MSK - Life and Limb Threatening Trauma Flashcards
(47 cards)
What is ATLS?
Advanced Trauma Life Support
What is A for in A->E? Explain the process and possible treatment.
Airway
Talking and alert?
Noises e.g. snoring, stridor
No noises
- Facial injuries put airway at risk
To treat:
Suction, removal of foreign body, Intubation
All trauma patients have high flow O2
C-spine control!
What is B for in A->E? Explain what you are to looking for?
Breathing
Thorasic cavity healthy or full of blood or air?
Is the thorasic cage damaged?
What should you inspect for when assessing breathing in A->E?
- Inspection: Evidence of chest injury, increased respiratory effort, asymmetrical chest
What should you palpate for when assessing breathing in A->E?
- Palpate: central trachea deviation, chest wall expansion, percussion (dull or hyper-resonate?)
What should you auscultate for when assessing breathing in A->E?
-Auscultation: Bubbling/gurgling noises, symmetrical air entry?
What Vital signs should you look for for when assessing breathing in A->E? (4)
SpO2
RR
Pulse
BP
What is a tension pneumothorax? (4 steps)
- Penetrating trauma makes hole in chest wall allowing air to be drawn in but preventing air from escaping.
- With each inspiration more air enters thorasic cavity, causing collapse of the lung and increased pressure inside.
- Pressure pushes mediastinum to the other side quashing remaining lung, compromising breathing.
- As pressure high enough to equal that in the great ving there is reduced venous return and eventually cardiac arrest.
What is the clinical diagnosis for a tension pneumothorax? (4)
- Decreased breath sounds on affected side
- Increased percussion note (Hyperresonant)
- Palpation finds deviation of trachea AWAY from affected side
- Engorged neck veins and reduced lung expansion.
How do you treat a tension pneumothorax?
- Insertion of a large bore needle through the chest wall at the 2nd intercostal space midclavicular line in adults and 5th intercostal space midaxillary line in children.
- Chest drain within 30 mins.
what is an open pneumothorax? (4)
- ‘Sucking chest wound’
- Air passes into thorasic cavity through path of least resistance through wound in chest wall, by-passing the lungs.
- Air expired through same hole, hence no tension effect
- Unable to oxygenate blood
How do you treat an open pneumothorax?
- Creating a one way valve only allowing air to escape.
- Place an occlusive dressing over the wound and tape on 3 sides.
- Chest drain needed for definitive management
What is a Flail chest?
2 or more ribs fractured in two or more places causing separation of a segment of the thorasic cage which moves independently, preventing effective ventilation.
How do you treat a flail chest?
Fix fractures with plates and screws to allow recovery, there is often over underlying injuries too.
What is the C for in A->E? What should you do to asses? (3)
Circulation - with hemorrhage control
- Recognise if circulation is compromised, could be pale, assess peripheral circulation, heart sounds, pulse and BP
- Establish x2 IV access allowing rapid fluid resis and blood samples.
- Control obvious sources, external pressure on peripheral wounds, pelvic binding to prevent exsanguination and hidden blood loss.
What is a massive haemothorax?
> 1500 mls of blood in the pleural cavity causing circulation and respiratory problems.
How do you treat a massive haemothorax?
Chest drain to decompress lungs, blood products to replace lost and cardiothoracic surgery to close the source.
What is a cardiac tamponade? (3)
Condition that can occur from penetrating trauma to the thorax.
As pericardium is a fixed sac like the skull, small pressure increased from blood in cavity had a big effect.
Leads to inability to pump in systole and dilate to fill during diastole.
What is the presentation of a cardiac tamponade?
Becks triad:
- Hypotension due to decreased stroke volume
- Jugular venous distension due to impaired venous return to the heart
- Muffled heart sounds due to fluid inside the pericardium
What is the treatment for a cardiac tamponade?
Pericardiocentesis = ultrasound guided insertion of the needle just under the xiphisternum aiming up to puncture the pericardium and extract blood that has collected there.
Urgent referral to cardiothoracics to identify and stop the cause of bleeding.
What is shock? (3)
- End organ dysfunction due to inadequate oxygen availability for tissues (perfusion). Upset of balance between Oxygen delivery and demand.
- Particularly effects oxygen sensitive tissues cardiac, gut, brain, renal.
- Organs keep functioning in the absence of oxygen, so metabolic acidosis develops from non-aerobic respiration which progresses to the lethal triad.
What is the lethal triad of trauma associated with shock?
- ACIDOSIS: pH <7.25, Base excess <-5 mmol/L, Lactate >2.5 mmol/L
- HYPOTHERMIA: <35 degrees temperature
- COAGULOPATHY: INR >1.5 Platelets <120 x10^9 /L
What types of shock are due to reduced delivery of O2? (4)
- Anaphylactic shock from constriction of blood vessels
- Cardiogenic shock due to inability for blood to pump
- Hemorrhagic shock due to loss of blood
- Neurogenic shock due to lack of nerve signals to blood vessels because of spinal cord damage
What type of shock is due to increased oxygen demand?
- Septic shock: when tissues metabolise faster to fight infection
