Trauma Management: Principles and Considerations, Exams of Nursing

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**1. Glasgow Coma Scale:

10. Principle Life saving measures for patients with burn injuries include: -**

• Establishing airway control
• Stopping the burning. process
• Intravenous access

11. Factors that increase the risk for upper AIRWAY OBSTRUCTION in burns include:: - Burns to the head and face

• Burn size and depth
• Burns inside the mouth

12. Partial thickness burn: Red remodeled appearance with associated swelling and blister formation. May have weeping or wet appearance and is painfully hypersensitive even to air current.
13. Signs and symptoms and history that suggest INHALATION INJURY include:: These patients should be intubated. Inhalation injury is an indication for transfer to a burn center.
14. Rule of nines - adult: The palm represents 1% of the body total surface area.

15. Symptoms of carbon monoxide poisoning and respective levels: PaO does not reliably predict carbon monoxide poisoning because a CO partial pres- sure of only 1 mmm Hg results in a hemoglobin CO level of 40% or greater.
16. Carbon monoxide has how many times greater affinity for hemoglobin than oxygen: 240 times. It displaces the oxyhemoglobin desaturated curve to the LEFT.
17. Two criteria required for the diagnosis of smoke inhalation injury: - Expo- sure to a combustible agent

• Signs of exposure to smoke in the lower airway, below the vocal cords, by bronchoscopy.

18. Performing this action will help reduce neck and chest wall edema in patients with burn and inhalation injury.: Elevation of the head and chest by 30 degrees.
19. IV fluid administration formula for burn victims: Indicated in burns involving over 20% of the body surface area. *(2- 4 mL/kg of LR/NS) (weight in kg) (% area of burn); give 1/2 of this volume in first 8 hours. Remainder in over 16 hours. Large caliber, at least 15 gauge intravenous line should be introduced.
20. Pitfalls for IV fluid requirements for burn victims.: These patients require greater fluid requirements: ~immolation injury ~pediatric burn victims ~concomitant blunt or crush injuries.
21. Basic rules regarding IV fluids administration in burn victims: IV fluid Rate should not be based on the time of actual injury. In very small children, less than 10 kilograms, it may be necessary to add glucose to the IV fluids to avoid hypoglycemia. Any adjustment in IV fluid rate should be based on urine output. In an adult, urine output above 0.5 ml/ kilogram should result in reduction of IV fluid rate.
22. Initial treatment of frostbite/ cold injuries: Place injured part in circulating water and a constant 40 degrees centigrade until pink color and perfusion return,

usually within 20 to 30 minutes. Antibiotics are not indicated empirically unless infection develops later.

23. Persisted ACIDEMIA in burn victims may reflect...: Cyanide poisoning. (Cyanide is a naturally occurring toxin that may be inhaled in a confined space fire). 24. Hypothermia Severe hypothermia: Core temperature of 36 degrees centigrade Temperature below 32 degrees centigrade
24. Definition of frostbite.: Freezing of tissue with intracellular ice crystal forma- tion, microvascular occlusion, subsequent tissue anoxia.
25. First degree frostbite: Hyperemia and edema without skin necrosis
26. Second-degree frostbite: Large clear vesicle formation accompanies hyper- emia and edema with partial thickness skin necrosis
27. 3rd degree frostbite: Full thickness and subcutaneous necrosis occurs, com- monly with hemorrhage and vesicle formation.
28. Although a compartment pressure > systolic blood pressure is required to lose a pulse distal to in extremity burn, a pressure of what was in the compartment may lead to muscle necrosis: 30 mm Hg. If a pressure of greater than 30 mm Hg in a burned extremity is present, eschatotomy is indicated.
29. Difference between fasciotomy and eschatotomy: Compartment syndrome is also present with circumferential chest and abdominal burns, which lead to increased peak inspiratory pressures.
30. Eschatotomy in circumferential chest and abdominal burns.: We are gen- erally not needed before the first 6 hours after a burn.
31. Gastric tube placement in burn victims.: Place of burn involves more than 20% of total BSA. 33. Alkali burns to the eyes require how many hours of continuous irrigation- : 8 hours.
32. Electrical burns.: Can cause thrombosis and entry to nerves, and digits are especially prone to injury. Patients with electrical injuries frequently require fasciotomies because of the degree of deep tissue injury and should be transferred to a burn center.

35. Immediate ELECTRICAL burn treatment measures.: Attention to airway and breathing, IV line placement, ECG monitoring, and placement of an indwelling Foley catheter. Rhabdomyolysis and subsequent metabolic acidosis are common complications. 36. Criteria for transfer of a burn victim to a burn center.:
36. Estimating WEIGHT in kilograms for a child: (2× AGE) + 10
37. Infant blood volume estimate: 80 ml/kg
38. Child blood volume estimate: 70 ml/kg. 40. IO needle size: Infant Child: 18 gauge 15 gauge
39. Packed red blood cell volume transfusion for a child: 10 mL/ kilogram 42. Pediatric verbal score:
40. Impacted fractures: Demonstrate no false motion of the humorous when the shoulder is rotated gently from a flexed elbow.
41. Nonimpacted Fractures: Generally experience pain on movement of the arm. Generally require hospitalization for orthopedic consultation and often operation
42. Fundal height in pregnancy: The amniotic fluid may cause amniotic fluid EMBOLISM and DIC following trauma if the fluid gains access to maternal intravas- cular space.
43. Physiologic changes in pregnancy: 1.Physiologic changes in pregnancysmall increase in rent till volume resulting in a decrease in hematocrit.
44. Elevation and WBC as high as 25,000.
45. Mild elevation in clotting factors. Bleeding and clotting times are unchanged, however.
46. Arterial pH 7.40-7.
47. PaCO2: 25 - 30mmHg
48. Bicarbonate space 17 - 22

(Compensatory metabolic Acidosis).

47. A resting PaCO2 of 35 to 40 mm in the setting of pregnancy: may represent impending respiratory failure. Normal PaCO2 for a pregnant woman is between 25 to 30 mmHg
48. Kleinhauer-Betke test: Maternal blood smear test which allows detection of fetal RBCs in the maternal circulation, indicates fetomaternal hemorrhage. Indica- tion for Rh immunoglobulin therapy. 49. Drugs to avoid in hypovolemia, head injured and intoxicated patients.: - Benzodiazepines, fentanyl propofol, ketamine 50. Initial Assessment components of seriously injured patient:
49. Primary survey: 1. Airway maintenance with cervical spine protection
50. Breathing and ventilation
51. Circulation & hemorrhage control
52. Disability: neurological status
53. Environment/Exposure: completely undress the patient but prevent hypothermia 52. Assume a CERVICAL SPINE injury in patients with BLUNT multisystem trauma, especially those with an altered level of consciousness's or a blunt injury about the clavicles.:
54. IV fluid warming temperature in shock: 37 to 40°C
55. Associated with aberrant conduction, premature beats, bradycardia.: hy- poxemia, hypothermia hypokalemia.
56. AMPLE history.: Allergies Medications Past illness/Pregnancy, Last meal Environment/events related to injury

56. Frontal impact automobile collision: Bent steering wheel, Knee imprint dashboard Bulls eye fracture windshield: Cervical spine fracture Anterior flail chest Myocardial contusion Pneumothorax Traumatic aortic disruption Fractured spleen or liver Posterior fracture/dislocation of hip and/or knee

57. Side impact automobile collision: Contralateral next sprain Cervical spine fracture Lateral flail chest Pneumothorax Traumatic aortic disruption Diaphragmatic rupture Fractured spleen/liver and/or Fracture of kidney, pelvis or acetabulum
58. Rear impact automobile collision: Cervical spine injury Soft tissue neck injury
59. Ejection from automobile: Ejection from the vehicle precludes meaningful prediction of injury patterns. Patient at greater risk from virtually all injury mecha- nisms.
60. Motor vehicle impact with pedestrian.: Head injury Traumatic aortic disruption 61. Blunt force to the neck or Traction injury from a shoulder harness restraint: Can cause carotid disruption dissection or thrombosis. Symptoms may develop late
61. Auscultation of chest: Auscultate high on the anterior chest for PNEUMOTH- ORAX and at the posterior basis for detection of HEMOTHORAX
62. Distended neck veins: Seen in Cardiac Tampanode or Tension Pneumotho- rax.

64. Abdominal injury Patients with unexplained hypotension, neurological injury, impaired sensorium secondary to alcohol and/or other drugs, and equivocal or normal findings: Should be considered candidates for DPL, or FAST. If hemodynamically stable, CT scan of the abdomen 65. Any increase in intracranial pressure can REDUCE cerebral perfusion pressure, and lead to secondary brain injury.:
65. Complete cervical cord transection which SPARES the phrenic nerve, C3 and C4, results in...: Results in quadriplegia and ABDOMINAL breathing but paralysis of the intercostal muscles. Assisted ventilation may be required.
66. Size of plastic cannula for cricothyroidotomy for jet insufflation: 12 to 14 gauge; 8.5 cm length
67. LMA sizes: 3 for small female 4 for large female 5 for large male RANGES FROM 1 FOR NEONATE 5 FOR ADULTS Consider Use when you cannot extend the neck (c-collar in place)
68. Laryngeal tube airway: Use when you cannot extend the c-spine (c-collar)
69. CO2 capnography: Yellow indicates adequate CO2 levels, violet: too low
70. Definition of Shock: Abnormality of the circulatory system resulting in inade- quate organ perfusion and tissue oxygenation. Hemorrhage is the most common cause of shock in the injured/trauma patient.
71. Earliest signs of shock: Tachycardia and cutaneous vasoconstriction.
72. Tachycardia an infant: Greater than 160 beats per minute
73. Tachycardia in a preschool child: Greater than 140 beats per minute
74. Tachycardia in a school age to puberty: Greater than 120 beats per minute
75. Tachycardia in an adult: Greater than 100 beats per minute.
76. Significance of narrowed pulse pressure: Significant blood loss and involve- ment of compensatory mechanisms.

78. What percent of body weight in kilograms represents the circulating blood volume of an adult (in liters).: 7%. Example, a 70 kilogram man's total circulating volume is 70 × 7% which equals 4900 ml. **79. Class hemorrhage and hemodynamic effects.:
79. Sepsis Hypovolemic shock:** Both are characterized by tachycardia, narrow pulse pres- sure, cutaneous vasoconstriction, decreased systolic blood pressure, impaired urinary output.
80. Normal blood volume percentage: 7% of body weight. e.g. a 70 kilogram male has a circulating blood volume of 4.9 liters.
81. Normal percentage blood volume for a child: 8 to 9% of body weight.
82. Blood loss associated with a fractured tibia or humerus: 750 milliliters of blood
83. Blood loss associated with a femur fracture: Up to 1500 milliliters of blood
84. Blood loss associated with pelvic fractures: 2 liters or more.
85. Initial warmed IV fluid bolus for shock.: 1 - 2 liters normal saline or LR for adults, and 20 ml/kilogram for pediatric patients.
86. Normal urinary output for adult: 0.5 milliliters per kilogram per hour
87. Normal urinary output for children greater than 1 year of age: 1 milliliter per kilogram per hour
88. Normal urine output for child less than 1 year of age: 2 milliliters per kilogram per hour 90. Responses to initial fluid resuscitation in shock:
89. What needs to happen when there is failure to respond to crystalloid and blood administration in the emergency room in the setting of a motor vehicle accident or trauma resulting in shock.: Depends, but some intervention such as operation or angioembolization to control exsanguinate hemorrhage 92. Three other causes of failure to respond to IV fluids that are not HEMOR- RHAGIC in origin.: =Tension pneumothorax, =Bunt cardiac injury, =Pericardial tamponade
90. Type-specific blood: Indicated in the setting of TRANSIENT responders.

94. Blood to be transfused for minimal or no response trauma patients after crystalloid fluid resuscitation.: Typed only packed red blood cells. Rh neg (O negative) preferred for females of childbearing age.
95. Definition of massive transfusion of pack RBC:: Greater than 10 units attack with blood cells in the first 24 hours of admission.
96. Preferred temperature of packed red blood cells or peritoneal or thoracic cavity crystalloid solutions for hypothermia: 39 degrees centigrade
97. Most common cause of poor response to IV fluids in the setting of shock.: Undiagnosed source of bleeding.
98. Central venous pressure: Reflects right heart function. May not represent left heart function in patients with primary myocardial dysfunc- tion or abnormal pulmonary circulation.
99. Conditions to consider if a patient does not respond to fluid therapy: Un- recognized fluid loss, Ventilatory problems Tension pneumothorax Cardiac tamponade Hypoadrenalism Neurogenic shock
100. Massive hemothorax findings on physical exam: Tracheal deviation FLAT neck veins (due to heavy blood loss) Percussion dullness Absent breath sounds
101. Distended neck veins are seen in what two conditions: Cardiac tampon- ade Tension pneumothorax 102. Conditions to consider in transient responders in the setting of shock.- : 1. Hemorrhagic: Bleeding within the abdomen, pelvis, retroperitoneum, extremity fracture, or obvious external bleeding.
102. Nonhemorrhagic: Tension pneumothorax or cardiac tamponade
103. NONresponder to IV fluids. Diagnostic consideration: Blunt cardiac injury.
104. Intraosseous needle size.: 18 gauge spinal needle with stylet.

105. Physical signs suggesting a pelvic fracture on physical exam: Scrotal hematoma, Blood at the urethral meatus Perineal hematoma, Leg length difference Mobile or high-riding prostate gland, Gross or occult blood in the stool. **106. Accurate lines of the sacrum:
106. To treat an open book fracture of the pelvis:**
107. Life-threatening thoracic injuries that need to be addressed in the pri- mary survey: Airway obstruction Tension pneumothorax Open pneumothorax Flail chest and pulmonary contusion Massive hemothorax Cardiac tamponade
108. Most common cause of tension pneumothorax: Mechanical ventilation with positive pressure ventilation in patients with visceral pleural injury **110. Flail chest:
109. Flail chest radiograph:**
110. Initial treatment of flail chest: Adequate ventilation, humidified oxygen, fluid resuscitation. Later, analgesia. Short Term intubation and ventilation may be necessary. Local nerve block pre- ferred over IV narcotics.
111. MASSIVE hemothorax definition: > 1500 milliliters of blood or one third or more of the patient's total blood volume in the chest cavity. Neck veins can be distended (if concomitant tension pneumothorax) or flat (if blood loss results in hypovolemia).
112. Treatment of MASSIVE hemothorax: Restoration of blood volume (crystal- loid then type specific blood) and decompression of the chest cavity. 36 or 40 French chest tube required 115. MASSIVE Hemothorax. Indications for thoracotomy:: If Greater than 1500 ml of fluid is immediately evacuated.

Less than 1500 milliliters of fluid evacuated but continued blood loss of 200 milliliters per hour for 2 to 4 hours

116. Beck's triad in cardiac tamponade: Venous pressure elevation, decline in arterial pressure, muffled heart tones.
117. Kussmal's sign: Paradoxical RISE in central venous pressure with inspira- tion. Seen in cardiac tamponade.
118. Resuscitative thoracotomy: Patients with PENETRATING injuries to the chest, pulseless, but with myocardial electrical activity may be candidates. Patients with BLUNT injuries to the chest, arrive pulseless but with myocardial electrical activity are NOT candidates.
119. SIMPLE hemothorax: Less than 1500 milliliters of blood. Most common cause is laceration of an intercostal vessel or internal mammary artery or lung laceration due to penetrating or blunt trauma.
120. Typical presentation of tracheobronchial tree injury: Hemoptysis, subcu- taneous emphysema, tension pneumothorax; incomplete expansion of the lung after placement of a chest tube also suggests tracheobronchial tree injury. Confirmed by bronchoscopy.
121. Treatment of tracheobronchial tree injury: Surgical.
122. Most common findings in blunt cardiac injury: Multiple PVCs, unexplained sinus tachycardia, atrial fibrillation, bundle branch block, ST segment changes.
123. Ligamentum arteriosum: Site of incomplete laceration in traumatic aortic disruption
124. Radiologic signs on chest x-ray in traumatic aortic rupture that indicate the likelihood of major vascular injury: Widened mediastinum Obliteration of aortic knob. Deviation of trachea to the RIGHT Depression of left main stem bronchus Obliteration of space between the pulmonary artery and the aorta. Deviation of esophagus to the right Widened paratracheal stripe Presence of a plural or apical cap. Left hemothorax Fractures of first or second rib or scapula

125. Traumatic diaphragmatic injury on the left. What action should you pursue: Insert a nasal gastric tube. If it appears in chest wall cavity on chest film the need for special contrast studies is eliminated.
126. Suspect blunt esophageal rupture when you see the following: Left pneumothorax or hemothorax without a rib fracture History of a severe blow to the LOWER sternum or epigastrium. Pain or shock out of proportion to the apparent injury. Particulate matter in the chest tube after blood begins to clear. Presence of mediastinal air.
127. Treatment of blunt esophageal rupture: Wide drainage of the pleural space and mediastinum, with direct repair of the injury through thoracotomy.
128. Causes of subcutaneous emphysema: Blast injury. Airway injury. Lung injury. The emphysema itself is generally not treated but underlying causes need to be addressed and treated.
129. Fractures involving ribs 1 through 3, sternum, scapula and clavicle can be associated with: Great vessel trauma or airway obstruction. Pneumothorax. Pulmonary contusion.
130. Middle rib fracture, 4 through 9, can be associated with: Pneumothorax hemothorax pulmonary contusion.
131. Fracture involving ribs 10 through 12 can be associated with: He- patosplenic trauma
132. Mediastinal widening: Great vessel injury Sternal fracture Thoracic spine injury.
133. Mediastinal air: Esophageal disruption Tracheal injury Pneumoperitoneum.
134. Air fluid level in the chest: Hemopneumothorax or diaphragmatic rupture.
135. Disrupted diaphragm: Indicates adominal visceral injury

136. X-ray findings in diaphragmatic ruptured: Elevation, irregularity or obliter- ation of diaphragm. Mass like density above the diaphragm. Air or contrast containing stomach or bowel above diaphragm. Pleural effusion.
137. Fracture of the scapula: Great vessel injury, airway injury, pulmonary con- tusion.
138. Sternal fractures are associated with: Myocardial contusion Great vessel injury
139. Pericardiocentesis needle, size: 15 - 18 gauge, 15 centimeters length.
140. Current of energy pattern that occurs in pericardiocentesis: Extreme ST wave changes Widened and enlarged QRS complex.
141. Organs contained within the retroperitoneum: Duodenum, pancreas, kid- neys and ureters; posterior aspect of the ascending and descending colon, part of the pelvic cavity.
142. Relative contraindications to DPL: Coagulopathy, obesity, previous abdom- inal operations, liver cirrhosis.
143. DPL: Positive test:

• greater than 100, RBCs/ cubic mm
• 500 WBCs
• Gram stain positive for bacteria.

144. Evaluation of penetrating (such as knife wound) trauma to the abdomen and the thoracoabdominal region.: Serial physical exam or DPL. Generally manage more selectively but approximately 30% associated with intraperitoneal injury.
145. Management of gunshot wounds to the abdomen: Most are managed by laparotomy.
146. Indications for laparoscopy in PENETRATING abdominal wound: - Any hemodynamically abnormal patient

• Gunshot wound with transperitoneal trajectory

• signs of peritoneal irritation
• signs of fascial penetration.

147. Management options for flank and back stab wounds and gunshot wounds.: Initially, serial physical exams if patient is asymptomatic except for local pain If patient becomes symptomatic: laparotomy. Triple contest CT scan. More fully evaluates the retroperitoneum. Earlier diagnosis in relatively asymptomatic patients. DPL can also be used as an early screening test. If it is positive, urgent laparotomy. 148. Indications for laparotomy in abdominal and pelvic trauma.:
148. Duodenal injury or trauma: - Suggested by free air on flat plate or upright of the abdomen

• Bloody gastric aspirate. Diagnosed using upper gastrointestinal series or double contrast CT scan.

150. Direct blows to the back or flank resulting in hematomas or ecchymo- sis.: Gross hematuria and microscopic hematuria with an episode of indicate they are at risk for NONRENAL abdominal injuries. Order a CT scan with IV contrast.
151. Anterior urethral injuries or distuptions: Usually present in patient with anterior pelvic fractures from a straddle injury. Usually an isolated finding only.
152. Posterior urethral injury: Usually associated with multisystem injuries and pelvic fractures. 153. Blunt injury to the intestines is associated with linear ecchymosis on the abdominal wall or a chance fracture:
153. Classic sign of uncal herniation: Ipsilateral dilated pupil with contralateral hemiparesis.
154. What is the normal intracranial pressure in the resting state.: Normal 5 to 15 mm Hg
155. Physical signs of a basilar skull fracture: Raccoons eyes Otorrhea Battle's sign CSF leakage from nose

157. Definition of MINOR traumatic brain injury GCS in 13 and 15: History of disorientation, and amnesia, or transient loss of consciousness in a patient who is conscious and talking. 158. CT scan indicated in the setting of minor traumatic brain injury (GCS 13 - 15) when the following are seen:: *GCS of less than 15 two hours after injury *Suspected open or depressed skull fracture *Any signs of basilar skull fracture *Vomiting more than 2 episodes *Age more than 65 years *Loss of consciousness more than five minutes *More than 30 minutes amnesia before impact *Dangerous mechanism of trauma

159. Management of moderate brain injury GCS 9-12: CT scan of the head in all cases Admission to intensive care unit for frequent neurologic checks repeat CT scan. (10 to 20% of these patients deteriorate and lapse into coma)
160. Management of patients with severe brain injury GCS 3-8: *CT Scan and admit to neurosurgical ICU *Therapeutic agents if needed including mannitol, hypertonic saline, moderate hyperventilation: PaO2 of ~35mmHg. *Repeat CT scanning as needed. *Intubation.
161. A midline shift of 5 millimeters or greater on CT scan of the brain: Indi- cate the need for surgery to evacuate the blood clot or contusion causing the shift
162. Indication for the use of Mannitol (1gm/kg): Acute neurologic deterioration such as development of a dilated pupil, loss of consciousness, or hemiparesis in a severe head trauma patient. Patient must be euvolemic.
163. Three main factors linked to a high incidence of late epilepsy in post traumatic patients: Seizures occurring within the first week Intracranial hematoma Depressed skull fracture.
164. Diagnosis of brain death criteria: *GCS score of 3 *Nonreactive pupils

*Absent brainstem reflexes (Doll's eyes, corneal, gag reflexes) *No spontaneous ventilatory effort on formal apnea testing

165. NEUROGENIC shock is rare in spinal cord injuries below this level.: T6. 166. Injury to this cervical spine level results in paralysis of the diaphragm- : C3 thru C5 segments.
166. Injury to the lower cervical upper thoracic spine results in paralysis of what muscles?: The intercostal muscles
167. Definition of neurological level when discussing spinal cord injuries.: - The segment of spinal cord that has normal sensory and motor function on both sides of the body.
168. Central cord syndrome: commonly in hyperextension injuries in elderly with cervical spondylosis. Weakness in UE > LE, possibly loss of local pain/tempera- ture. The motor fibers of the cervical segments are topographically arranged toward the center of the cord. Arms and hands are there for more severely affected.
169. Anterior cord syndrome: Paraplegia and dissociated sensory loss with a loss of pain and temperature sensation. Dorsal column function is preserved. Poorest prognosis of the incomplete injuries.
170. Brown-Sèquard syndrome: ipsilateral motor paralysis and loss of touch/vi- bration and contralateral loss of pain and temperature. Usually a result of a penetrating trauma.
171. Atlanto-occipital dislocation: Not Common - < 1% all acute C/S injuries. Caused by severe traumatic flexion. Most patients die from traumatic brain injury.
172. Atlas fracture: 40% of Atlas fractures are associated with fractures of the AXIS Occurs by strong vertical forces (e.g. Blow to head top or diving in shallow pool) fracturing the lateral masses and rupturing the transverse ligament. A fracture of the ring is a Jefferson fracture. Usually not associated with spinal cord injuries but are unstable.
173. C1 rotary subluxation: Patient population: children & patients with rheuma- toid arthritis. Patient presents with persistent rotation of the head.

175. Axis Fractures: fractures of odontoid, forceful flexion or extensio
176. Hangman's Fracture: fracture of both pedicles of C2 due to extreme hyper- extension (incredibly unstable as dens pushes against brainstem). Involves the posterior elements of c2. The pars interarticularis
177. C2 fractures.: Most are odontoid or hangman fractures. 20% of C2 fractures do not involve other one of these, however. C2 because of its unique anatomy is very susceptible to fractures.
178. The most common site of cervical fractures: C
179. Burst fracture: Due to direct axial load; retropulsion of fragments can injure the spinal cord; unstable.
180. Thoracolumbar junction fractures T11 through L1.: Most often result from a combination of severe hyperflexion and rotation, and, consequently are usually unstable.
181. Symptoms associated with lumbar fractures.: Bladder and bowel dysfunc- tion, decreased sensation and strength in the lower extremities.
182. Indication for flexion extension cervical x-rays.: When 3 view cervical spine imaging normal =To Detect occult instability. =Determine the stability of a known fracture such as a laminar or compression fracture
183. Approximately 10% of patients with a cervical spine fracture have a sec- ond, noncontiguous vertebral column fracture.: Need to complete a complete radiographic screening of the entire spine in these cases.
184. If on plain films of the cervical spine, no abnormality is identified, but the patient has evidence of a neurological deficit, order the following:: MRI scan to identify any spinal cord contusions,disruptions and paraspinal ligamentous and soft tissue injury.
185. AP films of the spine: Detect distance between the pedicles Unstable frac- tures commonly cause widening of the inter pedicular distance. 186. Lateral x-rays of the spine:
186. The Delta P in suspected compartment syndrome: Equals the diastolic pressure minus the compartment pressure. If 30 or less the suggest patient has a compartment syndrome. compartment syndrome, however, is a clinical diagnosis.

188. Clavicle fracture Scapular fracture Fracture / dislocation shoulder blade... Can be associated with....... Major thoracic injury, especially pulmonary contusion and rib fractures.

189. Displaced thoracic spine fracture can be associated with: Thoracic aortic rupture
190. Spine fractures can be associated with: Intraabdominal injury
191. Femur fracture can be associated with: Femoral neck fractures posterior hip dislocation
192. Fracture / dislocation of the elbow can be associated with: Brachial artery injury Median, mode, and radial nerve injury.
193. Posterior knee dislocation can be associated with: Femoral fracture Posterior hip dislocation
194. Need this location or displaced tibial plateau fracture can be associated with: Popliteal artery and nerve injuries.
195. Calcaneal fracture can be associated with: Spine injury or fracture, fracture dislocation of the hind foot, to be a plateau fracture.
196. Open fractures can be associated with: 70% incidence of associated non skeletal injury.
197. Any deformed or dislocated joints should be splinted and x-rayed before testing for stability.: Assess the neurovascular status of any extremity before applying a splint
198. Do not force realign a deformed extremity with a normal pulse.: Alterna- tively, place extremity in a splint if normally aligned. If malaligned, the extremity needs to be realigned and then splinted.
199. Characteristics of pediatric trauma: Motor vehicle associated injuries are the most common cause of death in children of all ages. Most serious pediatric trauma is blunt trauma that a bowl of the brain. As a result apnea, hypoventilation and hypoxia after five times more often. Multisystem injury is the rule and should be presumed. Internal organ damage is often noted without overlying bony fractures.

200. Use of atropine for drug assisted intubation.: Should be reserved for infants only.
201. Crycothyroidomy in infants and small children: Is rarely indicated
202. Up to 30% diminution in circulating blood volume may be required to manifest a decrease in the child systolic blood pressure.: Hypotension in a child represents a state of decompensated shock and indicates severe blood loss of greater than 45% of circulating blood volume. 203. Vital functions for pediatric population:
203. Characteristics of chest trauma in children.: Mediastinal structures are mobile.; pneumomrdiastinum is rare abdominal tension pneumothorax is most common life threatening injury. Chest tube placement is required but thoracotomy is generally not needed in children. Rib fractures are rare. The present, indicates significant energy impact.
204. Typical characteristics of paediatric abdominal trauma.: Most pediatric internal injuries occurred as a result of blunt trauma. The presence of shoulder or lap belt marks increases likelihood of intraabdominal injuries. FAST should not be relied upon as the sole diagnostic tool in pediatric abdominal trauma. If a small amount of interim nominal through it is found and the child is hemodynamically normal a CT scan should be obtained. Most pediatric patients have self in a minute intra-abdominal injuries and no hemodynamic abnormalities.
205. Diagnostic peritoneal lavage volume in pediatric patients: 10 milliliters per kilogram. A DPL or FAST exam that is positive for blood alone does not mandate laparotomy in a child who was hemodynamically normal, or who stabilizes rapidly with fluid resuscitation. Laparotomy is indicated if child's hemodynamic condition cannot be normalized
206. Characteristics of pediatric head trauma.: Subarachnoid space is relative- ly small and offers less protection to the brain because there is less buoyancy. parenchymal damaged structurally is more common.

Outcome in children suffering severe brain injury less than three years of age is worse than a similar injury in an older adult. Hypovolemia is a single worse risk factor for secondary brain injury in children. An infant who is not in a coma but who has bulging fontanelle or suture diastasis should be treated as having a more severe injury. Impact seizures, that occurs shortly after a brain injury, are more common in children and are usually self-limited. Increased intracranial pressure is more frequent in children than adults after head trauma.

208. Spinal cord injury characteristics in the pediatric trauma group.: Force is applied to the upper neck are relatively greater than in the adult. This accounts for more injuries at the level of the occiput to C Pseudo subluxation frequently complicates ingredient graphic evaluation and the child cervical spine. 40% of children younger than 7 years of age show anterior displacement of C2 on C3. Pseudo subluxation can mimic a true cervical spine injury in children. Ligamentous injuries are more common in children.
209. SCIWORA: Spinal cord injury without radiographic have the mountains on more common that in adults. A normal cervical spine series may be found in up to two-thirds of children who have suffered spinal cord injuries. Ligamentous injuries are more common in children than adults.
210. Musculoskeletal trauma.: Blood loss associated with long bone and pelvic fractures is proportionately last in children than adults. Hemodynamic instability in the presence of an isolated femur fracture should prompt evaluation for other sources of blood loss which usually will be found within the abdomen.
211. Characteristics of geriatric patients in trauma.: Most common mechanism of injury in older adults are falls. The account for 40% of death in this age group.

Consider early intubation in geriatric trauma patients with underlying chronic lung disease. Metabolic acidosis is a predictor of mortality.

212. Head trauma in the elderly.: Elderly with brain injuries have fewer se- vere cerebral contusions but higher incidence of subdural and intraparenchymal hematomas.
213. Spinal trauma in the elderly.: Because of osteoarthritis increase risk for spinal canal stenosis and posterior ligament I purchase food increases the risk for central and anterior cord syndrome.
214. Hypothermia not attributable to shock or exposure should alert the physician to the possibility of what diseases?: Substance, endocrine diseases such as hypothyroidism original insufficiency, or pharmacologic causes. **215. Most common locations of fractures in the elderly:
215. Normal vitals for peds:**