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A comprehensive set of questions and answers related to trauma care, covering various aspects of patient assessment, treatment, and management. It includes topics such as fluid resuscitation, neurogenic shock, ptsd, ethical principles, wound closure, electrical burns, and more. Designed to aid medical professionals in their understanding and application of trauma care principles.
Typology: Exams
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List three effects of inflammatory mediators - ANSWER- Diaphoresis, glycogeonolysis, bronchodilation, increased: HR, contractility, automasticity, RR Describe the technique for inserting IO into distal femur - ANSWER- Anterior midline above the external epicondyles, 1 - 3cm above the femoral plateau; the knee slightly flexed and the hip externally rotated and flexed Describe the technique for inserting IO into distal tibia - ANSWER- just proximal to the medial malleolus Describe the technique for inserting IO into humerus - ANSWER- Directly above the greater tuberosity Describe the technique for inserting IO into proximal tibia - ANSWER- 2cm distal and slightly medial to the tibial tuberosity Recognize adequate fluid resuscitation using four end points to resuscitation - ANSWER- Traditional - Vital signs, urinary output (>0.5mg/kg/hr), Mental status Invasive hemodynamic monitoring - Central Venous Pressure (normal 2-6mmHg), Pulmonary wedge pressure (8-10mmHg), Cardiac Index (2.5 - 4.0L/minute/m^2), Delivery of oxygen (DO2) (500-600mL O2/min/m^2) Metabolic parameters - Lactate (>4 is severe), Base Deficit (>6mmol/L indicates severe injury) Treatment for neurogenic shock - ANSWER- 1 -2 L bolus (often insufficient and may cause pulmonary edema) Vasopressors (Epi, Norepi, dopamine, phenylephrine, or vasopressin) MAP 85-90mmHg Atropine respiratory support as needed List 6 effects that a state of crisis may have on a trauma patient - ANSWER- Disruption of family Depression Failure to return to pre-event life Economic problems Social isolation Decreased pleasure in activities
Treatment goals for patients with PTSD - ANSWER- Restore sense of control Diminish power of the traumatic event Reduce chronic hyperarousal Reduce feelings of guilt/self-blame Restore sense of equilibrium List three patient dispositions allowed by COBA/EMTALA legislation - ANSWER- Admission to the facility Stabilizing care, followed by transfer to qualified facility Treated and discharged What is the performance improvement loop? - ANSWER- Identify the outcomes Determine plan Measure progress Describe quantitative research - ANSWER- A deductive process that utilizes numeric findings examples: randomized controlled trials, cohort studies Describe qualitative research - ANSWER- an inductive process where words are used to give meaning to data, involves interactions between researcher and the subject. examples: data collected by observation, questionnaires, or interviews, data is reported using words as opposed to numbers Five ethical principals utilized in trauma care - ANSWER- Autonomy Beneficence Non-malficence Veracity (honesty) Justice List three complications associated with a contusion and/or hematoma - ANSWER- Compartment syndrome Risk for infection Risk of hypovolemia The four interventions used to control hemorrhage in amputations - ANSWER- Direct pressure Pressure point Elevation Tourniquet Describe primary wound closure - ANSWER- Immediate wound closure Describe secondary wound closure - ANSWER- Allowed to close on own over time (for clean wounds with significant tissue loss)
Describe tertiary wound closure - ANSWER- Closure is delayed for a period of time (wounds with significant bacterial contamination) The Rule of Nines - adult - ANSWER- Head 9% Chest 9% Abdomen 9% upper back 9% lower back 9% Arm 9% upper leg 9% lower leg and foot 9% Genitals 1% Rule of Nines - pediatric - ANSWER- Head 18% Chest 9% Abdomen 9% upper back 9% lower back 9% arm 9% upper leg 7% lower leg and foot 7% Four treatment strategies for electrical burns - ANSWER- Fluid replacement using Modified Parkland Formula Consider starting with 20ml/kg bolus and adjust to maintain 1ml/kg/hr Continuous cardiac monitoring Osmotic diuretics Sodium bicarb (to alkalinize urine) Monitor for compartment syndrome Two complications associated with exposure to hydrocarbons - ANSWER- Respiratory failure Hepatic injury (delayed) Describe Volkmann's contracture - ANSWER- muscle contraction distal to nerve impingement injury List injuries commonly associated with blunt cardiac injury - ANSWER- Pericardial tamponade Cardiac contusion
Care for pulmonary contusion - ANSWER- Pain management Maintain respiratory rate, ventilation Adequate gas exchange - ETCO2, SaO Mobilize and clear blood and secretions Define Acute Respiratory Distress Syndrome (ARDS) - ANSWER- Non-cardiogenic pulmonary edema Describe components of ABD assessment on a traumatically injured patient - ANSWER- FAST - Focused Abdominal Sonography Assessment DPA - Diagnostic Peritoneal Lavage List common complications with splenic trauma - ANSWER- Gastric perforation Recurrent bleeding Acute gastric dilation Pancreatitis Post-op elevated WBC Spontaneous rupture Prioritize treatments for patients with rectal trauma - ANSWER- Early recognition and control of fecal contamination ABx therapy early to prevent sepsis Surgical irrigation Primary bowel repair Signs associated with NOT placing a urethral catheter in trauma patient - ANSWER- Rebound tenderness in suprapubic area Urge to urinate with inability to do so Blood in urinary meatus High-riding prostate Pelvic, perineal, or scrotal hematoma (butterfly ecchymotic area) Complications of renal trauma - early onset - ANSWER- Hemorrhage Abcess Infected urinoma AV fistula Prolonged extravasation of urine Infection (wound or UTI) Complications of renal trauma - late onset - ANSWER- Hypertension Change in lab values associated with pregnancy - ANSWER- Alkaline phosphatase ↑ Albumin ↓ Calcium ↓ BUN ↓ Creatinine ↓
Fibrinogen ↑ PT/PTT ↓ Hgb/Hct ↓ Sed rate ↑ WBC ↑ Define primary injury prevention - ANSWER- designed to prevent occurrence of injury Define secondary injury prevention - ANSWER- designed to reduce the severity of the injury Define tertiary injury prevention - ANSWER- improvement in outcomes related to traumatic injuries Advantages of ground transport - ANSWER- Larger payloads Readily available Advantages of helicopter transport - ANSWER- Rapid point to point transfer Can reach areas of difficult terrain Usually has advanced care crew Advantages of fixed wing transport - ANSWER- Can travel long distances rapidly Cabin is pressurized and roomy Can transport multiple patients Not limited by weather Disadvantages of ground transport - ANSWER- Slow Affected by weather Disadvantages of helicopter transport - ANSWER- Expensive Limited by:
Members of rehab team - ANSWER- Patient and family Nurse Physical therapist Respiratory therapist Occupational Therapist Speech pathologist Physiatrist Conditions of brain death - ANSWER- Irreversible Body temp > 35C Fixed pupils Apnea in presence of hypercarbia (PaCO2 > 60) No reflex activity: oculocephalic, oculovestibular, cough, gag, and corneal Describe corneal reflex - ANSWER- Brush a wisp of cotton against the cornea, or apply a small drop of saline; normal response is rapid closing of eyelid Gag reflex - ANSWER- Stimulate back of pharynx, normal response is to gag Swallow reflex - ANSWER- Stimulate uvula, normal response is elevation of uvula What is oculocephalic reflex - ANSWER- Dolls eyes; if eyes move opposite direction of head movement, it is abnormal finding What is oculovestibular reflex - ANSWER- Water is instilled in ear canal. Warm water - eyes deviate towards tested side; Cold water - eyes deviate towards opposite side; Lack of eye movement is consistent with brain death. Indications for ICP monitoring - ANSWER- Salvageable patients with severe injury GCS of 3 to 8 after resuscitation Abnormal CT findings Unconscious Contraindications for ICP monitoring - ANSWER- Awake patients Coagulopathies Pupillary response in brain injured patients - ANSWER- Irregular or oval shaped pupils Anisocoria (unequal pupil size) Slow or unequal or lack of pupillary response List five nursing activities that reduce cerebral metabolism - ANSWER- Maintain dark and quiet room Limit visitors Speak softly Cluster nursing activities Limit dialogue
Regular sedation/analgesia List symptoms associated with diffuse axonal injury - ANSWER- Coma Increased ICP Posturing Hypertension Increased temperature Hyperhydrosis from nipple line up No pupillary signs Describe deficits associated with anterior cord injuries - ANSWER- Loss of motor function, pain & temperature perception, crude touch and pressure Intact - fine touch, fine pressure, and vibration Describe deficits associated with posterior cord injuries - ANSWER- Loss of proprioception, vibration, fine touvhm fine pressure Intact - motor function, pain, temperature, crude touch, crude pressure Treatment for an avulsed tooth - ANSWER- Handle by crown Do not clean, rub, scrape, or disinfect Store in Hank's solution ( or milk or normal saline) Define penetrating globe injury - ANSWER- Entrance without an exit Define perforating globe injury - ANSWER- complete disruption of the sclera and cornea, through and through