Trauma Flashcards
1
Q
how do we evaluate the airway?
A
Airway should be assessed for patency
- is the pt able to communicate verbally
- inspect for any foreign bodies
- examine for stridor, hoarseness, gurgling, pooled secretions or blood
Assume C-spine injury in patients with multisystem trauma
- C-spine clearance is both clinical and radiographic
- C-collar should remain in place until patient can cooperate with clinical exam
2
Q
what are some airway interventions?
A
- Supplemental oxygen
- suction
- chin lift/ jaw thrust
- oral/ nasal airways
- definitive airways
3
Q
when assessing breathing what should be considered?
A
- airway patency alone does not ensure adequate ventilation
- inspect, palpate and ausculate (deviated trachea, crepitus, flail chest, sucking, chest wound, absence of breath sounds)
- cxr to evaluate lung fields
4
Q
what are some breathing interventions?
A
- Ventilate with 100% oxygen
- needle decompression if tension pneumothorax suspected
- chest tubes for pneumothorax/ hemothorax
- occlusive dressing to sucking chest wound
- if intubated, evaluate ETT position
5
Q
when assessing circulation what should be considered?
A
- hemorrhagic shock should be assumed in any hypotensive trauma patient
- rapid assessment of hemodynamic status
-level of consciousness
-skin color
-pulses in four extremities
-blood pressure and pulse pressure
5
Q
what are circulation interventions?
A
- cardiac montior
- apply pressure to sites of external hemorrhage
- establish IV access (2 large bore IVs, central lines if indicated, intraosseous)
- cardiac tamponade decompression if indicated
- volume resuscitation (have blood ready if needed, level one infusers available, foley catheter to monitor resuscitation
6
Q
when assessing disability what should be considered?
A
- abbreviated neurologic exam
-level of consciousness
-pupil size and reactivity
motor function
GCS (utilized to determine severity of injury, guide for urgency of head CT and ICP monitoring)
7
Q
what are disability interventions?
A
- spinal cord injury
- ICP monitor- neurosurgical consulation
- elevated ICP
-head of bed elevated
-mannitol HTS
-emergent decompression
8
Q
When assesing exposure, what should be considered?
A
- complete disrobing of patient
- logroll to inspect back
- rectal temperature
- warm blankets/ external warming device to prevent hypthermia
Always inspect the back
9
Q
- common source of traumatic injury
- mechanism is important
- high suspicion with tachycardia, hypotension, and abdominal tenderness
- can be asymptomatic early on; FAST exam can be early screening tool
- look for distension, tenderness, seatbelt marks, penetrating trauma, retroperitoneal ecchymosis
- be suspicious of free fluid without evidence of solid organ injury
A
Abdominal Trauma
10
Q
- most commonly injured organ in blunt trauma
- often assoicated with other injuries
- left lower rib pain may be indicative
- often can be managed non-operatively
A
splenic injury
11
Q
- second most common solid organ injury
- can be difficult to manage surgically
- often associated with other abdominal injuries
A
Liver Injury
12
Q
- injury can involve stomach, bowel, or mesentary
- symptoms are a result from combination of blood loss and peritoneal contamination
- small bowel and colon injuries result most often from penetrating trauma
- deceleration injuries can result in bucket-handle tears of mesentary
- free fluid without solid organ injury is this until proven otherwise
A
hollow viscous injury
13
Q
Benefits of CT scan in trauma?
A
- Abdominal CT scan visualizes solid organs and vessels well
- CT does not see hollow viscus, duodenum, diaphragm, or omentum well
- some recent surgery literature advocates whole body scan on all trauma
-keep in mind that there is an increase in mortality related to cancer from CT scans
14
Q
- focused abdominal scanning in trauma
- 4 views: cardiac, RUQ, LUQ, suprapubic
- Goal: elvaulate for free fluid
A
FAST exam
