ATLS - Primary Survey Flashcards
What is the initial trauma assessment
Do they need to be managed in a trauma center or on the scene
- airway issue => ED
- if not => trauma center
Airway + Anaesthetist Axial/cervical spine control (ASSUME SPINAL INJURY UNLESS PROVED OTHERWISE) Breathing + oxygen Circulation + bleeding control Disability Exposure
Primary survey (DRABC) => reevaluate
Resuscitation => reevaluate
Secondary survey => reevaluate
Definitive care
Describe the assessments done in the ED before the patient arrives
Ambulance control alert received
- anticipate injuries => assemble appropriate team members
- define roles
- prepare kit needed
- universal precautions and protection
Rapid critical and definitive intervention
Consists of an MDT
C spine protection
- equipment
- no equipment
Protect with collar or blocks+strap
Manual in-line immobilisation
-chin lift, jaw thrust
NO HEAD TILT
Who is at high risk for cervical spine injuries -high risk -low risk -no risk How would you manage these patients
High risk => spinal immobilisation
- 65+
- dangerous MOI
- numb limbs
Low risk + cannot actively rotate neck => spinal immobilisation
- minor rear end vehicle collision
- sitting comfortably
- walking
- no Cspine tenderness
- delayed neck pain
No risk
- low risk + can actively rotate neck 45deg to side
- no pain
How would you protect the airway
- what equipment could you use
- when would you use a definitive airway
Clear airway
- suction
- airway adjuncts (nasopharyngeal, orophrayngeal if unconscious)
Definitive airway - secured tube in trachea with inflated cuff if
- poor ventilation (exhaustion, mechanical injury)
- potential airway compromised (hoarse voice => laryngeal edema, could cause problems later)
- spontaneous airway protection not possible
Airway maintenance
Obstruction? => suction secretions, remove obstruction if possible
Conscious? => Nasopharyngeal unless head and facial trauma involved
Unconscious? => Oropharyngeal
Intubation if
- impending airway obstruction
- respiratory insufficiency
- multisystem trauma with shock
- GCS U9
Definitive airway
- cuffed oroendotracheal tube (orotracheal/nasotracheal)
- LMA
Surgical airway
- cricothyroidotomy
- tracheostomy
Airway
What would you assess in breathing
- examination
- investigations
- what conditions are you looking out for
- immediate management
Examination
- RR, SpO2
- Inspect, palpate, percuss, auscultate
Investigations
- CXR
- ABG
- capnography
Tension pneumothorax Flail chest Hemothorax/pneumothorax Cardiac tamponade Airway obstruction
NRM 15L high flow O2 if not intubated or ventilated
How would you manage
- tension PT
- open PT
- hemothorax
- cardiac tamponade
HYPERRESONANCE + TRACHEAL DEVIATION
BP starts dropping - tracheal deviation is the last sign
Tension pneumothorax initial => large bore cannula 5ICS ant MAL
-easier, less fat, muscle, easier to access
TP definitive => chest drain
Open pneumothorax => occlusive dressing and chest drain
Haemothorax => chest drain
Cardiac tamponade => pericardiocentesis
Signs of tension pneumothorax
SHOULD NOT SEE TP ON CXR, IF YOU SUSPECT TP => STAB
- resp distress
- pleuritic chest pain
- distended neck veins
- lack of breath sounds unlaterally
- falling BP
- hyperresonance
- tracheal displacement, cyanosis
Signs of cardiac tamponade
Hypotension
Raised JVP
Muffled heart sounds
Pulseless electrical activity
FAST scan must be done
Signs of shock
-causes of shock
Changes in mental state, anxious
Low BP, High HR, RR
Cold clammy skin
Low urine output
Base excess - measure of degree of shock
% of blood loss
Group and crossmatch 6 units -
Haemorrhagic - blood loss
Non haemorrhagic
-TP, CT, cardiogenic, neurogenic, septic
How would you assess for bleeding and circulation
- assessment
- immediate management
Assessment
- skin colour, temp
- HR, BP, CRT, warmth of peripheries
- remove all dressings
- floor, CAP (for tenderness), retroperitoneal, long bones
Immediate management
- 2 large bore IV cannula (orange, pink paeds) in elbow fossa
- FBC, U&E, LFT, CRP, G&S, lactate, toxicology, coagulation
- Struggle to get IV access => IO drill in proximal humerus
- urinary output - most sensitive for shock but takes time
How would you address any bleeds
Early hemorrhage control
- reverse AC
- direct pressure, splint fractures
Active major/suspected active bleeding - IV tranexemic acid
Active bleeding - restrict fluid resus until definitive bleeding control achieved
Pelvic binder, femur splinting
Surgery
Blood products
-RBC + FFP
How would you assess disability
Pernicketiness - GCS, AVPU Pupils - papilledema => increased ICP Gross motor and sensory in limbs Glucose Lateralising signs - wiggle fingers and toes, plantars if unconscious
Plantars - UMN issues
Power
Protruded tongue
How would you manage a major head injury
WANT TO PREVENT 2NDARY BRAIN INJURY ABCD -protect airway -adequate O2 and ventilation -maintain MABP -monitor GCS and pupil response
Treat high ICP
- 30 degree bed
- intracranial bleeds => neurosurgery
- cerebral edema => diuretic, ventilate
