Trauma Flashcards
components of trauma hx
- From pt, family, witnesses, or prehospital providers may provide important info
- Circumstances of injury (e.g., single-vehicle crash, fall from height, environmental exposure, smoke inhalation)
- Ingestion of intoxicants
- Preexisting medical conditions (DM, depression, cardiac disease, pregnancy)
- Meds (steroids, βB, anticoag) that may suggest certain patterns of injury or the physiologic response to injury.
4 mgmt/steps to trauma pt
- Primary survey
- Resuscitation
- Secondary Survey
- Definitive Care
- Airway maintenance with C-spine protection
- Breathing and ventilation
- Circulation with hemorrhage control
- Disability: neurological status
- Exposure/environmental control
ABCs
which type of assessment is this
Primary Survey
during primary survery Identify yourself and ask patient for their name, what happened
if they can respond, what can you determine already?
- no airway compromise (ability to speak clearly)
- no breathing compromise (ability to generate air movement to speech)
- no major decrease in level of consciousness (able to recall events)
mgmt for airway during primary survery?
- Suctioning/inspection for foreign bodies
- Facial, mandibular or tracheal laryngeal fractures
- Immobilize cervical spine
- Assume cervical spine injury in pts
with blunt trauma, altered LOC
breathing requires adequate function of what body parts?
how to determine if they have proper breathing?
lungs, chest wall, diaphragm
- Auscultate lungs to ensure gas flow
- Visual inspection/palpation of
- chest wall
- Inspect JVD, position of trachea
predominant cause of preventable deaths after injury
hemorrhage
how does altered LOC happen?
Decreased cerebral blood flow
Pts extremities are ashen grey pale, what does that mean?
hypovolemia
how to assess circulation? (4)
- LOC
- skin color
- pulse
- bleeding - ext vs int
pts pulse is rapid thready, what does that mean?
hypovolemia
mgmt for external hemorrhage?
Direct manual pressure
Tourniquets with caution
mgmt for internal hemorrhage
- Chest, abdomen, retroperitoneum, pelvis, long bones
- Once identified, splint application or immediate surgical intervention
- Fluids/blood
When can you consider CNS origin for trauma?
After ABC ruled out →alcohol, hypoglycemia, narcotics ruled out
how to assess disability?
GCS
mgmt for resuscitation
-
Airway
- Jaw thrust chin tilt initially
- If unconscious and no gag reflex: definitive airway - < 8, intubate - Breathing - oxygen
-
Circulation
- Definitive bleed control & volume replacement: Fluids, blood products
- Definitive: surgery, pelvic stabilization
- 2 large bore IV
adjuncts/workup in primary survey
- EKG
- Urinary catheters
- Gastric catheters
- ABG
- Pulse Ox
- Blood pressure
- Xray
- FAST
Begins after primary survey, resuscitation began, and normalization of vital functions
Secondary survey
Do not move on until definitive treatment and normalization of vital functions
PE of secondary survey
- Head
- Inspect ears and nose for cerebrospinal fluid leakage
- Eyes: VA, pupillary size, conj hemorrhage, penetrating injury, contacts (remove before edema), dislocation of lens, ocular entrapment
- Maxillofacial structures: palpate bony structures, intraoral exam, soft tissues, occlusion
- Blood collects in the potential space between the skull and the dura mater
- Convex, focal
- Blunt trauma to the temporal or temporoparietal area with associated skull fracture and middle meningeal arterial disruption
what type of head trauma?
Epidural Hematoma
significant blunt head trauma with loss of consciousness or altered sensorium, followed by a lucid period and subsequent rapid neurologic demise
dx?
w/u? findings?
mgmt?
- Epidural Hematoma
- CT: biconvex (football-shaped) mass, MC temporal region
- Maintain cerebral perfusion and oxygenation
- Definitive Tx: Neurosurgery consult
highest risk for epidural hematoma?
Traumatic blows to temporal bone over the lateral aspect of the head
epidural hematoma
what SBP do you want to maintain for 50-69 y/o? 15-49? >70?
≥100 - 50-69 y/o
≥110 - 15-49 y/o or >70 years old
- sudden acceleration-deceleration of brain parenchyma with subsequent tearing of the bridging dural veins.
- formation between the dura mater and the arachnoid
- Collect more slowly than epidural hematoma because of its venous origin.
dx?
who is more susceptible to develop this dx?
- Subdural Hematoma
- Brains with extensive atrophy (elderly, chronic alcoholics); < 2y/o
classifications of subdural hematoma based on severity?
- Acute sx - within 14 days of injury.
- > 2 wks - chronic
- No specific clinical syndrome associated with a subdural hematoma.
how may an acute case of subdural hematoma present?
immediately after severe trauma, and often the patient is unconscious