Trauma Surgery -
Chapter 28 - SFA202
Exam Questions and
Complete Solutions
Graded A+
Denning [Date] [Course title]
,TRAUMA - Answer: #1 CAUSE OF DEATH IN THE U.S. FOR PEOPLE 1-46 YRS OLD
MAJOR ADVANCES IN CARING FOR CRITICALLY INJURED PATIENTS HAVE BEEN GAINED FROM MILITARY
EXPERIENCE
***MASH - MOBILE ARMY SURGICAL HOSPITAL
Implemented during Korean War 1950 & again during
Vietnam War 1955
MASH - MOBILE ARMY SURGICAL HOSPITAL 1089 - Answer: -BROUGHT NECESSARY TRAUMA SUPPLIES,
EQUIPMENT, & PERSONNEL CLOSER TO THE BATTLEFIELD
-SINCE MASH UNITS WERE CLOSE, PATIENT OUTCOMES IMPROVED
- MASH CONCEPT has been applied to CIVILIAN POPULATION & is called the "GOLDEN HOUR" of trauma
care
GOLDEN HOUR of trauma care 1089 - Answer: -REFERS TO THE TIME IMMEDIATELY AFTER A TRAUMATIC
INJURY WHEN RAPID & DEFINITIVE INTERVENTIONS ARE MOST EFFECTIVE TO REDUCE MORBIDITY AND
MORTALITY
- STARTS AT THE SCENE OF THE INJURY - prehospital personnel determine severity of injury, initiate
immediate medical treatment, & identify most appropriate facility for patient to be transported
TRAUMATIC DEATHS 1089 - Answer: OCCUR IN 3 PHASES or TIME FRAMES:
1st - OCCURS IMMEDIATELY AFTER INJURY -
*during this phase, death most often occurs as a result of lacerations to heart, aorta, or as a result of
brain stem injury
*patients commonly die at the scene or rarely survive transport to hospital
2nd - OCCURS DURING INITIAL 1-2 HOURS AFTER INJURY -
,* patients generally have injuries to spleen, liver, lung, or other organs resulting in significant blood loss.
* DEFINITIVE TRAUMA CARE is needed - appropriate and aggressive resuscitation with adequate volume
replacement within the GOLDEN HOUR may have most significant effect
3rd - OCCURS DAYS TO WEEKS AFTER INJURY -
*while patient is in Intensive Care phase
*patient death is usually caused by complications or failure of multiple organ systems
WAR IN AFGHANISTAN (2001) & IRAQ (2003) 1089 - Answer: RESULTED IN CHANGES TO HOW TRAUMA
INJURIES WERE MANAGED
- MILITARY DIDN'T SET UP CONVALESCENCE CENTERS
(Vietnam 1955 and Gulf Wars 1991 both did)
- Instead, a doctrine of "ESSENTIAL CARE IN THEATER" was implemented
- DOCTORS & NURSES were TRAINED to provide IMMEDIATE CARE while being aware of treatment
resources that would be available at the NEXT LEVEL OF CARE
-SOLDIERS WITH UPPER BODY INJURIES had GREATER SURVIVAL RATES because they had improved
BODY ARMOR.
***This did not protect extremities = many amputations
- THE NEW PHILOSOPHY stressed CONTINUITY OF CARE with the goal of returning soldiers to the
HIGHEST POSSIBLE LEVEL OF FUNCTION
EMS - EMERGENCY MEDICAL SERVICES 1089 - Answer: A SIGNIFICANT NUMBER OF PATIENT DEATHS
CAN BE PREVENTED WHEN RAPID TRANSPORT IS PROVIDED FROM THE TRAUMA SCENE TO A FACILITY
EQUIPPED TO PROVIDE RESUSCITATION AND TREATMENT IN AN EFFICIENT & TIMELY MANNER. (**this
concept is the foundation for national development of the EMS system)
TRAUMA CENTERS (TC) 1089 - Answer: FACILITIES THAT MEET THE CRITERIA FOR ACCOMODATING
SPECIALIZED NEEDS OF CRITICALLY INJURED PATIENTS ARE DESIGNATED AS "TRAUMA CENTERS"
, - COMMUNITIES ESTABLISH TRANSFER AND TRIAGE PROTOCOLS THAT ENABLE PATIENTS TO REACH
APPROPRIATE FACILITIES WITH THE LEAST "OUT-OF-HOSPITAL" TIME POSSIBLE (Life Flight
Helicopter/Ambulance)
U.S. TRAUMA CENTERS undergo a DESIGNATION PROCESS & A VERIFICATION PROCESS.
* DESIGNATION occurs on state or local level
*VERIFICATION occurs only by the ACS (American College of Surgeons). The ACS verifies presence of
resources that include COMMITMENT, READINESS, RESOURCES, POLICIES, PATIENT CARE, &
PERFOMANCE IMPROVEMENT
LEVEL 1 TRAUMA CENTER 1090 - Answer: CAPABLE OF PROVIDING TOTAL CARE FOR EVERY TYPE OF
INJURY FROM PREVENTION TO REHABILITATION
- LEVEL 1 TC MUST PROVIDE QUALIFIED PERSONNEL & EQUIPMENT NECESSARY FOR RAPID DIAGNOSIS
AND TREATMENT 24 HOURS A DAY
LEVEL II TRAUMA CENTER 1090 - Answer: PROVIDES COMPREHENSIVE CARE FOR ALL INJURIES BUT
LACKS SOME OF THE SPECIALIZED CLINICIANS & RESOURCES REQUIRED TO BE LEVEL 1
- MAY PROVIDE SURGICAL INTERVENTION IF THE CRITICAL NATURE OF THE INJURY DICTATES
IMMEDIATE INTERVENTION BEFORE TRANSFERRING TO A LEVEL 1.
- ACS RECOMMENDS AN OR AND SURGICAL TEAM BE READILY AVAILABLE AT ALL TIMES
LEVEL III TRAUMA CENTER 1090 - Answer: PROVIDES PROMPT EVALUATION, RESUSCITATION,
EMERGENCY SURGERY & STABILIZATION AS NEEDED BEFORE TRANSFERRING TO A HIGHER LEVEL TC.
- ACS RECOMMENDS AN OR AND SURGICAL TEAM BE READILY AVAILABLE AT ALL TIMES
LEVEL IV TRAUMA CENTER 1090 - Answer: HAS THE ABILITY TO PROVIDE ATLS (advanced trauma life
support) BEFORE THE PATIENTS ARE TRANSFERRED OUT TO A HIGHER LEVEL OF CARE
Chapter 28 - SFA202
Exam Questions and
Complete Solutions
Graded A+
Denning [Date] [Course title]
,TRAUMA - Answer: #1 CAUSE OF DEATH IN THE U.S. FOR PEOPLE 1-46 YRS OLD
MAJOR ADVANCES IN CARING FOR CRITICALLY INJURED PATIENTS HAVE BEEN GAINED FROM MILITARY
EXPERIENCE
***MASH - MOBILE ARMY SURGICAL HOSPITAL
Implemented during Korean War 1950 & again during
Vietnam War 1955
MASH - MOBILE ARMY SURGICAL HOSPITAL 1089 - Answer: -BROUGHT NECESSARY TRAUMA SUPPLIES,
EQUIPMENT, & PERSONNEL CLOSER TO THE BATTLEFIELD
-SINCE MASH UNITS WERE CLOSE, PATIENT OUTCOMES IMPROVED
- MASH CONCEPT has been applied to CIVILIAN POPULATION & is called the "GOLDEN HOUR" of trauma
care
GOLDEN HOUR of trauma care 1089 - Answer: -REFERS TO THE TIME IMMEDIATELY AFTER A TRAUMATIC
INJURY WHEN RAPID & DEFINITIVE INTERVENTIONS ARE MOST EFFECTIVE TO REDUCE MORBIDITY AND
MORTALITY
- STARTS AT THE SCENE OF THE INJURY - prehospital personnel determine severity of injury, initiate
immediate medical treatment, & identify most appropriate facility for patient to be transported
TRAUMATIC DEATHS 1089 - Answer: OCCUR IN 3 PHASES or TIME FRAMES:
1st - OCCURS IMMEDIATELY AFTER INJURY -
*during this phase, death most often occurs as a result of lacerations to heart, aorta, or as a result of
brain stem injury
*patients commonly die at the scene or rarely survive transport to hospital
2nd - OCCURS DURING INITIAL 1-2 HOURS AFTER INJURY -
,* patients generally have injuries to spleen, liver, lung, or other organs resulting in significant blood loss.
* DEFINITIVE TRAUMA CARE is needed - appropriate and aggressive resuscitation with adequate volume
replacement within the GOLDEN HOUR may have most significant effect
3rd - OCCURS DAYS TO WEEKS AFTER INJURY -
*while patient is in Intensive Care phase
*patient death is usually caused by complications or failure of multiple organ systems
WAR IN AFGHANISTAN (2001) & IRAQ (2003) 1089 - Answer: RESULTED IN CHANGES TO HOW TRAUMA
INJURIES WERE MANAGED
- MILITARY DIDN'T SET UP CONVALESCENCE CENTERS
(Vietnam 1955 and Gulf Wars 1991 both did)
- Instead, a doctrine of "ESSENTIAL CARE IN THEATER" was implemented
- DOCTORS & NURSES were TRAINED to provide IMMEDIATE CARE while being aware of treatment
resources that would be available at the NEXT LEVEL OF CARE
-SOLDIERS WITH UPPER BODY INJURIES had GREATER SURVIVAL RATES because they had improved
BODY ARMOR.
***This did not protect extremities = many amputations
- THE NEW PHILOSOPHY stressed CONTINUITY OF CARE with the goal of returning soldiers to the
HIGHEST POSSIBLE LEVEL OF FUNCTION
EMS - EMERGENCY MEDICAL SERVICES 1089 - Answer: A SIGNIFICANT NUMBER OF PATIENT DEATHS
CAN BE PREVENTED WHEN RAPID TRANSPORT IS PROVIDED FROM THE TRAUMA SCENE TO A FACILITY
EQUIPPED TO PROVIDE RESUSCITATION AND TREATMENT IN AN EFFICIENT & TIMELY MANNER. (**this
concept is the foundation for national development of the EMS system)
TRAUMA CENTERS (TC) 1089 - Answer: FACILITIES THAT MEET THE CRITERIA FOR ACCOMODATING
SPECIALIZED NEEDS OF CRITICALLY INJURED PATIENTS ARE DESIGNATED AS "TRAUMA CENTERS"
, - COMMUNITIES ESTABLISH TRANSFER AND TRIAGE PROTOCOLS THAT ENABLE PATIENTS TO REACH
APPROPRIATE FACILITIES WITH THE LEAST "OUT-OF-HOSPITAL" TIME POSSIBLE (Life Flight
Helicopter/Ambulance)
U.S. TRAUMA CENTERS undergo a DESIGNATION PROCESS & A VERIFICATION PROCESS.
* DESIGNATION occurs on state or local level
*VERIFICATION occurs only by the ACS (American College of Surgeons). The ACS verifies presence of
resources that include COMMITMENT, READINESS, RESOURCES, POLICIES, PATIENT CARE, &
PERFOMANCE IMPROVEMENT
LEVEL 1 TRAUMA CENTER 1090 - Answer: CAPABLE OF PROVIDING TOTAL CARE FOR EVERY TYPE OF
INJURY FROM PREVENTION TO REHABILITATION
- LEVEL 1 TC MUST PROVIDE QUALIFIED PERSONNEL & EQUIPMENT NECESSARY FOR RAPID DIAGNOSIS
AND TREATMENT 24 HOURS A DAY
LEVEL II TRAUMA CENTER 1090 - Answer: PROVIDES COMPREHENSIVE CARE FOR ALL INJURIES BUT
LACKS SOME OF THE SPECIALIZED CLINICIANS & RESOURCES REQUIRED TO BE LEVEL 1
- MAY PROVIDE SURGICAL INTERVENTION IF THE CRITICAL NATURE OF THE INJURY DICTATES
IMMEDIATE INTERVENTION BEFORE TRANSFERRING TO A LEVEL 1.
- ACS RECOMMENDS AN OR AND SURGICAL TEAM BE READILY AVAILABLE AT ALL TIMES
LEVEL III TRAUMA CENTER 1090 - Answer: PROVIDES PROMPT EVALUATION, RESUSCITATION,
EMERGENCY SURGERY & STABILIZATION AS NEEDED BEFORE TRANSFERRING TO A HIGHER LEVEL TC.
- ACS RECOMMENDS AN OR AND SURGICAL TEAM BE READILY AVAILABLE AT ALL TIMES
LEVEL IV TRAUMA CENTER 1090 - Answer: HAS THE ABILITY TO PROVIDE ATLS (advanced trauma life
support) BEFORE THE PATIENTS ARE TRANSFERRED OUT TO A HIGHER LEVEL OF CARE
