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Exam 18: Trauma Surgery

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Question 1

Multiple Choice

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Which statement regarding level III and level IV trauma centers best describes the difference between the two types of centers?

A) A level III trauma center provides advanced cardiac life support (ACLS) , surgery, stabilization, and transfer, while a level IV only provides ACLS services before immediate transfer to a higher level center.
B) A level III trauma center immediately transfers to a higher level center, while a level IV does not accept trauma patients.
C) A level III trauma center determines severity of injury and provides ACLS support before transfer to a level IV center, while a level IV provides all comprehensive services.
D) A level III trauma center provides all types of trauma services but is located in a rural setting, while a level IV provides post-hospital convalescent care for trauma patients.

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Question 2

Multiple Choice

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When the patient arrives in the ED, the trauma team initiates a primary assessment. This is a logical, orderly process of patient assessment for potential life threats. These assessment activities are based on established protocols for advanced trauma life support (ATLS) . The mnemonic "ABCDE" is used, representing assessment of the following: Airway, Breathing, Circulation, Disability, and Exposure. The D and E represent what degree of investigation?

A) D = musculoskeletal impairments; E = environmental issues
B) D = a brief reflex examination; E = extraneous sensory impairments
C) D = history of prior impairments; E = events that contributed to the injury
D) D = a brief neurologic examination; E = exposure to reveal all life-threatening injuries

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Question 3

Multiple Choice

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If cervical spine precautions were not implemented before arrival at the hospital, the emergency department team initiates them before performing any other procedures on the patient. A trauma team member can stabilize the head and neck, if necessary, until a cervical collar is placed. What event needs to take place before the team removes the cervical collar and continues care?

If the injury to the patient is a result of a violent crime, the team must give special attention to preservation of evidence during the course of patient care. When clothing is removed from the patient, why must it be placed and secured in a paper bag rather than a plastic bag?

What special consideration should the perioperative team be alert to in order to prevent a negative surgical outcome in bariatric trauma patients?

Traumatic deaths may occur in three phases, or time frames. The first phase occurs immediately after the injury, the second phase within the first 1 to 2 hours after the injury, and the third phase occurs days to weeks after the injury. Approximately 30% of total fatalities from trauma could be prevented with definitive trauma care, including appropriate and aggressive resuscitation with rapid transport to an appropriate facility. Which phase, or timeframe, of potential for trauma death, does this group represent?

Focused assessment with sonography in trauma (FAST) may assist with diagnosis in difficult situations. What group of scans is performed and what do they identify?

A trauma patient is rushed to the OR after a primary survey is completed in the emergency department. He is a 36-year-old male with multiple penetrating gunshot and knife wounds to the abdomen. He is bleeding profusely. What appropriate actions are critical in the rapid preparation for this procedure?

Autotransfusion can present a vital asset in trauma care, when considering the high blood loss associated with many traumatic injuries. This process provides immediate volume replacement, decreases the amount of bank blood used, and reduces the possibility of transfusion reactions or risk of transfusion with bloodborne pathogens. What are the contraindications to using autotransfusion as a blood replacement source?

What special consideration should be made when assessing a pediatric trauma patient for level of consciousness?

Blunt force to the larynx can result in a fracture and impose immediate airway obstruction. These patients are at risk for a lost airway and may require immediate tracheotomy followed by repair of the fracture when the fracture is unstable or displaced. It is also important to consider that a trauma patient is assumed to have a full stomach; thus these patients are at high risk for aspiration and resultant pneumonia. What is an appropriate action in the event of a lost airway after anesthesia induction and before intubation?

The emergency medical services system consists of trained prehospital personnel who arrive at the scene and perform definitive interventions designed to reduce morbidity and mortality. What is the primary role of the prehospital personnel? Select all that apply from the list below.

What statement regarding level I and level II trauma centers best describes the difference between the two types of centers?

A 26-year-old woman is rushed to the operating room after a primary and secondary survey in the emergency department. She was hit by a small truck as she was riding her bicycle through a busy intersection. She has sustained rib fractures and several fractured transverse vertebral processes. Renal injury is suspected. As the circulator prepares to insert a urinary catheter, she notices blood at the urinary meatus. What should the circulator's next action be?

What special consideration should be made when assessing a geriatric trauma patient before surgery?

Blunt trauma injuries may not fully reveal the degree or depth of injury. What noninvasive diagnostic test is critical to diagnosis in potential traumatic brain injury?

Trauma to the chest area is the primary cause of death in approximately 25% of trauma victims. Involvement of the heart, great vessels, lungs, and diaphragm, attributable to penetrating or blunt injury, can provide multiple unexpected findings when the chest is opened. Because of the nature of the potential findings and expected surgical intervention, what would be an appropriate preparatory action for the surgical technologist to take?

What is the description of damage control surgery, and what conditions may be present?