Primary Survey (Trauma) Flashcards
(27 cards)
Principle of Primary Survey
To identify immediate life threatening conditions and rectify it once identified
Components of Primary Survey
A: Airway + cervical immobilization
B: Breathing and Ventilation
C: Circulation and Hemorrhage control
D: Disability
E: Exposure and environment control
Indication for definitive airway
- GCS 8 or below
- Severe maxillofacial trauma
- Aerodigestive tract injury (larngyeal/tracheal injury)
- Protect from aspiration (bleeding/vomiting)
- Need for ventilation
How to assess for difficult airway?
LEMON
- L: Look for evidence
- E: Evaluate using 332 rule
- M: Mallampati classification
- O: Obstruction
- N: Neck mobility
Mallampati classification
- Class 1: soft palate, uvula, fauces, pillars
- Class 2: soft palate, uvula, fauces
- Class 3: soft palate, base of uvula
- Class 4: only hard palate
What is the 332 rule?
- Intercisor distance: 3FB btw incisor teeth
- Hyomental distance 3FB btw hyoid and chin
- Thyromandibular distance: 2FB btw thyroid notch and floor of mouth
What is rapid sequence induction?
Rapid intubation without need for manual ventilation. Induction agent given immediately followed with muscular relaxant
Preparation of equipment for RSI
- Pre-oxygenation (+/- bag valve mask)
- IV access
- Drugs: induction, muscle relaxant
- Direct laryngoscope, ET tube, bougie, suction
- CO2 capnogram
Mneumonic for RSI equipment and planning
SOAPME
- Suction
- Oxygen (BVM)
- Airway: ET tube, stylet / bougie, direct laryngoscope (blade + handle), syringe for test balloon, backup surgical cric kit
- P: preoxygenation
- Monitoring equipment/ Medication
- End-tidal CO2
Induction agents for RSI
Etomidate (0.3mg/kg)
Propofol (2mg/kg)
Muscle relaxants for RSI
Succinylcholine (2mg/kg) (preferred) depolarizing NMB
Rocuronium (1mg/kg) non-depolarizing NMB
Indication for surgical airway
- Failed intubation
- Glottis edema
- Laryngeal fracture
- Severe oropharyngeal bleeding obstructing airway
Needle cricothyroidotomy
12-14G angio-catheter + jet ventilation
How to perform a surgical cricothyroidotomy
- Supine with neck in neutral position + c-spine immobilization
- Aseptic technique +/- LA
- Stabilize thyroid cartilage with left hand
- Palpate cricothyroid membrane with right hand + transverse incision over
- Incise through membrane
- Use left hand to insert tracheal spreader
- Use right hand to insert ET tube
- Inflate and check position
What is the technique for C-spine immobilization
Use two palms to hold shoulders
Keep C-spine inline with body using ulnar side of both forearm
Life threatening conditions related to Breathing
Tension pneumothorax
Open pneumothorax
Massive hemothorax
Flail chest with lung contusion
Cardiac tamponade
How to insert a central venous line to IJV
- Supine, head down
- Large bore needle
- Locate R IJV by apex of triangle formed by 2 heads of SCM
- insert needle at 30 degrees with syringe toward ipsilateral nipple
- remove syringe, occlude needle to prevent air embolism
- insert guidewlire, removed needle, insert catheter
Landmark of subclavian artery
- 1 cm below the junction of middle and medial third of clavicle
- Direct medially, slightly cephalad and posteriorly behind the clavicle, towards sternal notch
Puncture site for intraosseous needle
- Anteromedial surface of proximal tibia, 1 FB below the tubercle
- First at 90 degree, after gaining purchase, direct at 45 towards to foot
- Flush catheter
Definition of rapid responder
- responds quickly
- estimated blood loss < 20%
- no further fluid/blood needed
Definition of transient responder
- responds initially but slowly deteriorate afterward
- likely inadequate resuscitation or ongoing blood loss
- estimated 20-40%
Definition of transient responder
- responds initially but slowly deteriorate afterward
- likely inadequate resuscitation or ongoing blood loss
- estimated 20-40%
Definition of non-responder
- Exsanguinating hemorrhage, >40%
- Immediate blood transfusion with unmatched blood
- Activation of massive blood transfusion protocol
Primary survey adjuncts
ECG
Foley
Blood test
XR (lateral C-spine, AP CXR, AP Pelvis)
FAST
