ED - Trauma Management + ATLS Flashcards
(67 cards)
When does ATLS start and what is important
Time of injury
Platinum 10 minutes
Golden hour
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
What is put out
Trauma call to all teams Anaesthetist ED ITU Surgical Radiology
What is important in the history
AMPLE Allergies Medication PMH / pregnancy Last meal Events / environment relating to injury
What is the primary assessment
CABCDE
Restart if any changes
C
Catastrophic haemorrhage control
- Tourniquet
- Pressure
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
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
How do you manage airway
Chin lift jaw thrust Oropharyngeal airway - guedel Nasopharyngeal airway Endotracheal intubation Needle / surgical cricothyroidectomy Intubation
What do you avoid in trauma and why
Nasopharyngeal
Incase of basal skull fracture
When do you intubate
If reduced GCS <8
Requires anaesthetic
Continuous capnograpy after
Tension pneumothorax will get worse after ventilation
What requires urgent aesthetic assessment
Impending obstruction
What do you do for C-spine
Consider early on
Immobilise
When do you assume C-spine injury
Dangerous mechanism
Reduced GCS
Injury above clavicle
Any neurology
B
Breathing
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
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
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
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
C
Circulation + haemorrhage control
What is shock in a trauma patient
Hypovolaemic until proven otherwise
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
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
Options for haemorrhage control
Direct pressure
Pelvic binder if pelvic fracture
Thomas splint for femur fracture
