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Early empiric antibiotic therapy can improve outcome in multiple organ dysfunction syndrome.
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Trauma patients need to have their airway, breathings, circulation, nervous system, and environment evaluated first.
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Patients can die immediately, early in the course of trauma, and late in the course.
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After the primary and secondary surveys, imaging can take place to further evaluate the head, cervical spine, abdomen, and pelvis.
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Simultaneous examination and treatment offer the best chance of survival.
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Trauma patients often need care at a trauma center as these can provide the services a trauma patient needs for definitive care.
Quiz 1. A patient is seen on the medical ward with new onset hypotension, low body temperature, and changes in mentation. How do you further evaluate this patient? a. Obtain a CT scan of the head to rule out intracranial pathology. b. Obtain a bedside radiograph of the chest to rule out pneumonia. c. Send the patient to the intensive care unit and begin a thorough evaluation for sepsis. d. Start IV antibiotics and look for a source of infection. Answer: d. This patient is presenting with all the signs of septic shock. They need intensive care treatment and a thorough workup for sepsis that can only be done in the intensive care unit. 2. You are evaluating a patient for sepsis who is otherwise immunocompetent. Blood cultures are obtained as are cultures of suspected infected areas. How do you further treat the patient? a. Start them on at least two bactericidal antibiotics while awaiting culture. b. As the patient is immunocompetent, you can await the culture results before starting the patient on an appropriate antibiotic. c. Start the patient on a third-generation cephalosporin and await the results of the culture. d. Start the patient on an intravenous aminoglycoside and await the results of the culture. Answer: c. An immunocompetent patient with sepsis can be placed on a single agent course of a thirdgeneration cephalosporin while awaiting the results of the culture. An aminoglycoside doesn’t provide adequate coverage, and the patient doesn’t need more than one antibiotic. Antibiotic therapy should start before cultures return. 3. The patient is being treated for sepsis and has not had normal blood pressure readings after fluid resuscitation. How do you respond next? a. Give the patient intravenous phenylephrine
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