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CSTR ACTUAL EXAM 2024 QUESTIONS
AND ANSWERS
American College of Surgeon: Resources for Optimal Care of the Injured Patient Correct Answer Definition of a "Trauma Patient" can be found here: Any patient that has an injury in the code range between 800 and 959.9, but not one of the exclusion codes, for late effects of injury (905-909.9), superficial injuries, including blisters, contusions, abrasions, insect bites (910-924.9), and foreign bodies (930- 939.9). and meets one of the three event criteria: Hospital admission; Patient transfer via emergency medical services transport from one hospital to another hospital; or, Death resulting from the traumatic injury. Correct Answer ACS inclusion criteria Three Types of Data Abstraction Correct Answer Concurrent, Retrospective & Hybrid Concurrent Abstraction Correct Answer Daily abstraction while the patient is in house Retrospective Abstraction Correct Answer Abstraction after patient discharge. Hybrid Abstraction Correct Answer Data entry is begun during the patient encounter but the record is closed after patient discharge. The American College of Surgeons registry staffing recommendation for manual data entry: Correct Answer 1 full-time equivalent employee dedicated to the registry to process the data for approximately 750 to 1,000 patients annually
In order to run data for reporting the registrar needs to know several basic details: Correct Answer What information is needed to identify the correct data fields, the time frame that is of interest, any related filters, and what format for display grouping, such as year, month, ISS range, age range, etc. Format Correct Answer Presentation Concept of the way that the viewer wishes to view the result of the data compiled. The format identifies how the data is to be displayed such as paper, website, dashboard, PowerPoint presentation, etc. Tables Correct Answer Show the actual data elements arranged in rows and columns. Graphics Correct Answer A picture showing the result of data calculations. Graphic displays of information generally work better than tables for faster interpretation of changes, trends, and outliers. Bar Graphs Correct Answer Horizontal or vertical bars proportional to the values of the data. These are used for quick comparison of information. Pie Charts Correct Answer Show proportions of a whole or percentage of a whole. Line Graphs Correct Answer Line connecting data points in a sequential order to show a trend over time. Control Charts Correct Answer Used to observe performance by studying variation over time and monitors if a process is within control or out of control limits using upper and lower control lines calculated using standard deviation or sigma values with the center line representing the overall average.
PIPS Correct Answer Process Improvement Patient Safety PIPS Process Improvement Patient Safety Correct Answer Uses the continuous process of recognition, assessment, and correction. This includes processes such as data collection, collation, analysis, modification, and instruction. American College of Surgeons Correct Answer An educational association of surgeons created in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice. National Trauma Data Bank Correct Answer A voluntary national data repository of information related to trauma patients. The Joint Commission of Accreditation of Healthcare Organizations Correct Answer It is a national organization that provides standards so that hospitals may obtain accreditation for licensure and gain the right to receive payment from Medicaid and Medicare. Created by merging the Hospital Standardization Program with similar programs run by the American College of Physicians, the American Hospital Association, the American Medical Association, and the Canadian Medical Association. Correct Answer Joint Commission of Accreditation of Healthcare Organizations Benchmarking Correct Answer A standard by which something can be measured or judged, comparing like data over time with different organizations, providers, or with a recommended or desired outcome/standard. Filters Correct Answer Tools that can be used to gather data into specifically defined groups, or a single item.
PI and Loop Closure Identification of Issues Correct Answer Issues can be identified through many different avenues such as, communication from staff, patient satisfaction, risk management, chart review processes, trauma meetings/rounds, and direct patient interaction. PI and Loop Closure Review of Issues Correct Answer PI review process whereby the issue is brought to the Trauma Medical Director for evaluation, determination of issue and if there is a need for corrective action. PI and Loop Closure Corrective Action Correct Answer Examples of corrective actions are: new guidelines, protocol change , or pathway development and review, targeted education, enhanced resources/facilities, or communication, process improvement team implementation, counseling, peer review presentation, change in provider privileges or credentials, or external review. PI and Loop Closure Result Evaluation Correct Answer Demonstration that a corrective action has the desired effect determined by on-going or repeat evaluation. Population Demographics Correct Answer The demographics of a population involves analysis of differing grouping of items such as the population age, gender, residence, nationality, etc. Sampling Correct Answer The process of taking a small portion of a larger set of data to study in order to obtain a picture of the probable larger total population. This can save time and money. Frequencies Correct Answer Frequency is the number of occurrences of a repeating similar event that is identified within a defined set of reference.
Types of Calculations Correct Answer Frequencies, Averages, Percentages, Ranges, Ratios, Mean, Median, Mode & Standard Deviation Bones in the Head Correct Answer Ethmoid bone, frontal bone, occipital bone, parietal bones x 2, sphenoid bone, temporal bone x 2. Brain Correct Answer Adult average brain weighs approximately 3 pounds with 500 milliliters of cerebral spinal fluid (CSF). Neck Correct Answer Cervical vertebrae x 7, trachea, esophagus, larynx, pharynx, hyoid bone. Facial Bones Correct Answer 14 stationary bones and a lower jaw bone. Inferior nasal conchae x 2, lacrimal bones x 2, mandible, maxilla x 2, nasal bones and septum, palatine bones x 2, vomer, zygomatic bones x 2, eye, ear. Chest Correct Answer Thoracic spine, ribs 1-12, sternum, heart, bronchi and lungs, thoracic aorta, diaphragm, thoracic esophagus. Abdomen Correct Answer Liver, spleen, colon, rectum, small bowel, pancreas, kidneys, pelvis, uterus, bladder, stomach, gallbladder, retroperitoneum, abdominal aorta and other vessels. Spinal Column Correct Answer Cervical--7, thoracic--12, lumbar-- 5, sacrum—5 (fused), coccyx (tailbone)—2, 3, or 4. Note: C1 = Atlas, C2 = Axis and has a "dens" (spikelike projection) that projects upward on which the atlas 14 rotates.
Vertebrae Parts Correct Answer Vertebral body, spinous process, transverse process, pedicle, foramen, lamina, superior and inferior articular processes. Note: The 5 separate bones of the sacrum begin to fuse during the late teen years and are usually completely fused by 25 or 26 years of age. Coccygeal vertebrae are also fused. Upper Extremities Correct Answer Shoulder girdle, humerus, ulna, radius, hand Shoulder Girdle Correct Answer Scapula and Clavicle Humerus Correct Answer Median and lateral epicondyle (end of humerus), capitulum, trochlea, coronoid fossa, deltoid tuberosity, greater & lesser tubercle, head & neck. Ulna Correct Answer Olecranon process (elbow), coronoid process, ulnar tuberosity, styloid process (projection at the distal end of the ulna). Radius Correct Answer Has a styloid process at the distal end Hand Correct Answer Carpal bones x 8 (scaphoid, locate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate), metacarpals x 5, and phalanges (proximal x 5, middle x 5, distal x 5). Upper Extremity Joints Correct Answer Acromioclavicular, carpal bones (wrist), elbow, sternoclavicular, glenohumeral, metacarpophalangeal, interphalangeal. Lower Extremities Correct Answer Pelvic girdle, pelvis, legs, joints, ankle bones foot
used to identify free air, free fluid, identify solid organ injuries and bone/cervical abnormalities not visible on a plain film. MRI Correct Answer Magnetic resonance imaging (MRI), nuclear magnetic resonance imaging (NMRI), or magnetic resonance tomography (MRT) is used to visualize detailed internal structures. It is especially useful in brain, spinal cord, muscles, and heart, compared with other medical imaging techniques. MRI uses no ionizing radiation. Instead it uses a powerful magnetic field to align the magnetization of some atoms in the body, then uses radio frequency fields to systematically alter the alignment of this magnetization. This causes the nuclei to produce a rotating magnetic field detectable by the scanner—and this information is recorded to construct an image of the scanned area of the body. DPL Correct Answer Diagnostic peritoneal lavage is a test that can be used to diagnose intraperitoneal fluid. PET Scans Correct Answer Positron Emission Tomography, or PET scan, uses a radioactive isotope injection along with a radiology scanning to obtain structural detailed 16 images of the organ as it functions Interventional Radiology Procedure Correct Answer A procedure performed by a radiologist, usually in the radiology department, such as arteriography, angiography, or placement of a filter in a vein as a therapy for DVT's. Types of Laboratory Tests Correct Answer Toxicology, Chemistry, Hematology, Coagulation, Blood Gases, Infection Control, Urine Toxicology Labs Correct Answer Toxicology can involve either a blood or urine sample. Toxicology labs tests look for levels of alcohol (BAC) or drugs that may have been used.
Chemistry Labs Correct Answer Chemistry labs typically include electrolyte levels with other options that may vary at different labs. Some of the tests included in a chemistry are: sodium, potassium chloride, calcium, creatinine (blood), glucose(blood sugar), magnesium, phosphorus, etc. Hematology Labs Correct Answer Involves testing on the blood itself to determine the patient blood volumes in relation to the normal values. It includes a: CBC (complete blood count) and differential. The CBC includes: WBC, hemoglobin, hematocrit, MCV, platelets, etc. The differential includes such things as neutrophils, lymphocytes, basophils, etc. Coagulation Labs Correct Answer Protime, PTT, INR Studies to determine the length of time for blood to clot for the patient compared to what is expected. Blood Gas Labs Correct Answer ABG: Arterial blood gases measure the amount of oxygen, carbon dioxide, sodium bicarbonate, base excess, etc., in the arterial blood. This involves a special blood draw from an artery. Infection Control Labs Correct Answer Infection control testing usually involves a culture of a certain part of the body/fluid. This can be a wound culture, urine culture, blood culture, oral culture. It can also include a culture of a foreign body that was in the body/wound, such as a culture of the tip a central line catheter that has been removed. Urine Testing Correct Answer Urine testing is done to identify urinary tract infections, for drug screens, or pregnancy testing, etc. Not Artificial Airways Correct Answer Oral, nasopharngeal, oropharyngeal & nasal trumpets
6 Main Body Regions of AIS Codes Correct Answer Region 1: Head/Neck, Region 2: Face, Region 3: Chest/Thorax, Region 4: Abdomen - Lumbar Spine, Region 5: Extremities, Shoulder & Pelvic Girdles, Region 6: External Including Burn, hypothermia, Asphyxiation, Drowning, Electrocution and Full Body Explosion AIS Post-Dot Code Correct Answer A numerical value that is assigned according to the severity of the injury: .1 -- Minor .2 - Moderate .3 - Serious .4 - Severe .5 - Critical .6 - Maximum (not fatal, currently untreatable) A .6 is automatically an ISS = 75, code other injuries but don't add to this highest ISS total (.9 -- indicates injury present but no severity value) E Codes Correct Answer Classify the environmental events, circumstances, and conditions as the cause of injury, poisoning or other adverse event related to the external cause of the injury. Injury Severity Scoring Correct Answer The Injury Severity Score (ISS) provides a score for patients with multiple injuries. The ISS score can be correlated with the mortality and morbidity of the injuries. Each injury is assigned an Abbreviated Injury Scale (AIS) score and is allocated to one of six body regions (Head/Neck, Face, Chest, Abdomen, Extremities (including Pelvis), and External. Only 23 the highest AIS score in each body region is used. The 3 most severe injuries in different body regions have their score squared and added together to produce the ISS score. ISS Range Correct Answer 1 - 75
ISS Range Values Correct Answer 9 - 15 - Mild, 16- 25 - Moderate,
25 - Severe AIS of .6 Correct Answer If an injury is assigned an AIS of. (Maximal) the ISS score is automatically assigned to 75. Revised Trauma Score Correct Answer The Revised Trauma Score (RTS) is a physiological scoring system, with high inter- rater reliability and demonstrated accuracy in predicting death. It is scored from the first set of data obtained on the patient, and consists of Glasgow Coma Scale, Systolic Blood Pressure and Respiratory Rate. Glasgow Coma Scale Correct Answer Glasgow Coma Scale (GCS) represents an indication of brain function/impairment (Eye/Verbal/Motor). It is important to understand the descriptors of each numerical value, i.e., "1" for verbal means no verbal response; "1" for motor means decorticate posturing. A patient cannot have a score less than 3: Eye - 1 + Verbal - 1, + Motor - 1 = total of 3. The range is 3 - 15. Normal is 15. Trauma Score Correct Answer Score for multiple traumatic injuries with a range of 1-16. There are 5 components that go into calculating this score: : GCS, Systolic BP, Respiratory Rate, Capillary Refill, and Respiratory Effort. Probability of Survival (TRISS) Correct Answer The TRISS determines the probability of survival from the ISS, RTS and patient's age. 4 TRISS Probability: TRISS > 0.50 = Probability of Survival TRISS < 0.50 = Probability of Death W Scores Correct Answer The w score measures the clinical significance. The w score represents the difference between the
