Emergency and Trauma Surgery

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? A. A halo traction apparatus is applied. B. A cervical radiograph is obtained to rule out injury to the neck. C. A CT scan with contrast of the upper body is obtained to rule out vascular involvement. D. A myelogram of the cervical spinal canal is obtained to rule out injury to the spinal cord.

A cervical radiograph is obtained to rule out injury to the neck.

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? A. Clean, hemodiluted blood B. Blood contaminated with food, bowel contents, or antibiotic irrigation C. Blood and fluids squeezed out of sterile bloody sponges D. Pooled blood from a ruptured aortic aneurysm

Blood contaminated with food, bowel contents, or antibiotic irrigation

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? A. Pupil reflex and response to light B. Skull radiograph C. CT scan of the head D. Neurovascular arteriography

CT scan of the head

The term "up" means what during an emergency case? A. Items are sterile and ready for use B. On the Mayo ready for use C. The patient's blood pressure is too high D. The patient's heart rate is too high

On the Mayo ready for use

Normothermia is maintaining core body temperature __________. A. at the absolute minimum that supports life. B. as close to normal as possible. C. as close to maximum as possible. D. at 25 degrees Celsius.

as close to normal as possible.

matching Trauma that results in deep tissue injury without rupture of the skin

blunt injury

matching Tearing of the atria or ventricles as a result of trauma

cardiac rupture

matching Pressure on the heart causing restriction and damage to the conduction system

cardiac tamponade

To avoid having instrument sets opened but not used, specialty instruments can be placed on a __________ the operating room (OR) in the sterile core. A. cart inside B. cart outside C. sterile uncovered Mayo stand in D. sterile covered Mayo stand in

cart outside

matching Condition in which the body's normal blood clotting mechanism ceases to function; characteristic in severe multitrauma

coagulopathy

Clear _____________ is the pivot point of team efforts in an emergency. A. teamwork B. accuracy C. preparation D. communication

communication

The compensatory mechanisms in acute injury can lead to the condition called __________. A. compartment syndrome B. metabolic acidosis C. hemorrhagic shock D. hypothermia

compartment syndrome

matching Increased pressure in any compartment of the body

compartment syndrome

One goal of damage control surgery is to focus solely on lifesaving maneuvers, including all of the following EXCEPT __________. A. control of feeding B. control of hemorrhage C. control of fecal spillage D. relief of compartment syndrome

control of feeding

matching Bruising

contusion

You are scrubbed in on an emergency case when the circulator tells you that all standardized ____________ procedures may be suspended in life-threatening situations. A. surgical B. count C. aseptic D. anesthetic

count

Hospitals should have basic setups for __________. A. craniotomy B. bowel resection C. replantation D. vasovasostomy

craniotomy

matching Surgery whose objective is to stop hemorrhage and prevent sepsis without attempting reconstruction or anatomical continuity

damage control surgery

If the patient is stabilized in 12 to 48 hours, he or she can then be returned to surgery for a ____________ procedure. A. follow-up B. emergency C. schedule D. definitive

definitive

matching Evidence-based diagnosis of a medical problem using normal investigative procedures, such as imaging studies

definitive diagnosis

matching A planned surgical procedure, usually with specific objectives for reconstruction or restoring continuity of anatomical structures

definitive procedure

Postoperative serosanguinous pooling is controlled with wound _________. A. drains B. dressings C. clamps D. pins

drains

You are called in on a motor vehicle accident; the patient is disoriented and scared. As a health care professional, it is important to provide some measure of _______ for the patient. A. emotional comfort B. distress relief C. safety education D. standard precaution

emotional comfort

matching Hemorrhage with the potential to deplete the patient's total blood volume

exsanguinating

Death from ______ is the second leading cause of mortality in the United States, and approximately 115,000 cases of _______ injury are treated each year. A. firearms; firearm B. stabbing; stabbing C. trauma; trauma D. motor vehicle accident; motor vehicle accident

firearms; firearm

matching A type of shock characterized by vascular failure resulting from severe bleeding

hemorrhagic shock

The secondary survey is also known as __________. A. occult injury B. hospital care C. clinical care D. emergency care

hospital care

Subnormal core body temperature for an extended period of time is known as __________. A. metabolic acidosis B. coagulopathy C. hypothermia D. hyperthermia

hypothermia

matching Injury that results in air in the pleural space causing displacement or collapse of the respiratory structures

pneumothorax

Consent for invasive procedures, including emergency surgery, is obtained from the patient if he or she is able, or from _____________________, according to hospital policy. A. another person B. responsible individuals C. the parents D. none of the above

responsible individuals

During a true surgical emergency, more so than in any other scenario, ___________ is key to a successful outcome for the patient. A. teamwork B. preparation C. counting D. instruments

teamwork

When passing any instrument that will come in contact with a bullet, fragments, shrapnel, or other ballistic item, ensure that the _______ of the instrument are protected with rubber shod or completely covered with a sponge. A. finger hold B. ratchets C. serrations D. tips

tips

What special consideration should be made when assessing a pediatric trauma patient for level of consciousness? A. Use the modified Glasgow Coma Scale for children. B. Use the Broslow tape. C. Stimulate the child gently in case he or she is a victim of shaken baby syndrome. D. Use the universal Glasgow Coma Scale for all ages.

Use the modified Glasgow Coma Scale for children.

Although the ability to respond quickly to the demand of surgery is important, so is _______________. A. teamwork B. accuracy C. preparation D. instruments

accuracy

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. A chest, pelvic, and four abdominal scans; collections of fluid and free air B. A chest, abdominal, and cervical spine scans; hemorrhage C. A full body scan; midline shifts D. A full body CT, MRI, and PET scans; life-threatening and secondary injuries

A chest, pelvic, and four abdominal scans; collections of fluid and free air

What statement regarding level I and level II trauma centers best describes the difference between the two types of centers? A. A level I trauma center is staffed 24 hours/7 days, while a level II has many support services that are open and staffed 8 hours/5 days. B. A level I trauma center has a transplant program, while a level II is only able to complete organ procurements. C. A level I trauma center provides care for every type of injury, while a level II lacks some specialized resources. D. A level I trauma center requires trauma certification and 8 hours of annual trauma education for all staff, while a level II does not.

A level I trauma center provides care for every type of injury, while a level II lacks some specialized resources.

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.

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.

ATLS is __________. A. Advanced Trauma Life System B. Advanced Trauma Limited Support C. Advanced Trauma Life Support D. Advanced Trauma Limited System

Advanced Trauma Life Support

____________ is/are treatment pathways in trauma surgery. A. Signs and symptoms B. Algorithms C. Hemorrhagic shock D. None of the above

Algorithms

What special consideration should be made when assessing a geriatric trauma patient before surgery? A. They may have preexisting diseases and conditions. B. They may take many prescription and nonprescription drugs. C. They have decreased physiologic reserves. D. All of the options can negatively impact the geriatric patient's perioperative experience.

All of the options can negatively impact the geriatric patient's perioperative experience.

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? A. Assist in setting up the autotransfusion system and resuscitation equipment. B. Prepare the rapid response team and chaplain to be on alert. C. Call for the small fragment set for rib fracture fixation at closure. D. Prep the patient from the xiphoid to mid-thigh.

Assist in setting up the autotransfusion system and resuscitation equipment.

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? A. Assist the anesthesia provider with securing the airway while applying cricoid pressure. B. Assist the anesthesia provider by inserting a nasogastric tube and connecting to suction. C. Leave the room to get the emergency tracheostomy tray and trach tubes. D. Increase the oxygen delivery and perform a head tilt-chin lift.

Assist the anesthesia provider with securing the airway while applying cricoid pressure.

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

D = a brief neurologic examination; E = exposure to reveal all life-threatening injuries

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? A. Place a gauze dressing over the perineum after inserting the urinary catheter. B. Insert the catheter and notify the surgeon. C. Discontinue the catheter insertion. D. Insert a latex-free straight catheter to empty the bladder and then remove it.

Discontinue the catheter insertion.

matching A protocol of ATLS in which ultrasound is used in a focus area to diagnose severe trauma

FAST

____________, a vascular failure caused by prolonged, severe blood loss, is the most common cause of mortality in trauma. A. Hypothermia B. Coagulopathy C. Hemorrhagic shock D. Metabolic acidosis

Hemorrhagic shock

Lower-than-normal blood pH is what condition? A. Metabolic acidosis B. Coagulopathy C. Hypothermia D. Hyperthermia

Metabolic acidosis

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? A. Phase I B. Phase II C. Phase III D. This represents all phases of trauma, not one distinct phase.

Phase II

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? A. Plastic bags may trap moisture and allow mold growth, destroying evidence. B. It is easier to write identifying information on paper rather than plastic. C. Plastic bags trap air, which could kill anaerobic microorganisms needed as evidence. D. Paper bags are more secure as they cannot be untied and retied.

Plastic bags may trap moisture and allow mold growth, destroying evidence.

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? A. Set up the autotransfusion system. B. Prep the patient from the suprasternal notch to the mid-thigh. C. Place the aortic cross-clamp on the Mayo stand. D. Open a silo-bag closure system on the sterile field.

Prep the patient from the suprasternal notch to the mid-thigh.

____________ is the process of restoring physiological balance in injury. A. Metabolic acidosis B. Hypothermia C. Hyperthermia D. Resuscitation

Resuscitation

What is the description of damage control surgery, and what conditions may be present? A. Trauma surgery performed by a nontrauma surgeon; lack of specialty training B. Surgery performed during ambulance or helicopter transfer; patient movement C. Surgery at a non-level I center before transfer to a level I; intentional retained sponges D. Surgery performed in the emergency department; inadequate sterile technique

Surgery at a non-level I center before transfer to a level I; intentional retained sponges

What special consideration should the perioperative team be alert to in order to prevent a negative surgical outcome in bariatric trauma patients? A. They may have decreased self-esteem and suffer from societal prejudice. B. They are at risk for retained foreign bodies related to the size of the abdominal cavity. C. Several persons will be needed to position the patient. D. They may not be able to fit into the CT or MRI scanner.

They are at risk for retained foreign bodies related to the size of the abdominal cavity.

____________-based tissue sealants are used only if there is no coagulopathy present because these depend on an intact coagulation response. A. Thrombin B. Lidocaine C. Heparin D. Warfarin

Thrombin

___________ is/are the leading cause(s) of death between the ages of 1 and 45 and the third leading cause of death in all age groups. A. Motorcycle accidents B. Motor vehicle accidents C. Boating accidents D. Trauma

Trauma

Copious amounts of _________ solution are often needed during trauma surgery. A. drug B. irrigation C. heparin D. coagulation

irrigation

The real potential for extending the patient's injuries exists during ___________ and _____________. A. positioning; skin prep B. moving; handling C. induction; wake up D. preoperative preparations; postoperative preparation

moving; handling