TARMS Flashcards
(42 cards)
When do deaths from trauma occur?
In a TRIMODAL distribution:
- At time of injury (seconds to minutes)
- Minutes to hours post injury
- Day to weeks post injury
How do we assess the severity of trauma?
With TRAUMA SCORES
ISS (injury severity score) most commonly used, others include AIS (abbreviated injury score), RTS (revised trauma score)
How should you initially assess a patient with trauma?
- Airway and cervical spine control
- Breathing and ventilation (oxygenation)
- Circulation with haemorrhage control
- Disability and neurological status
- Exposure (trauma observation) and environmental control (pain, temp)
What extra considerations should you have when assessing an airway of a trauma patient?
ALL NORMAL THINGS (stridor, obtundation, snoring, trachea central, paradoxical movements)
+
Facial injuries/burns
Neck wounds
Epistaxis or vomiting
Head injury leading to low GCS (GCs<8 intubate)
C-SPINE INJURY - might impact airway manoeuvres
What things should be considered in BREATHING primary survey?
Summarised by ATOM FC
- Airway obstruction
- Tension pneumothorax
- Open chest wound
- Massive haemothorax (>1500mL)
- Flail chest (2 or more ribs broken in 2 or more places - indicates high force injury)
- Cardiac tamponade
When assessing circulation in trauma what should we be assessing/looking for and what are some common types?
Main concern is SHOCK:
- Assess pulse (rate rhythm character),
- Blood pressure
- Heart rate
- CRT (peripherally and centrally)
- Skin temperature
- Urine output / consciousness level
CAUSES OF SHOCK IN TRAUMA
- Haemorrhagic, Cardiogenic, Neurogenic, Obstructive
What is the most common form of shock in trauma and where can volume commonly be lost?
-Hypovolaemic (haemorrhagic). Blood loss commonly described as being OCCULT (meaning hard to discern).
‘one on the floor and four more’
CHEST, ABDO, PELVIS and LONG BONES (esp femur)
If you suspect someone is loosing a lot of blood and is shock how should they be initially managed?
- AIRWAY AND OXYGEN
- STOP BLEED (splints/binder/tourniquets/direct pressure)
- REPLACE CIRCULATING VOLUME (permissive hypotension-reduce risk of clot dislodge and further bleeding)
- Get access 2x Wide-Bore Cannulas into each ACF
- FBC/UsEs/LFT/amylase/coagulation/crossmatch/VBG
- Warm crystalloid fluid whilst waiting for O-negative blood
- RESTORE HEAMAGLOBIN
- Activate major haemorrhage protocol
- Red cells and FFP in a 1:1 ratio (and 1 platelets if required)
- Tranexamic acid if active haemorrhage <3 hours since trauma)
- TREAT CAUSE
How does TXA work?
Tranexaminc acid binds to lysine receptors on plasminogen which prevents plasmin from being used and degrading fibrin (prevents clot breakdown)
What does the massive transfusion protocol include?
4 units red cells 4 units FFP
Can give O- blood if waiting for cross match but group specific blood should be given as soon as possible because O- is scarce resource
Also always give TXA
What should be included on your disability assessment for a trauma patient?
A thorough assessment for any head trauma is necessary
GCS, Pupil response (important for head injury)
ALWAYS GET GLUCOSE HERE
Where is the most common area of the spine to be affected in trauma?
Cervical region (55%)
What kinds of things can cause secondary injury to the spine?
Hypoxia, hypotension, hypoglycaemia or mechanical disturbances due to inappropriate moving or positioning
What are the four main types of spinal cord injury to be aware of?
Anterior cord syndrome
Central cord syndrome
Brown-Sequard Syndrome
Complete spinal cord syndrome
How does anterior cord syndrome present?
What causes it?
- Bilateral loss of motor, pain and temp below lesion
- Caused by flexion injury
How does central cord syndrome present? Who is it more common in?
- Sensory and motor loss
- paralysis ARMS>legs (man in barrel)
- OLDER people with cervical neck disease (hyperextension injury)
How does Brown-Sequard syndrome present?
When does this happen
Hemisection of cord
- Ipsilateral motor/vibration/proprioception
- Contralateral pain and temperature
- most commonly seen after knife injury or sometimes when tumour compresses one half
***this is because fibres in the spinothalamic tract decussate at the level of the spinal cord whereas dorsal column fibres cross over at the pyramid level
How do we assess whether someone might have a C-Spine injury?
Using the CANADIAN C-SPINE RULE
1. Any high risk factors? (65, drive, deprived)
-sixty five
-fast drive (dangerous mechanism)
-sensory deprived (paraethesia in extremities)
IF YES>CT (image if alive) IF NO> go to question 2
- ANY low risk factors?
-slow wreck (simple mechanism)
-slow neck (delayed neck pain)
-sitting down
-walking round (ambulatory at any time)
-C spine fine (absence of midline C spine tenderness)
IF YES>range the spine IF NO>CT - Able to rotate neck 45 degrees left and right?
IF YES> DONT CT IF NO>CT
How should a patient with a suspected spinal injury be managed?
Optimise oxygenation Prevent blood pressure drops to maintain perfusion to spinal cord Immobilise Urinary catheter Definitive imagining Early specialist advice
What are the three factors of the trauma triad of death?
Coagulopathy, hypothermia and metabolic acidosis
Explain how the three aspects of the trauma triad of death feed into one another
HYPOTHERMIA LEADS TO COAGULOPATHY
- Imbalance between thromboxane and prostacyclin meaning clotting cascade not as efficient. This is why it is essential to warm a patient during trauma care (blood products and fluid resuscitations should also be warmed)
COAGULOPATHY LEADS TO METABOLIC ACIDOSIS
Poor distribution of blood means ischaemic tissues and hypoxia leading to lactic acidosis. Acidaemia reduces cardiac output, exacerbating the shocked state and causing right shift to oxygen dissociation curve
METABOLIC ACIDOSIS LEADS TO HYPOTHERMIA
Poor CO means less perfusion and worsening hypothermia
How are pelvic fractures managed?
Pelvic binders commonly placed pre-hospital (prevents movement of pelvis and hopefully encourages stasis of any blood loss)
What is an emergency complication of bone fractures?
COMPARTMENT SYNDROME
Pressure builds up in muscular compartment - sometimes pressure builds up so high that it can occlude blood vessels leading to death of the limb
- FASCIOTOMY needed to treat
Landmarks for a chest drain?
- lateral edge of pec major
- lateral edge of lat dorsi
- base of axilla
- 5th ICS
