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Flashcards in Approach to Trauma Deck (26)
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1

Airway

Patency:
- Ask patient's name
- Foreign bodies?
- Stridor, hoarseness, gurgling, pooled secretions or blood?

Assume C-spine injury

Supplemental O2
Suction
Chin lift / jaw thrust
Oral/nasal airways
*Definitive airways*

2

"Definitive airways"

(Intubation)

RSI for agitated patients with c-spine immobilization

ETI for comatose patients (GCS <8)

3

Definitive airway appropriate for comatose patients

ETI - Endotracheal Intubation

4

Definitive airway appropriate for agitated patients with c-spine immobilization

RSI - Rapid Sequence Intubation

5

Findings with inspection, palpation, auscultation - Breathing

Deviated trachea

Crepitus

*Flail Chest*

Sucking chest wound" ?

Absence of breath sounds

6

Flail Chest

Inspiration causes injured portion of chest wall to "suck in", expiration causes it to "bulge out"

poor ventilation, depending on size of injury

7

Pneumothorax

Identification, intervention

8

What should be assumed in any hypotensive trauma patient

Hemorrhagic shock

9

Rapid assessment of hemodynamic status

Level of consciousness
Skin color
Pulses in FOUR extremities

*Mental status, cap refill at extremities both good, quick indications of perfusion*

(Blood pressure and pulse pressure - once stabilized)

10

Circulation interventions

Cardiac Monitor
Apply pressure to external hemorrhage (tourniquet)

Establish IV access - 2 large bore or central lines

Cardiac tamponad decompression, if indicated

Volume resuscitation (IV fluids, blood)

11

Circulation interventions

Cardiac Monitor
Apply pressure to external hemorrhage (tourniquet)

Establish IV access - 2 large bore or central lines

Cardiac tamponad decompression, if indicated

Volume resuscitation (IV fluids, blood)

12

Abbreviated neurological exam to assess Disability (Brain and Spine)

Level of consciousness

Pupil size and reactivity

Motor function

GCS
- to determine severity of injury
- guide urgency of heat CT and ICP monitoring

13

Disability intervention for spinal cord injury

High dose steroid within 8 hrs

14

Disability intervention for elevated ICP

Elevate head of bed

Mannitol

Hyperventilation

Emergent decompression

15

Exposure Interventions

Complete disrobing

**Logroll to inspect back**

Rectal temp

Warm blankets / warming devices, prevent hypothermia

16

Secondary survey - 3 steps

Focused heat to toe exam
(similar to general exam)

Identify non-life threats
- wounds
- ortho trauma

17

After primary and secondary survey - what's next?

- Obvious violation of chest of abdomen = OR

- Otherwise, CT
> Thoracic trauma (aorta, vena cava)
> Abdominal trauma (aorta, vena cava)
> Head trauma (epidural hematoma)

18

Early screening tool for abdominal trauma

FAST exam (Focused Abdominal Scanning in Trauma)

via ultrasound

GOAL: EVALUATE FOR FREE FLUID

19

Most commonly injured organ in blunt trauma

Spleen

20

Injury which involves stomach, bowel, mesentary known as

Hollow Viscous Injury

21

Symptoms of a hollow viscous injury are a result of

Blood loss, and peritoneal contamination

22

Small bowel and colon injuries most often result from

Penetrating trauma

23

Deceleration injuries can result in what kind of abdominal injuries

Bucket-handle tears of mesentery

24

What should you suspect until proven otherwise when a patient presents with free fluid (in abdomen) without solid organ injury

hollow viscous injury

25

4 views of the FAST exam

1. Cardiac
2. RUQ
3. LUQ
4. Subrapubic

goal: evaluate for free fluid

26

General flow of trauma management in ED

1. Primary survey >> immediate life saving interventions
2. Secondary Survey >> OR, penetrating ab or chest
3. FAST >> OR, blood on FAST
4. CT head to pelvis >> OR w findings
5. Home or observation or nonemergent OR