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Trauma Resuscitation
Case StudiesShelley Atkinson, MSN, ANP-BC, ACNP-BC
Case Study #120 year old male, unrestrained driver, in a motor
vehicle that collides into a large tree. +LOC at the scene and unresponsive. Starred windshield. Life flight transported to VUMC.
VS: 120/70 mm Hg, HR= 110-115, RR= 15Receiving oxygen 100% NRBVideo: 2b
What is the number one priority during the initial assessment of this trauma patient?
A. AirwayB. BreathingC. CirculationD. Disability
What Level One Criteria does the patient meet?
A. GCS < or = 8B. Head injury with
LOC > 5 minC. Moderate to severe
respiratory distressD. All the above
The patient’s need for airway protection and ventilation is due to unconsciousness.
A. TrueB. False
Which two steps listed below are early steps in the RSI procedure?A. Pre-oxygenate with
80% oxygen & apply cricoid pressure
B. perform chin lift/jaw thrust to open airway& pre-oxygenate with 100% oxygen
C. Administer a paralytic & ventilate
How do I know the ETT is in the correct position?
A. Presence of CO2 in the end tidal CO2 detector only?
B. Equal breath sounds bilaterally and gurgling in the epigastrium
C. Presence of CO2, equal bilateral breath
sounds and CXR
Case Study #2• 20 year old male assaulted. GSW to right
chest and left lower extremity. Patient is c/o chest pain, SOB, and left lower extremity pain
• HR= 110; BP=120; RR = 30; SaO2= 90% on 100 % NRB; No BS on Right
Video 3a
This patient does not meet Level One Criteria.
A. TrueB. False
What trauma imaging is needed for this patient?
A. CXR onlyB. CT of the chestC. CXR, CT
chest/abd/pelvis, Left femur XR
D. Head CT
What is wrong with this CXR?
What do you think is wrong with this patient based on the CXR provided?
A. Labored breathing due to pain
B. Spleen lacerationC. Pneumothorax D. Hemothorax
What should be assessed in the secondary survey?A. Pulses of right leg onlyB. Roll the patient for
posterior checkC. Roll patient over
(posterior check) and assess pulses (Fem, DP,PT)
D. Secondary survey excluded because the patient states, “I am fine”
Case Study #318-20 year old male unrestrained passenger. Car hit a bridge. Driver DOA. Reported by EMS, “Initially awake, not acting right”. Gradually more confused & verbally uncooperative. 2L NS in air craft. BP=110 and decreasing. HR=120. RSI per life flight.Video: Case 4
What signs/symptoms are the patient exhibiting that he needs resuscitation?
A. Decreased mentation
B. Increasing HR and decreasing BP
C. Both
The patient has increasing HR =130s BP= 84PWhat stage of shock is the patient in?
A. Stage 1B. Stage 2C. Stage 3D. Stage 4
The patient was given 2L of NS during his flight and was unresponsive to this. What is the next step? BP 84P HR=130
A. Order a 3rd liter of crystalloid
B. Order 2 U PRBCsC. Do nothingD. Give 4 FFP
What trauma imaging is needed at this time? Secondary survey noted left lower abdominal ecchymosis
A. CXRB. CT chest/abd/pelvisC. FAST examD. A and B only
A FAST exam (focused assessment sonography)is used to rapidly identify hemorrhage or potential hollow viscous injury
A. TrueB. False
FAST study positive for a large amount of fluid in the abd. What intervention is needed for the patient at this time?
A. Go to the operating room
B. Activate the trauma exsanguination protocol
C. Go immediately to CT scan
D. Both A and B
What is the trauma exsanguination protocol or Massive transfusion protocol?
A. 2 L crystalloidB. 2 U PRBCC. 2 L crystalloid and 2
U PRBCD. 6 U PRBC, 4 U FFP, 1
pack plts
