Multitraumer Flashcards

1
Q

Concepts of Initial Assessment

A

Preparation

Primary survey
Resuscitation
Adjuncts

Reevaluation

–>

Deailed secondary survey
Resuscitation
Adjuncts

–>

Reevaluation

Definitive care

Initial assessment and management refers to the entire process of evaluating, treating, conducting a detailed head-to-toe evaluation, reevaluating the patient, and transferring that patient, as necessary, to a facility with the resources to provide optimal care.

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2
Q

Primary survey?

A

ABCD

Airway, C spine
Breathing
Circulation (hemorrhage)
Disability (neuro)
Exposure

Primary survey and resuscitation of vital functions are done simultaneously using a team approach.

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3
Q

Hurtig vurdering af ABCD

A

Ask the patient his or her name

Ask the patient what happened

Emphasize the need for adequate cardiac output to ensure clear sensorium.

The patient who fails this simple test needs immediate attention.

Inappropriate or no response requires urgent intervention.

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4
Q

Specielle considerationer ved primary survey?

A

Elderly – diminished reserve, cormobidity, meds → early decompensation.

Pediatric – early compensation, sudden deterioration – aggressive approach.

Pregnancy – 2 patients – best treatment is resuscitation of the mother.

Athlete – compensate because of reserve. Lack of tachycardia early.

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5
Q

A- Airway

Pittfalls

A

Occult airway injury

Progressive loss of airway

Equipment failure

Inability to intubate

Emphasize the need to protect the c-spine during airway management, especially avoiding the ACLS head-tilt maneuver.

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6
Q

B- Breathing

Pittfalls

A

Airway versus ventilation problem?

Iatrogenic pneumothorax or tension pneumothorax?

Emphasize the need to attend to adequate oxygenation and ventilation in the injured patient, recognizing that altered chest wall mechanics may be new to those doctors who have taken only the cardiac life support course.

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7
Q

C- Cirkulation

Pittfalls

A

Elderly
Children
Athletes
Medications

Emphasize the need to control hemorrhage or stop the bleeding.

Explain that hemorrhage is the major source of hypoperfusion in the trauma patient and the prime goal is to identify and stop the hemorrhage.

The different responses of the elderly, child and athlete to hypoperfusion and the effect of medications such as B-blocker should be discussed.

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8
Q

D- Disability

Pittfalls

A

Observe for neurologic deterioration

Emphasize that it is essential to identify neurologic injury using the tools of GCS score and pupil response early in order to avoid secondary brain injury, identify surgically correctible lesions rapidly, and provide a baseline GCS score to identify trends and changes.

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9
Q

E-Exposure

Pittfalls

A

Prevent
Hypothermia

Missed injuries

Emphasize the need to completely undress the patient to adequately assess the entire patient, while at the same time preventing hypothermia.

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10
Q

Resuscitation

A

Protect and secure airway

Ventilate and oxygenate

Stop the bleeding!

Blood resuscitation - balanced

Protect from hypothermia

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11
Q

Adjuncts to Primary Survey

A
EKG
Vitale tegn
Urin
ABGs
Puls
Pximeter
CO2
Katetre

Afhænger af skaden osv.

The primary purpose of these adjuncts during the primary survey is to determine where occult bleeding may be occurring that is not obvious on clinical exam.

Emphasize the need to determine the source of shock.

Portable chest and pelvic x-rays in the emergency department are the ONLY x-rays obtained during the primary survey.

These x-rays assist in identifying the cause of shock in “C” of the A, B, C’s of the primary survey.

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12
Q

Secondary Survey

A

The complete history and physical examination

Mechanisms of Injury

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13
Q

When do I start the secondary survey?

A

Primary survey is completed

ABCDEs are reassessed

Vital functions are returning to normal

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14
Q

Adjuncts to Secondary Survey

A

Special Diagnostic Tests as Indicated

Pittfalls:

  • Patient deterioration
  • Delay of transfer
  • Deterioration during transfer
  • Poor communication

These include specialized radiographic studies.

Emphasize that adjuncts should NOT delay appropriate transfer to definitive care.

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15
Q

How do I minimize missed injuries?

A

High index of suspicion

Frequent reevaluation and monitoring

_____

Emphasize that meticulous attention to detail, integrated with clues from the mechanism of injury and physical findings, and continued reassessment, are the best methods to avoid missed injuries.

Some institutions conduct a “tertiary” survey within 24 hours of admission to assess for missed injuries.

Missed injuries are avoided by frequent re-evaluation , monitoring and having a high index of suspicion.

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16
Q

Pain Management

A

Relief of pain / anxiety as appropriate

Administer intravenously

Careful monitoring is essential