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01 Flashcards

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1
Q

4 key areas of non technical skills

A

Teamwork
Task management
Decision making
Situational awareness

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2
Q

Stop and summarise

A

ATMIST
A to E
Interventions
Impression
Plan: immediate, next 10 mins, next 30mins
Thoughts from team

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3
Q

PACE

A

Probe; are you sure
Alert; won’t x cause x
Challenge; this will harm
Emergency STOP; stop I will get help

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4
Q

Types fixation error

A
  • This and only this
  • everything but this
  • everything is ok
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5
Q

TSP

A

Trauma support practitioner
Additional to A/B/C person
Remove clothes, monitoring, access, bloods, assist with procedure, relatives

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6
Q

ATMIST

A

Age, sex, relevant Hx (NOAC)
Mechanism
Injuries
Signs A to E and trends
Treatment given and required

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7
Q

Allocate roles TTM; skills needed

A

A intubate, FONA
B chest drain, resuscitative thoracotomy
C access, IO, pelvic binder, FAST, resuscitative hysterotomy, lateral canthotomy
Nurse
Scribe

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8
Q

Team brief Plan A, B

A

Plan A;
Primary survey, bloods prioritise; gas, G+S, to CT
Plan B;
Any primary interventions ?RSI, needle decomp, chest drain, major haemorrhage
?direct to theatre, ?HOTT principles

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9
Q

Preparation for A

A

O2, mask, BVM, capnography
Basic and advanced airways
Suction checked
Ventilator checked
Blocks and tape

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10
Q

Preparation for B

A

Monitors functioning
Equipment for chest drain
Equipment resuscitative thoracotomy

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11
Q

C preparation

A

Monitors
Tourniquet, celox
Pelvic binder
Vascular and IO access
Level 1 transfuser for speed and warmth
Blood products

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12
Q

TTL preparation

A

Check
- A can intubate
- B can surgical drain
- C eFAST
Communicate with
Blood bank, radiology, surgical specialities, OR, critical care

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13
Q

Team brief

A

Team introduction
Case introduction (ATMIST)
Role allocation
Competency check
Plan A, B
Start preparation

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14
Q

5 second round

A

Airway obstruction
Massive haemorrhage
TCA

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15
Q

5 sec round assessment triangle

A

Social interaction
- calm, agitated, absent
Resp effort
- normal, increased, absent
Skin perfusion
- pink, pale/mottled, absent

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16
Q

Pain relief (physical measures)

A

Splinting fractures
Cover burns - longitudinal strips plastic film
Remove spinal board
Prevent hypothermia

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17
Q

Assess airway

A

Talking?
Look, listen, feel
Manoeuvres, suction
O2 and Sats

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18
Q

Airway plan A,B,C,D

A

A: intubate with VL
B: face mask and waters circuit
C: iGel
D: front of neck

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19
Q

TTL allocation of roles for RSI

A

A: primary intubator
B: intubators assistant; tube, bougie, syringe
C: Mils
Nurse drugs

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20
Q

Before putting OPA in

A

Open mouth and remove any debris

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21
Q

Inadequate ventilation next actions

A

SoL
Ventilate with BVM
No SoL
HOTT principles

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22
Q

Prior to RSI

A

Complete checklist (unless emergency)
Complete ABCDE
Note GCS, pupils size and reactivity
? Signs c-spine injury
- diaphragmatic breathing, vasodilation, priapism
AMPLE hx
2 large bore cannula

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23
Q

Roles of team members in RSI

A

Nurse does checklist
A
B - MILS
C - remove blocks ?cricoid, prep drugs
TTL gives drugs

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24
Q

Intubation process

A

Displacing tongue to left
Blade is in vallecula
Suction
Vocal cords/ posterior structures
Bougie, Tube
Bougie out, cuff up
Ventilate
Chest rise (?bilat), misting, CO2, auscultate
Secure with tape or tie
Ventilator

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25
Maxillofacial trauma haemorrhage control
Secure airway Reduce any boney fractures Mandible support by collar Insert bite blocks (handle away from mouth) Balloon tamponade; folley catheter posterior nasopharynx (5-7ml saline), tension ant Rapid rhino Pack oral cavity with gauze ?Bandage head
26
B - 6 life threatening injuries
Tension Open PNX Massive haemothorax Flail chest Cardiac tamponade Airway disruption
27
B interventions
O2 Needle decompression Thoracostomy Surgical drain CXR BVM, I+V ART line
28
B interventions
O2 Needle decompression Thoracostomy Surgical drain CXR BVM, I+V ART line
29
Indications for resuscitative thoracotomy
Penetrating trauma and arrest <15min Blunt trauma and arrest <10min Refractory hypotension (<60mmHg) despite fluid resus with ultrasound showing effusion
30
Indications for resuscitative thoracotomy
Penetrating trauma and arrest <15min Blunt trauma and arrest <10min Refractory hypotension (<60mmHg) despite fluid resus with ultrasound showing effusion
31
Procedures after clamshell
Aortic occlusion Pericardial release Inspection of heart, staple Internal massage Inspection lungs , hilar twist
32
CXR ruptured airway findings
Pneumomediatinum Surgical emphysema Collapse of lung PNX
33
Ruptured airway management
Attempt to place ET tube past site of rupture Thoracic surgeon
34
Prescribe post surgical chest drain
Prophylactic Abx LA given
35
Lethal triad
1) Coagulopathy 2) Hypothermia - worsens 1 - can reduce BP and HR 3) Acidosis - worsens 1
36
Options for haemorrhage control (5)
Direct pressure and elevation Haemostatic dressing (kaltostat, celox) Tourniquet Splint Pelvic binder
37
Max tourniquet time
2h Write time on patient when tourniquet applied
38
Damage control resuscitation; 4 aspects
Hypotensive resuscitation (sBP80-90) Haemostatic resuscitation Damage control surgery Interventional radiology
39
Types of trauma and haemorrhage: BP aims
Penetrating; sBP80-90 Blunt: sBP80-90 Complex; brain or spinal cord and haemorrhage - aim sBP~100, MAP>80 - once haemorrhage controlled aim MAP>90, sBP>110
40
Trauma induced coagulopathy
Characterised by depletion of fibrinogen Early replacement improves survival
41
Blood product transfusion strategies
RBC and FFP 1:1 or 2:1 ?1:1:1 Hb 7-9g Platelets >100 INR<1.5 Fibrinogen >2g Cryoprecipitate Ionised Ca>0.9
42
Major haemorrhage in trauma management
TRAUMATIC TXA Resuscitation; major Haem protocol; 1:1:1 Avoid hypothermia Unstable ?damage control surgery Metabolic; blood gas Avoid vasoconstrictors uncles spinal or TBI Test clotting; TEG and replace Imaging: ?IR Calcium; maintain >1 (ionised)
43
Dabigatran reversal
Idarucizumab
44
Fluid resus in burns: paed and adult
>10% TBSA in child >15% TBSA in adult 4 x TBSA x kg (50% in 8h, 50% next 16h)
45
Burns urinary catheter output aim (adult and paed)
1ml/kg/h in Paeds 2ml/kg/h in adult
46
Always consider
Analgesia Pregnancy Tetanus TXA
47
Peri arrest state Ix to determine cause of shock
EFAST
48
Stop resuscitation in TCA if
- Injuries incompatible with life - no signs of life >15mins - no ROSC after reversible causes addressed - no detectable cardiac activity on US
49
TCA algorithm
Control bleeding; tourniquet, splint Replace warmed blood products Advanced airway; iGel or ET tube Finger thoracostomies bilat If no ROSC and indication proceed clamshell ?REBOA
50
TCA algorithm
Control bleeding; tourniquet, splint Replace warmed blood products Advanced airway; iGel or ET tube Finger thoracostomies bilat If no ROSC and indication proceed clamshell ?REBOA
51
Damage control surgery (3 phases)
1) Laparotomy to control haemorrhage and contamination 2) resuscitation in intensive care 3) second look and definitive surgery
52
Extra concerns in pregnancy
Higher risk of aspiration Desaturate faster Lateral displacement fetus Anti D in cases uterine bleeding
53
Types pelvic fractures q
Open book: AP force Lateral compression (best) Vertical shear (worst) Combination
54
Unstable patient with pelvic injury definitive management
Operation (esp if intra peritoneal or external haemorrhage) Or IR (if blush on CT)
55
Pelvic XR interpretation
A - ah! Most obvious findings - accuracy and adequacy - alignment: 3 pelvic rings; obturator, ?pelvic 3 lines; shentons, ilopelvic, iliopubic B: bones C: SI and pubic symphysis <4, <5mm S: soft tissue
56
Before and after applying pelvic binder
Check pulses ensure nothing trapped in binder; genitalia
57
?urological injury management
Single attempt at catheter (16F) Any blood stained urine = retrograde cystogram Unable to pass = suprapubjc catheter
58
GCS determine localising vs flexion
Reaches above clavicle
59
Tx TBI and seizures
Witnessed seizure - lorazepam 4+4mg - keppra 20mg/kg - ?hypertonic saline - RSI No seizures - keppra 1g BD
60
Test for CSF
Beta transferrin
61
CTH reporting acronym
ABCs Ah!: obviously abnormalities Accuracy, adequacy, alignment Blood: clot is white, acute bleeding black Bone and brain (#, midline shift) Cisterns; effacement (compression) Symmetry, soft tissue,
62
Spinal cord injuries and breathing difficulties
Above C3 - apnea C345 - diaphragm; resp failure Below C5 - intercostals and abdominal muscles - paradoxical movements
63
Neurogenic shock caused by what injury
Above T6 Loss of sympathetic activation
64
Signs of spinal injury in an unconscious patient
Neurogenic shock Flaccid areflexia Diaphragmatic breathing Dermatomes level - No response to pain Priapism
65
Spinal shock
Transient (days to weeks) - loss sensation and power - flaccid areflexia
66
Central cord syndrome Sx
Weakness arms>legs LOS arms>legs
67
Anterior cord syndrome
Loss of power and sensation Proprioception, vibration and deep pressure all preserved
68
Brown sequard syndrome
Loss power and proprioception on side of injury Contralateral loss pain and temp sensation
69
C spine XR process
ABCs Ah! Major abnormality Accuracy and adequacy C7/T1 junction Alignment - ant/post vertebral line, spinolaminar, spinous process Bones Cartilage Soft tissues Peg to C1 less than 3mm C1-3: 1/3 width vertebrae C5 width vertebrae
70
Secondary survey musts
Identify limb threatening trauma - vascular injuries - compartment syndrome - neurological injuries AMPLE history
71
Wound management interventions
Stop bleeding Analgesia Photograph Removal gross contamination Reduction and splint Sterile dressing ?betadine Abx and tetanus
72
Delayed primary closure
Closure 48-72h post wound
73
Thomas splint application
Analgesia, FIB Measure unaffected leg (inner thigh to heel +30cm) Apply skin traction Wrap around stop before Achilles tendon Apply splint Use tongue depressors to create windlass Add traction
74
How to place a Kendrick splint
Upper thigh strap Pole leather extending 1 section below foot Ankle strap - tighten with green, yellow over pole, red for traction Apply red yellow green straps Neuro vasc check
75
Analgesia in Paeds
IN Fent 2mcg/kg IV morphine 0.1mg/kg IV fentanyl 1mcg/kg IV ketamine 0.2mg/kg Paracetamol 15mg/kg
76
Commonest paed chest injury
Pulmonary contusions Usual can see on CXR Can be delayed and take upto 48h to see on CXR
77
Changes in Paeds resuscitation
WETFLAG No hypotensive resuscitation as hypotension late sign
78
Paeds GCS (V)
5; babbles or usual words 4: irritable cry or less words 3: cries only to pain 2: moans to pain 1: no response
79
Pseudosubluxation c-spin XR (Paeds)
C2 on C3 Or C3 on C4
80
IO sites of insertion (Paeds)
- 2-3cm below tibial tuberosirtt - 3cm above lateral condyl ant femur - humeral head
81
EFAST look for
Abdominal blood Haemothorax Pericardial effusion PNX Consider look at IVCa
82
CRM crew resource management (buzz words)
Anticipate and plan Leadership and followership Assertiveness Distribution of workload 10 for 10 Mobilise resources Fixation error Cross check and double check Re evaluate Cognitive aid Allocate attention wisely Dynamic decision making
83
5 sec round findings
We have a pulse, airway and no massive external haemorrhage. Let’s take handover then proceed to primary survey
84
CT scan request
Head, cspine, chest/abdo/pevis to mid femur Consider angio leg/ arm
85
RSI checklist
Patient - O2, position, access, baseline Neuro, allergies Equipment - monitoring, equipment, drugs, maintenance Team - Leader, intubator, assistant, MILS - further help? Difficulty - plan ABCD - OHELP
86
Difficult intubation changes to make
OHELP Oxygenation optimisation Head position External laryngeal manip Laryngoscope blade Pal - change intubator
87
Stable RSI drug doses
Fentanyl 3mcg/kg Ketamine 2mg/kg Roc 1.2mg/kg
88
Unstable and GCS<12 RSI doses
Fentanyl 0-2mcg/kg Ketamine 0.5mg/kg Roc 1.5mg/kg
89
Status epilepticus RSI drug dose
Propofol 2mg/kg Roc 1.mg/kg
90
Chest drain equipment
Chlorhex Lidocaine 3mg/kg Needle and syringe Drape Scalpel 10 Spencer wells x2 30Fr Underwater seal 1-0 Silk Fixation dressing
91
Thoractomy equipment
Chlorhex Scalpel x2 Spencer Wells x2 Tough cuts Gigli saw Stapler
92
Secondary survey
Look, feel, move Head; scalp Ears; otoscope Eyes; ophthalmoscope Nose: septal Mouth: teeth jaw; malocclusion Neck, chest, abdo pelvis Perineum, genitalia Limbs; look, feel pulses and bones, move Back; log roll, PR exam Neuro exam; CN+PN, GCS
93
Extra considerations pregnancy
? 2 patients Obs and Paeds present Displace uterus Rhesus; anti D Domestic violence: safeguarding

ETC (1 decks)

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