Trauma Flashcards
(34 cards)
Name some causes of major trauma?
Assault, knife crime, road traffic collisions, jumps/fall from height, fire, industrial/work-related accident, penetrating head injuries, head lacerations, fractures hip/NOF, complex long bone fractures, pelvic fractures, rib fractures, spinal cord injuries, limb amputation, abdominal trauma
Describe the mechanism of injury of the following;
- blunt trauma
- penetrating trauma
- compression injury
- blast trauma
- Blunt force with no entry wound
- projectile that enters body causing small or large hole
- body is caught between 2 objects and compressed
- direct or indirect exposure to explosions
Describe what happens when the pelvis is fractured?
There will always be at least 2 breaks within the ring
Pelvic fracture patients may bleed into the stomach or the peritoneum
Pelvic fractures are common in falls and road traffic accidents
What is REBOA?
Resuscitative endovascular balloon occulsion of the aorta
A surgical technique that prevents the patient from bleeding out before they can be taken to theatre (by passing a small inflatable balloon into the aorta). It controls intracavity haemorrhage below the diaphragm
What is the leading cause of death in the under 45 year old age category?
Trauma
More common in males than females
What kind of way may fractures present
Compartment syndrome (may need a fasciotomy) Weight bearing restrictions Method of fixation may be complex Femoral fractures Tib/fib fractures Humeral fractures Fracture dislocation
How is abdominal trauma categorised?
- Usually categorised by what’s damaged on an injury scaling system (Grades 1-5) - splenic CT injury grading, renal injury scale, hepatic CT injury grading. Grade 1 will be a small laceration and grade 5 will be no blood supply & complete disruption to blood supply & will need surgery asap
With a FAST scan (focussed assessment with sonography for trauma) - Will then determine if they need surgery or not
What is blunt chest wall trauma?
There is no opening of the chest wall. Can vary in severity from minor bruising/isolated rib fracture to severe crush injuries which can cause respiratory compromise
How would you evaluate chest wall trauma?
Stumbl risk factors (a scoring system) Age Number of rib fractures (the more rib fractures the higher the risk of developing respiratory compromise) Pre-injury use of anti-coagulants Oxygen sats on initial assessment in A&E
Describe the different types of pain management.
Oral analgesia - paracetamol, ibuprofen, tramadol, or
PCA - morphine, fentanyl, ketamine
Nerve blocks - epidural, intercostal block, serratus anterior block
What is a penetrating chest trauma?
Is a more isolated injury
Ballistics trauma is based on velocity, calibre and design of projectile
There will be damage to lung tissue and associated bleeding
How is a fractured rib managed?
Conservative management which includes pain relief, epidural or a nerve block
If this doesn’t work then they will fix the rib (especially if there is multiple rib fractures)
Define pulmonary contusion
A pulmonary contusion/lung contusion is a bruise in or on your lungs caused by blunt force to the chest. It is different than the tearing of lung tissue because a pulmonary contusion doesn’t affect the structure of the airways.
They develop 24-72hr post injury. patient may be fine initially but later develop pulmonary contusion
Describe the inertial effect
Its a type of pulmonary contusion
Lighter alveolar tissue is sheared from heavier hilar structures due to different tissue densities at different ares of lung
(think trees)
Describe the spalling effect
Lung tissue bursts or is shear where a shock wave meets the lung tissue at interfaces between gas and liquid. It occurs in areas with large differences in density
What are the 3 different ways pulmonary contusions occur?
Inertial effect, spalling effect, implosion effect
Describe the implosion effect
When a pressure wave passes through a tissue containing bubbles of gas. The bubbles first implode, then rebound and expand beyond their original volume
The over-expansion of gas bubbles stretches and tears alveoli
(pebble in a pond)
Outline how the process of how respiratory failure occurs after chest trauma
- Damage to ribs & thorax impairs normal breathing mechanics.
Direct damage to lung tissue along with increased vascular permeability in the lung capillaries causes extra production of surfactant - Diffusional changes due to pulmonary contusions
Reduction of compliance, reduction in FRC and V/Q mismatch - Intrapulmonary shunt with hypercapnia and hypoxia
Respiratory failure
What does spinal cord injury (SCI) cause?
Loss of power and/or sensation below the level of the injury
Presentation may vary - there may be loss of loss with sensation preserved
How is SCI diagnosed?
MRI and reviewed by neurosurgeons
What is unstable SCI?
The cord has been compromised due to injury or there is a risk of compromise If this occurs patient needs to be on completely horizontal bed rest, may require a neck collar and rolling will be performed with a head hold. They may need decompression or fixation
When would the ASIA Impairment Scale (AIS) assessment be performed?
Performed on suspect cord injury.
Full motor and sensory assessment (Ax) as well as Ax of anal tone in order to classify the injury
Completed before & after surgery
A light touch and pinprick sensation Ax is performed at specific points on each dermatomal level (according to a body chart)
Describe the 5 categories of AIS
A = complete. No sensory/motor function preserved in sacral segments S4-5 (no anal tone)
B = Sensory incomplete
Sensation but no motor function below level of injury)
C = Motor incomplete
Anal tone is preserved
D = motor incomplete
At least half of key muscle functions are below a MRSC Grade 3
E = normal
Normal motor and sensation in all segments - i.e. they have recovered
What is the overall consequence of SCI on the body as a whole?
Impaired homeostasis - a disruption occurs between parasympathetic and sympathetic systems
Higher the injury the worse the effects
Autonomic dysreflexia can occur - a strong sensory input, full bladder/inability to open bowels- causes a strong sympathetic surge but the parasympathetic system cannot respond. Patients can get severe vasoconstriction, will have difficulty regulating their body temperature e.g. they will be very hot above the level of their injury and very cold below the level of the injury
