Trauma Management Flashcards

A 25-year-old male is found unresponsive after being ejected from a vehicle. His vital signs are BP 180/100 mmHg, HR 50 bpm, and an irregular breathing pattern is noted. His right pupil is dilated and non-reactive. These findings are most indicative of:

Answer: Cushing's Triad, indicating increased intracranial pressure

The patient's presentation of hypertension (with a widening pulse pressure), bradycardia, and irregular respirations is the classic Cushing's Triad. This triad is a late and ominous sign of significantly increased intracranial pressure (ICP), often indicating impending brainstem herniation.

You are treating a patient with a deep junctional wound in the groin that is not amenable to a tourniquet. Direct pressure is failing to control severe arterial bleeding. According to TCCC and modern trauma guidelines, what is the most appropriate next intervention?

Answer: Pack the wound with a hemostatic gauze and hold firm pressure.

For junctional hemorrhage (e.g., groin, axilla) that is not controllable by direct pressure alone, the standard of care is to pack the wound, preferably with a hemostatic gauze, and then apply and maintain firm, direct pressure over the packing.

Which of the following is the most critical initial step in the prehospital management of a patient with extensive full-thickness burns covering their chest and abdomen after being removed from a fire?

Answer: Assessing for and managing signs of airway compromise or inhalation injury.

In a patient with significant burns, especially from a fire in an enclosed space, the highest priority is assessing and managing the airway. Signs of inhalation injury (e.g., soot in the nares/mouth, facial burns, hoarseness) can precede rapid and complete airway obstruction due to edema. Airway management supersedes all other interventions in the initial primary survey.

You are assessing a 40-year-old male who was the restrained driver in a high-speed MVC. He complains of left upper quadrant abdominal pain that radiates to his left shoulder. He is tachycardic and hypotensive. This specific pattern of referred pain is known as Kehr's sign and is highly suggestive of what injury?

Answer: Splenic injury

Kehr's sign is referred pain to the left shoulder caused by irritation of the diaphragm from blood, most commonly associated with a splenic rupture. The phrenic nerve (C3, C4, C5) innervates the diaphragm, and its cutaneous branches also supply the shoulder region, causing this classic referred pain pattern.

When treating a patient with a suspected unstable pelvic fracture, which intervention is most appropriate for prehospital stabilization?

Answer: Applying a pelvic binder or improvised sheet wrap centered over the greater trochanters.

The proper management of a suspected unstable pelvic fracture involves the application of a commercial pelvic binder or an improvised sheet wrap. This device should be centered over the greater trochanters, not the iliac crests, to effectively compress the pelvic ring, reduce potential space for hemorrhage, and provide stability.

A 34-year-old male presents with a single stab wound to the right side of his chest. He is anxious, with a respiratory rate of 36, a heart rate of 130, and a BP of 88/60. You note absent breath sounds on the right and jugular vein distention. What is the most appropriate and immediate intervention?

Answer: Needle decompression of the right chest.

The patient is exhibiting clear signs of a tension pneumothorax: unilateral absent breath sounds, tachycardia, hypotension (obstructive shock), and jugular vein distention. The definitive prehospital treatment is to immediately decompress the pleural space by performing a needle thoracostomy to convert the tension pneumothorax into a simple pneumothorax and relieve the pressure on the heart and great vessels.