1. Patients with a GCS of less than 8 usually require intubation.
2. The "A" in ABCD stands for Airway maintenance with CERVICAL SPINE
PROTECTION.
3. You should assume that any patient in a multisystem trauma with an
altered level of consciousness or blunt injury above the clavicle has what
type of injury? Cervical spine injury.
4. Flail chest is invariably accompanied by pulmonary contusion which can
interfere with blood oxygenation. Do NOT over-fluid resuscitate these
patients!
5. Hypotension is caused by hypovolemia until proven otherwise.
6. When you don't have/can't get a blood pressure, what are three things to
look for when evaluating perfusion? 1. Level of consciousness (brain
perfusion), 2. Skin color (ashen face/grey extremities), 3. Pulse (bilateral
femoral - thready/tachy).
7. Elderly patients have a limited ability to increase heart rate to compensate
for blood loss.
8. Resuscitation fluids should be warmed to 39 degrees Celsius (102.2 F). Can
you use a microwave to do this? YES - for CRYSTALLOID ONLY (but NOT for
blood products).
,9. Urinary catheters are good for assessing renal perfusion and volume status.
List 5 signs of urethral injury that might prevent you from inserting one:
Blood at urethral meatus, perineal ecchymosis, blood in scrotum, high-
riding/non-palpable prostate, pelvic fracture.
10.Which arm should you NOT put a pulse-ox on? The arm with a blood
pressure cuff on it.
11.Name two anatomical things that can interfere with doing a FAST scan:
Obesity & intraluminal bowel gas.
12.When should radiographs be obtained? During the SECONDARY survey.
13.How do you get an ample patient history? A=Allergies, M=Medications,
P=PMH/Pregnancy, L=Last meal, E=Events/Environment of injury.
14.Why might you want a Bair Hugger for a patient who smells of alcohol?
Vasodilation can lead to hypothermia.
15.What things are you looking for when you do a DRE in a trauma? Blood,
high-riding prostate (in males), and sphincter tone.
16.What should you do for every female patient? Pregnancy test (females of
childbearing age).
17.Adult patients should maintain UOP of at least 0.5 mL/kg/hr. Kids should
have at least 1.0 mL/kg/hr.
18.Preventing hypercarbia is critical in patients who have sustained a head
injury.
19.What two places would you LOOK at a patient if you suspect hypoxemia?
Lips and fingernail beds.
, 20.Patients may be abusive and belligerent because of hypoxia, so don't just
assume it's due to drugs, alcohol, or the fact that they are just inherently a
jerk.
21.Can a patient breathe on their own after complete cervical cord
transection? Yes, if the phrenic nerves (C3-C5) are spared. This will result
in "abdominal" breathing. The intercostal muscles will be paralyzed
though.
22.Can you use an OPA (Guedel) in a conscious patient? No, it could make
them vomit. An NPA (trumpet) would be okay.
23.Bougies are typically inserted blindly; how do you know you are in the
trachea and not the esophagus? You can feel the "clicks" as the distal tip
rubs against the cartilaginous tracheal rings, or it will deviate right or left
when entering either bronchus (usually at 50 cm).
24.What do you NOT want to hear if you auscultate a patient after placement
of an ET tube? Borborygmi - rumbling or gurgling noises suggesting
esophageal insertion.
25.What is the RSI dose for etomidate? 0.3 mg/kg (usually 20 mg).
26.What is the RSI dose for succinylcholine (sux)? 1-2 mg/kg (usually 100 mg).
27.How does etomidate affect blood pressure? It doesn't - at least it
SHOULDN'T have any significant effect on BP. Ketamine will increase BP,
and propofol and thiopental will both drop BP.
28.A RSI dose of sux usually lasts about 5 minutes.
29.What hypnotic/sedative/induction agent do you NOT want to use for a
severely burned patient? SUX - patients with severe burns, crush injuries,
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