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Flashcards in ED - Trauma Management + ATLS Deck (67)
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1

When does ATLS start and what is important

Time of injury
Platinum 10 minutes
Golden hour

2

What is important to know pre-hospital

Mechanism of injury
If RTA - where sitting / where they thrown?
Time of injury
Suspected serious injuries - LOC / head injury / neck pain
Vital signs
Any interventions

3

What is put out

Trauma call to all teams
Anaesthetist
ED
ITU
Surgical
Radiology

4

What is important in the history

AMPLE
Allergies
Medication
PMH / pregnancy
Last meal
Events / environment relating to injury

5

What is the primary assessment

CABCDE
Restart if any changes

6

C

Catastrophic haemorrhage control
- Tourniquet
- Pressure

7

A

Airway with C-spine control
Always stabilise C-spine and never put into recovery if suspect injury
Always assume C-spine injury in major trauma till proven otherwise
- Triple mobilisation with collar, block and tape
- May not need collar if able to cooperate and keep head still
- Beware of patient with AS when immobilisation C-spine due to subluxation and risk of fracture and nerve damage

8

What do you look for in A

Noises
- Speech suggest patent
- Stridor = worrying so DEAL
Visual
- Any swelling / deformity / blood / vomit
- Can suction away any visible foreign body

9

How do you manage airway

Chin lift jaw thrust
Oropharyngeal airway - guedel
Nasopharyngeal airway
Endotracheal intubation
Needle / surgical cricothyroidectomy
Intubation

10

What do you avoid in trauma and why

Nasopharyngeal
Incase of basal skull fracture

11

When do you intubate

If reduced GCS <8
Requires anaesthetic
Continuous capnograpy after

Tension pneumothorax will get worse after ventilation

12

What requires urgent aesthetic assessment

Impending obstruction

13

What do you do for C-spine

Consider early on
Immobilise

14

When do you assume C-spine injury

Dangerous mechanism
Reduced GCS
Injury above clavicle
Any neurology

15

B

Breathing

16

What do you look for in B

Look and felt chest including posterior aspect
- Want to see if any stab areas / open wound
- Any bruising
- Look for distended or flat neck veins
- Distended = tamponade / SVC obstruction
- Flat = hypo

Work and effort of breathing
- Use of accessory / abdominal

Chest expansion
Tracheal position - should be central
JVP fdifficult to do in trauma
Palpate and percuss
Ausculate
O2 sats
Get CXR

17

What is important to look for

Any flair segment or signs of pneumothorax
- Tracheal deviation = late sign in tension
- Decreased movement / unequal expansion / no air entry / hypo and low sats and look unwell = suggestive
- Will go into cardiac arrest

Underlying fracture
- Subcut emphysema - crepitus on palpation (due to pneumothorax or gas producing infection)
- Pneumothorax
- Flail chest

Bruising or open wounds

18

What are 6 main causes of breathing problems in trauma

ATOMFC
Airway obstruction
Tension pneumothorax
Open pneumothorax / Sucking Chest injury
Massive haemothroax
Flail chest
- 2+ rib broken next to each other in 2 places causing portion of rib cage to be separated from the chest wall
- Get parodical movement of flail / bruising when chest moves
Cardiac tamponade

19

How do you manage B

15l O2 non-breath for all trauma
Decompress pneumothorax
- Wide bore cannula into 2nd IC space midclavicular will decompress
- Need chest drain if in hospital
Decompress haemothorrax with chest drain if in hospital
High flow O2 - 15l non-rebreath
O2 monitoring
ABG
CXR

20

C

Circulation + haemorrhage control

21

What is shock in a trauma patient

Hypovolaemic until proven otherwise

22

How do you assess and what imaging

HR
Pulse
Pulse pressure
CRT
BP
Urine output
Confusion
Colour and temp
Hb and lactate on VBG will give good idea
USS / CT

23

What are common sites of blood loss

Floor and 4 more
Haemothorax
- Will detect on chest exam / CXR
Abdomen
- Peritonism / rigid + shock
Pelvis
Long bones - femur
- Look swollen / brusised / tender

24

Options for haemorrhage control

Direct pressure
Pelvic binder if pelvic fracture
Thomas splint for femur fracture

25

How do you value replace

IV access - 2 large bore
Get bloods - can see Hb drop
X-match
Catheter to see UO
O2
Fluid resus
Massive transfusion protocol

26

If can't get vein what are options

IO access for max 48 hours
Tibial tuberosity
Proximal humerus
Distal femur

27

What type of fluid do you give

Want to replace blood lost with blood and clotting
4 units O neg blood in ED
Whilst waiting for blood can give crystalloid resus but will eventually dilute and won't clot
Need to replace clotting to prevent DIC
Give tranexamic acid

28

How do you monitor replacement and response

Vital signs
Want high enough BP to perfuse organs
UO hourly
Lactate
Repeat gas

29

What is lethal triad of haemorrhage

Coagulopathy
Acidosis
Hypothermia

30

Wha scan to look of bleeding

FAST
- Focussed assessment with sonography in trauma