Patient Assessment and Management Flashcards

During a SAMPLE history, a trauma patient reports taking clopidogrel (Plavix) and rivaroxaban (Xarelto). How does this information change the clinical urgency of even minor injuries?

Answer: Both medications impair hemostasis—clopidogrel inhibits platelet aggregation and rivaroxaban is a direct anticoagulant—making even minor trauma potentially dangerous due to inability to form and maintain clots

Dual antiplatelet/anticoagulant therapy severely impairs hemostasis at two levels: platelet plug formation and the coagulation cascade. This makes hemorrhage control much more difficult and increases the risk of significant bleeding from otherwise minor injuries.

What is the ITLS approach to reassessing a patient who initially appeared stable but is now showing signs of deterioration during transport?

Answer: Immediately repeat the primary survey (ABCDE), address any new life threats found, increase monitoring frequency, and consider upgrading transport to ALS or trauma center

Any patient deterioration triggers an immediate return to the primary survey to systematically identify and address new or worsening life threats, with consideration for upgrading the level of care.

What is the significance of mechanism of injury in the ITLS trauma decision tree, and when can it be used as a sole criterion for trauma center transport?

Answer: Significant mechanisms (ejection, death in same vehicle, high-speed impact, pedestrian struck at >20 mph, falls >20 feet) can independently trigger trauma center transport even without abnormal physiologic findings

ITLS recognizes that certain high-energy mechanisms carry such a high probability of significant occult injury that they independently warrant trauma center evaluation, regardless of current physiologic parameters.

A patient involved in a high-speed MVC is trapped with bilateral femur fractures and a suspected pelvic fracture. Extrication will take 20 minutes. What management should occur during the extrication period?

Answer: Begin treatment during extrication: establish IV access, administer fluid for shock, apply pelvic binder if accessible, provide pain management, manage airway, and prepare for rapid transport once freed

ITLS teaches that patient care begins immediately upon access, not after extrication. All interventions that can be performed within the constraints of entrapment should be initiated during extrication to minimize treatment delays.

What is the 'platinum ten minutes' concept in ITLS, and how does it relate to the golden hour?

Answer: It means prehospital scene time for critically injured patients should not exceed approximately 10 minutes, preserving the maximum golden hour time for definitive surgical care

The platinum ten minutes emphasizes that scene time for critical trauma patients should be minimized to approximately 10 minutes, performing only essential life-saving interventions on scene while maximizing the time available for definitive hospital care within the golden hour.

How does ITLS recommend documenting and communicating patient information during handoff to the receiving hospital?

Answer: Structured communication using MIST (Mechanism, Injuries, Signs/vital signs, Treatment) or similar format, combined with written documentation of assessments, interventions, and patient responses

ITLS recommends structured handoff communication (MIST: Mechanism, Injuries found, Signs/vital signs with trends, Treatment given and response) along with written documentation to ensure continuity of care and preserve critical information.