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CHAPTER 1 - Initial assessment and Management What does the initial assessment include? | 1. Preparation 2. Triage 3. Primary survey - ABCDEs** 4. Resuscitation 5. Adjuncts to primary survey + resuscitation 6. Consider need for patient transfer 7. Secondary survey - head-to-toe evaluation and patient history** 8. Adjuncts to secondary survey 9. Continued post-resuscitation monitoring and re-evaluation 10. Definitive care **repeat FREQUENTLY to: - identify deterioration - institute Rx if adverse changes are identified |
CHAPTER 1 - Initial assessment and Management How do I prepare for a smooth transition from the prehospital to the hospital environment? | 1. Prehospital phase - Co-ordination - Notify the receiving hospital before arrival - so that necessary personnel + resources are present in ED - Emphasis on: 1. airway maintenance 2. control of external bleeding + shock 3. pt immobilisation 4. immediate transport to closest facility, pref trauma centre 5. MINIMISE scene time 6. obtain and report info needed for hospital triage - time of injury, events related to injury, pt hx 7. Mechanism of injury- suggests degree and specific injuries 2. Hospital phase - resuscitation area - proper airway equipment - laryngoscope, tubes - warmed iv crystalloid solutions - monitoring equipment - method to summon additional medical assistance - personnel wear standard precautions - FACE MASK, EYE PROTECTION, WATER-IMPERVIOUS APRON, LEGGINGS, GLOVES - these are the MINIMUM precautions |
CHAPTER 1 - Initial assessment and Management What is triage? | TRIAGE involves the sorting of patients based on their need for treatment and the resources available to provide that treatment. Treatment is based on ABC priorities - Airway with cervical spine protection - Breathing - Circulation with haemorrhage control |
CHAPTER 1 - Initial assessment and Management What are the 2 types of triage situations? | 1. Multiple casualty incidents - the number of patients and the severity of their injuries do NOT exceed the ability of the facility to render care. - Patients with life-threatening problems and those sustaining multiple systen injuries are treated first 2. Mass casualties - Number of patients and the severity of their injuries EXCEED the capability of the facility and staff - Patients with the greatest chance of survival and requiring the least expenditure of time/equipment/personnel are treated first |
CHAPTER 1 - Initial assessment and Management What is a quick, simple way to assess the patient in 10 seconds? (THINK PRIMARY SURVEY) | PRIMARY SURVEY 1. AIRWAY maintenance with cervical spine protection 2. BREATHING and ventilation 3. CIRCULATION and haemorrhage control 4. DISABILITY- neurologic status 5. EXPOSURE/ ENVIRONMENTAL control - completely undress the patients but prevent hypothermia |
Is the risk of death from ANY given injury greater for elderly males or females? | |
CHAPTER 1 - Initial assessment and Management: How do you assess the airway? | Airway maintenance with cervical spine protection. 1. Any signs of airway obstruction? (stridor, foreign body , facial/ mandibular/ tracheal/ laryngeal fractures, severe head injuries with GCS</=8. Use chin-lift or jaw-thrust. Do not hyper-extend, hyper-flex or rotate the neck. If immobilisation devices must be removed temporarily, one member of the trauma team should MANUALLY STABILISE the patients head and neck using INLINE IMMOBILISATION TECHNIQUES |
CHAPTER 1 - Initial assessment and Management: How do you check for adequate breathing and ventilation? | 1. Expose the chest - look for chest wall excursion and auscultate. 2. Inspect and palpate the chest to detect injuries to the chest wall. (Percussion is unreliable during a noisy resuscitation). DURING THE PRIMARY SURVEY LOOK FOR: tension pneumothorax, flail chest with pulmonary contusion massive haemothorax and open pneumothorax. (secondary survey may identify simple pneumothorax/haemothorax, rib #, pulmonary contusion) |
CHAPTER 1 - Initial assessment and Management: Circulation with haemorrhage control. What do you look for? | BLOOD VOLUME AND CARDIAC OUTPUT - hypotension following injury is due to hypovolemia until proven otherwise. Look for: 1. Level of consciousness- decreased due to reduced cerebral perfusion. 2. Skin colour- pink vs ashen grey/white. 3. Pulse- quality/ rate/ regularity ?rapid/thready ?irregular 4. External haemorrhage- manual pressure, splinting. (Occult blood loss often via chest/abdo/retroperitoneum/pelvis/long bones) |
CHAPTER 1 - Initial assessment and Management: DISABILITY- What is the rapid neurologic evaluation? | RAPID NEUROLOGIC EVALUATION - 1. level of consciousness- GCS esp best motor response, ?decreased cerebral perfusion ?brain injury ?low BGL ?EtOH/narcotics 2. pupillary size and reaction, 3. lateralising signs, 4. spinal cord injury level NB. talk and die - think of acute epidural haematoma |
How does hypovolemia affect the elderly/children/athletes? | 1. Elderly - limited ability to increase HR. BP has little correlation with CO 2. Children (abundant reserve)- often have few signs. Deterioration = precipitous/catastrophic 3. Athletes (good compensation)- may have bradycardia, not usual tachycardia |
CHAPTER 1 - Initial assessment and Management: What are the steps of resuscitation | RESUSCITATION: 1. AIRWAY +protect c-spine - protect and secure, jaw-thrust, chin-lift ?definitive airway 2. BREATHING/ VENTILATION/ OXYGENATION- supplemental O2. ?tension ptx 3. CIRCULATION and BLEEDING CONTROL- 2 x large IVC, pressure, definitive control of haemorrhage (operation, angioembolisation, pelvic stabilisation), warm IVF resuscitation and blood products |
CHAPTER 1 - Initial assessment and Management: What are the adjuncts to the primary survey? | 1. ECG monitoring ?dysrhythmia ?tachy ?PEA?brady 2. IDC - monitor UO, volume status 3. NGT- reduce stomach distension and reduce risk of aspiration 4. Monitor RR, pulse oximetry, BP, temp 5. ABG 6. XRay- CXR, pelvis XRay |
1. blood at urethral meatus 2. perineal ecchymosis 3. blood in scrotum 4. high-riding or non-palpable prostate 5. pelvic fracture IDC should not be inserted before rectum/genitalia have been examined. | |
A- allergies M- Medications currently used P- past illness/pregnancy L- last meal E- events/environment related to the injury - mechanism ?blunt vs penetrating | |
1. seat-belt use 2. steering wheel deformation 3. direction of impact 4. damage to the car - ?major deformation ?intrusion into passenger compartment 5. ejection from the vehicle | |
What is the secondary survey and when does it start? (once primary survey is completed and resuscitation has begun) | 1. History - AMPLE, mechanism of injury, hazardous environment? 2. Physical examination head-to-toe - scalp and head- laceration/contusion/ # - eyes- VA, pupil size, haemorrhage, penetrating injury, contact lenses, ocular entrapment - maxillofacial structures- midface/cribriform plate # - c-spine and neck- inspect ,palpate, ausculate - chest, abdo - perineum/rectum and vagina - MSK- ?pelvic # ( LOG ROLL TO CHECK BACK/SPINE) - Neuro- LOC, pupils, sensory, motor |
1. XRAY- spine/extremities 2. CT-head/chest/abdo/spine 3. TOE 4. bronchoscopy 5. endoscopy |
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This app provides Trauma and Life Support questions with explanations to help you identify and correct weaknesses in your knowledge base.
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Explanations are linked to additional online references and can be accessed on the explanation page.
Statistics are generated and include a list of keyword topics missed. These keyword topics will enable you to determine what areas need further study.
Repeat all questions as many times as you wish.
The app offers 10 multiple-choice questions with additional questions available as an in app purchase.
Explanations are linked to additional online references and can be accessed on the explanation page.
Statistics are generated and include a list of keyword topics missed. These keyword topics will enable you to determine what areas need further study.
Repeat all questions as many times as you wish.
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Good questions but poor interface
It would be very helpful if your questions have answer choices listed under A, B, C, etc. instead of the choices by themselves, much like the standardized exams we get. This relates to another BIG problem I have with the interface: it doesn’t give me a “go back” option after I answer a question to reread the question to see how I might have missed something. And, you don’t list the answer clearly. Again, good questions but poor interface really impede the learning
Poor maneuverability
Can’t move back and forth between question and answer. This limits learning the material in an effective way.
Also some questions have nothing to do with ATLS (though they do make good Emergency Medicine questions).
Also some questions have nothing to do with ATLS (though they do make good Emergency Medicine questions).
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