tourniquet, dressing or direct pressure. Describe the clinical concerns associated with increased intracranial pressure Correct Answer Clinical concerns associated with ICP are hemorrhagic stroke, brain contusions, herniation Describe the equipment that should be brought to the patient's side for blunt vs penetrating trauma Correct Answer The black bag should be the only equipment needed for blunt and penetrating trauma calls. The bag contains all necessary equipment to be able to control all life threats consistent with the injury. Explain assessment components of the primary assessment for a trauma patient Correct Answer The primary focus during the primary assessment is to make sure the patients airway is open and patent, the patient is breathing appropriately and to address any life threatening bleeding or circulatory complications. Explain how to assess a scene for potential injuries and hazards upon the initial size up when arriving on scene Correct Answer Your initial scene size up should consist of recognizing hazards

such as wires down, hazmat considerations, crowd, and/or gunman or assailant still present on scene. At this time you can determine a brief description of the mechanism of action, possible number of patients, the need for additional resources, etc. Identify the capabilities and limitations of Wake Med Cary regarding pediatric and OB trauma patients Correct Answer Wake Med Cary is able to care for OB trauma patients > weeks with minor blunt trauma for trauma evaluation and prolonged fetal monitoring; If a patient meets level 1 trauma criteria they must be transported to a level 1 trauma center for mom and baby monitoring. Wake Med Cary should only be utilized for significant mechanism of injury WITHOUT hemodynamic compromise. All pediatric trauma patients should be transported to a level 1 trauma center. Identify the signs and symptoms of hemorrhagic shock Correct Answer • Hypotension

• Decreased/altered mental status
• Tachycardia
• Tachypnea
• Thirst
• Loss of peripheral pulses
• Reduced body temperature
• Cool, pale, diaphoretic skin presentation. Identify the signs and symptoms of spinal cord injuries Correct Answer • High cervical nerves(C1-C4) - Paralysis in arms, hands, trunk and legs, patient may or may not be able to breath

on their own, cough, or control bowel or bladder functions, impaired/absent speech, quadriplegia.

• Low Cervical nerves (C5-C7)- These nerves are corresponding with arms and hands control; patient may be able to breathe on their own and speak normally
• Upper Thoracic nerves (T1-T5)- Corresponding nerves affect muscles, upper chest, mid-back and abdominal muscles, arm and hand function are usually normal, injuries usually affect the trunk and legs
• Lower Thoracic Nerves (T6-T12)- Nerves affect muscles of the trunk (abdominal and back muscles) depending on the level of injury, usually results in paraplegia, normal upper body function, fair to good ability to control and balance trunk while in a seated position, little to no control of bowel or bladder function.
• Lumbar nerves (L1-L5)- Injuries generally result in some loss of function in the hips and legs, little to no control of bowel or bladder functions, depending on strength in the legs may need wheelchair and may also walk with braces.
• Sacral nerves (S1-S5)- Injuries generally result in some loss of function in the hips and legs, little to no voluntary control of bowel or bladder functions, most likely will be able to walk. Know the required information for a scene notification Correct Answer Required scene notification information is patients age, injury, GCS and estimated time. This is important to do so that the hospital can call in all available resources needed for that patient and get all necessary components in line for patient arrival.

Know the three QA criteria of a trauma call Correct Answer • Making the scene notification

• Transporting to appropriate destination
• Meeting the required scene time. List reasons we expose all trauma patients Correct Answer Exposing trauma patients allows for a more detailed head to toe assessment and allows providers to be able to find and treat all injuries that may not have been observed with patients clothing still intact. List signs and symptoms of increased intracranial pressure Correct Answer • Headache
• Vomiting (often without nausea)
• Altered mental status
• Seizures
• Cheyne-Stokes Respirations
• Hypertension
• Widened pulse pressure
• Bradycardia
• Nonreactive pupils
• Central neurogenic hyperventilation
• Decerebrate posturing
• Blown pupils
• Ataxic/Biots respirations
• Flaccid paralysis
• Irregular pulse rate, QRS, ST, T wave changes
• Fluctuating blood pressure
• Cushing's Triad
• All dependent on level of ICP.

List the CDC trauma triage criteria Correct Answer • Step 1 in the CDC trauma triage is measure vital signs and level of consciousness. Determine patients GCS, SBP and respiratory rate. The range of those should be a GCS <14, SBP of <90mmhg and <10 or >29 breaths per minute. If they are all within those limits then the next step in the CDC triage criteria is to transport to a trauma center and attempt to identify the most seriously injured patients. These patients should be transported preferentially to the highest level of care within the trauma system. If the patient does not meet this criteria, you move on to step 2 which is assessment of anatomy of injury.

• Step 2 consists of all penetrating trauma to the head, neck, torso, and extremities proximal to the elbow and/or knee, Flail chest, two or more proximal long bone fractures, crushed, degloved, or mangled extremity, amputation proximal to wrist and ankle, pelvic fractures, open or depressed skull fracture and paralysis. If patient meets any of these then patient should be to transport to a trauma center and attempt to identify the most seriously injured patients. These patients should be transported preferentially to the highest level of care within the trauma system. If the patient does not meet any of these injuries then the step 3 is to assess mechanism of injury and evidence of high- energy impact.
• Step 3 consists of Falls in adults that are greater than 20 feet and pediatrics that are 10 feet or 2 to 3 times the child's height, high risk auto crashes that have intrusion greater than 12 inches on the occupants side or 18 inches in the passenger compartment, ejection (partial or complete) from automobile, death in same passenger compartment, vehicle telemetry data consistent with high risk of injury, auto vs. pedestrian/bicyclist

thrown, run over, or with significant (>20mph) impact, motorcycle crash >20mp List the five areas from which you can exsanguinate Correct Answer • Chest (3000 each side)

• Abdomen (1500)
• Pelvis (1000- massive)
• Femur (1000-2000)
• Externally (all of it) List the life threats that should be corrected during the primary assessment Correct Answer • Control of external hemorrhage
• Splint suspected fractures
• Pelvis binding
• Needle decompression Paramedic: Know the mechanism of action, class, onset, contraindications, indications, side effects, dose and route of Cefazolin. Correct Answer • Class- Antibiotic, first generation cephalosporin.
• Mechanism of action- Cefazolin inhibits biosynthesis of the bacterial cell wall. This mechanism interferes with the bacteria's ability to maintain a stable cell wall.
• Indications- Adult patient with open fracture.
• Contraindications- Allergy to cephalosporin or Penicillin.
• Side Effects: Diarrhea, nausea, vomiting, abdominal pain, yeast infection.
• Dosage - 2 Grams.
• Route- IV.
• Other information- Administration of Cefazolin is a prophylactic measure to prevent infection in adult patients with

an open fracture. Cefazolin is not indicated for sepsis or other infection. Do not delay scene times or wash-out of the wound to administer Cefazolin. Recite the Glasgow Coma Scale and explain why it is used Correct Answer • Eye opening: Spontaneous (4), verbal (3), painful (2), none (1)

• Verbal response: Oriented (5), confused/disoriented (4), Inappropriate words (3), Incomprehensible sounds (2), none (1)
• Best Motor Response: Obeys (6), Localizes (5), Withdraws/flexion (4), abnormal flexion (3), Extension (2), none (1).
• The Glasgow Coma Scale shows if there is no neurological disabilities (15), mild dysfunction (13-14), moderate dysfunction (9-12) or severe dysfunction (8 or less) Understand the Wake EMS protocol adaption of the CDC trauma triage criteria Correct Answer Wake EMS trauma protocol goes directly based of CDC trauma criteria and has been adapted by Wake EMS due to the clinical studies that have been made by the CDC that result in increased positive outcomes of patients. These protocols have been proven to provide the best possible outcome for the patients and help the patients receive the appropriate level of care.