Knowledge Flashcards
Define Major Trauma?
Serious injuries of multiple where there is a strong possibility of death or disability.
What is an ISS?
Injury Severity Score - Used for multiple traumatic injuries
> 15 More = Major trauma
What is the most common injury causes long term harm and expense to the NHS?
Scaphoid Fracture
- Arthritis
- Affects the patient’s occupational activity
Which is more severe and why?
Stabbing or Shooting
Stabbing - Follows track of the knife, better outcomes, predictable
Shooting - Bullets can tumble, causes displacement of tissues, Multiple variables (Depends on bullets and kinetics)
Explain the 4 categories of injuries caused by blasts?
Primary - Blast disrupts gas filled structures (e.g Bowel perf, Lungs, Stomach
Secondary - Impact airborne debris (Surrounding detonation
Tertiary - Transmission of body (Your body is thrown)
Quaternary - All of forces (Building collapses on you)
What are the top priorities of trauma?
4 Marks
Stop bleeding
Prevent hypoxia
Prevent acidaemia
Avoid traumatic cardiac arrest
According to NICE, what is the expected time frame for securing an airway in Major Trauma?
45 Mins
What are the ABSOLUTE indications for intubation?
Inability to maintain airway. GCS <8 (Reduced LOC) Airway injury High aspiration risk Larynx trauma, Penetrating injuries to the neck, abdomen or chest
What findings would make you flag a MAJOR TRAUMA ALERT?
RR<10 or 30+
Systolic < 90 (2 Readings)
Suspected fractured Pelvis 2+ long bone fractures Amputation proximal (above) to wrist and ankle
GI Bleeds
Main Major complication of what condition?
PUD - Peptic ulcer disease
Main Presentation Signs of a GI Bleed?
Haematemesis + Melena [Both or separate]
Abdo discomfort
Dizziness
Causes of a GI Bleed
Varices - Oesophageal Gastric malignancy Oesophagus Duodenal Ulcer Gastric Ulcer
Main Ix
GI Bleeds
Bloods - MONITOR HB, LFTs, FBC, Clotting
OGD - Gastroscopy
What are the key differentials to consider for life-threatening blood loss?
Ruptured AAA, GI Haemorrhage, Obstetric Emergencies - APH/PPH, Recent surgery
BLOOD on the FLOOR and 4 MORE -
What are the main sources of bleeding in trauma?
Blood on FLOOR and 5 MORE
Floor - Obvious external bleeding Thorax Abdomen Pelvis Long bones Retroperitoneal - Non-obvious concealed bleeding
What are the primary survey investigations that should be completed for trauma?
Looking for blood loss
AP CXR
AP Pelvis XR
FAST Scan - Occult intra-abdominal/cavity bleeding
Polytrauma CT Scan (Pan-CT) - Identify missed injuries/sources of bleeding
Lactate bloods
What marker is useful for assessing shock severity?
Lactate - <4mmol/L associated with INCREASED MORTALITY
Immediate actions that can be done A+E to control bleeding?
Tourniquet application
Splint/bind fractures
Suture/Tie off bleeding vessels
Direct pressure/haemostatic dressings to wounds
What is the LETHAL TRIAD in trauma that are irreversible and lead to DEATH?
How each lead to compromise?
HAC
Hypothermia - Impairs platelet function and enzymatic function within the clotting cascade
Acidosis - Inadequate tissue perfusion leads to lactic acidosis which can impair clotting
Coagulopathy - Hypothermia and acidosis both help to aggravate it (Multifactorial)
Primary - Acute, traumatic (Tissue injury, Shock, Hyperfibrinolysis, systemic anticoagulation mediated by protein C)
Secondary - Iatrogenic - HAC (Dilution, Consumption of coagulation factors)
How can Acidosis be avoided in Trauma?
Maximise oxygenation and minimise causes of hypoventilation to avoid any additional respiratory acidosis.
Avoid giving 1-2L of crystalloid at the outset. (crystalloid administration which also has a dilutional anaemia effect. Restore tissue perfusion ASAP with haemostatic resuscitation)
Define Haemostatic resuscitation?
Process of restoring and sustaining normal tissue perfusion of a patient presenting in uncontrolled haemorrhagic shock.
2:1:1
Packed RBCs: Fresh Frozen Plasma: Platelets
Tranexamic acid (1g Bolus + 1g over 8Hrs)
Maintain circulating volume
Preservation of effecting clotting
Prevent lethal triad
Define Permissive Hypotension?
AKA Hypotensive Resus
Act of maintaining a blood pressure lower than physiologic levels to maintain adequate vasoconstriction, organ perfusion, and prevent an undesired coagulopathy during initial fluid resuscitation.
TARGET - 65mmHg (Head injury - Higher value)
Reasons Permissive hypotension is used?
Avoid disruption of an unstable clot by higher pressures and worsening of bleeding (“don’t pop the clot”)
Lower SBP as a compromise pending emergency surgical intervention
Target values for permissive hypotension?
TARGET - 65mmHg (Head injury - Higher value)
If MAP < 65 – give fluids/ blood products
If MAP > 65 – check perfusion (strong pulse, warm peripheries)
> 65+good perfusion = Masterful inactivity
65+ poor perfusion = Fentanyl 25mcg(Vasodilation + reducing adrenaline release)
Allow SBP to fall low enough to avoid exsanguination but keep high enough to maintain perfusion.
