approach to a polytrauma pt Flashcards
(32 cards)
What is polytrauma?
The co-existence of multiple traumatic injuries in the same patient, present in about 40% of trauma admissions.
What makes a diagnosis of “multiple trauma”?
The presence of two or more separate injuries, at least one or a combination of which endangers the patient’s life.
What percentage of trauma admissions involve polytrauma?
Up to 40%.
What is unique about road traffic injuries in Africa?
Pedestrians account for more than half of all road traffic fatalities, with injury-related mortality rates six times the global rate.
What is the optimal approach to manage polytrauma patients?
A multidisciplinary team approach
Name at least five specialists who may be part of the multidisciplinary team for polytrauma.
Trauma surgeons, intensivists, orthopedic surgeons, radiologists, urologists, neurosurgeons, and anesthetists.
What protocol is the standard for initial assessment of polytrauma patients?
The Advanced Trauma Life Support (ATLS) protocol.
What does ATLS focus on in its training?
Practical exercises and simulations of emergency room procedures with some theoretical tuition.
Primary Survey - what the ABCDE approach involves ?
Airway: Secure/establish airway, immobilize cervical spine.
Breathing: Secure adequate gas exchange.
Circulation: Secure adequate tissue perfusion.
Disability: Identify neurological deficits.
Exposure: Examine whole body of a fully exposed patient, keep patient warm and manage injuries that are not life-threatening.
Why is hemorrhagic shock a central problem in polytrauma patients?
It is a common cause of death, and excessive bleeding can lead to a cascade of shock, inflammation, and coagulopathy that worsens blood loss and halts resuscitation attempts.
What is the dual goal of management for hemorrhagic shock?
To “find the bleeding and stop the bleeding” with simultaneous rapid and effective restoration of blood volume.
What blood functions should be preserved during resuscitation?
Hemostasis, oxygen-carrying capacity, oncotic pressure, and biochemistry.
Name the six major potential areas of blood loss in trauma patients.
1) Chest, 2) Abdomen, 3) Long bones (especially femur fractures), 4) Pelvis, 5) Retroperitoneum, 6) ‘Blood on the floor’: Scalp and external sources.
When is surgical hemostasis recommended?
When the patient does not respond to non-surgical measures.
Are ortho interventions such as management of fractures PART OF THE PRIMARY OR SECONDARY ?
secondary survey and management
What should be applied to all femur fractures and why?
A Thomas splint, to realign the fracture, provide immobilization, control muscle spasm, reduce pain, reduce fat embolism incidence, decrease blood loss, and prevent further damage to blood vessels, neurovascular structures, and soft tissue.
hat are two limb-threatening phenomena that should be identified early?
Compartment syndrome and a pulseless limb.
What is the immediate management for open injuries?
Wash with saline, cover with Betadine-soaked gauze, and splint while waiting for radiographs and formal orthopedic consultation.
What medications should be administered for all open fractures?
Anti-tetanus toxoid and appropriate antibiotics.
What percentage of musculoskeletal injuries are missed in the first assessment of polytrauma patients?
Up to 50%.
When are these missed injuries often discovered?
Weeks after the initial injury.
What type of missed injury can result in considerable morbidity?
Undiagnosed foot trauma.
How does an awareness of the mechanism of injury help in assessment?
It helps focus history taking and guides examination to the relevant parts of the body.
What associated injuries should you look for with a posterior hip dislocation from a dashboard injury?
Ipsilateral patellar fracture, PCL disruption, femoral fracture, acetabular fracture, or a combination of these injuries.
