Trauma Flashcards by Kiara Maieron

Recite the CPG for Haemorrhagic hypovolaemia

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Recite the CPG for Chest injuries

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Recite the CPG for Traumatic head injuries

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Recite the CPG for Spinal Injuries

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Recite the CPG for Fracture dislocation and management

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Recite the CPG for Diving Related Emergencies

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In what timeframe should a major trauma be transported to a trauma center?

within 1 hour from the incident

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In what timeframe should a major trauma be transported to a trauma center?

within 1 hour from the incident

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Whats the aim of scene time in an untrapped trauma?

20 mins

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Whats the aim of scene time in an untrapped trauma?

20 mins

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What are the 3 time critical categories?

actual
emergent
potential

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What is actual time critical?

at the time the VSS was taken, the patient was in actual physiological distress

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What is emergent time critical?

At the time the VVS was taken, the patient was not physiologically distressed but does have a pattern of injury or significant medical condition which is known to have a high probability of deteriorating to actual physiological distress.

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What is potential time critical?

At the time the VVS was taken, the patient was not physiologically distressed and there was no significant pattern of actual injury/illness but there is a mechanism of injury/illness known to have a potential to deteriorate to actual physiological distress.

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In the setting of potential major trauma an adult is considered ACTUAL time critical if they meet these vital sings…

HR < 60 or > 120
RR < 10 or > 30
BP < 90
GCS < 13 (if pt > 16 yo)
GCS < 15 if pt < 15
SpO2 < 90%

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What specific injuries meet Major trauma criteria (emergent)

All penetrating injuries
- (except superficial limb)

Blunt injuries

Specific injuries
- limb amputation or limb threatening injury
- suspect SCI or #
- Burns >20% TBSA (<10% if <15 years) or suspected resp tract burn
- High voltage (>1000 volts) burn injury
- Serious crush injury
- Major compound fracture or open dislocation
- Fracture to two or more of femur/tibia/humerus
- Fractured pelvis

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What is the high risk criteria for Major trauma?

MVA/cyclist impact >30km/hr
high speed MVA >60km/hr
Pedestrian impact
Ejection from vehicle
Prolonged extrication
Fall from height >3m
Struck on head by onject falling >3m
Explosion

and co-morbidities
- Age <12 or > 55
- Pregnant
OR
- significant underlying medical condition

From what gestational age is considered a pregnant trauma, and In what time frame should a pregnant trauma be transported and where

> 24 weeks gestation
transported within 45 mins
to RMH

What vital signs indicate ‘red flags’

HR > 120
RR >30
SBP <90
SpO2 <90%
GCS <13

What specific condtiions are considered red flags

stridor
first presentation seizure
anaphylaxis
ACS
ectopic pregnancy
primary obstetric issue
stroke/TIA
sudden onset HA
unable to walk (when usually able)
post-tonsillectomy bleeding (of any amount) up to 14 days post op

what are the clinical yellow flags?

ongoing patient or carer concern
infection non responsive to community care
immunocompromised with suspected infection
surgical procedure in last 14/7
unexplained pain >5
syncope
abdo pain

what are the paediatric TCG?

Recite the CPG for Tension Pneumothorax

What is the NEXUS criteria?

Increased injury risk
- Age >65
- Hx of bone or muscle weakening disease/injury

Difficult patient assessment
- ACS
- Intoxication
- Significant distracting injury

Actual evience of structural injury
- Midline pain/tenderness on palpation of the vertebrae

Neck range of motion
- patient unable to actively rotate neck 45 degees left and right without pain

Define tension pneumothorax

* Ongoing escape of air into the pleural space through a one way flap or valve. Air enters the pleural space during inhalation but cannot escape during exhalation. * The increasing pressure in the pleural space leads to collapse of the lung on the affected side, with associated hypoxia as the lung’s gaseous exchange is compromised. * This creates a tension on the internal structures, eventually compressing them and impeding their ability to function * This pressure also tends to push the mediastinum in the opposite direction (evidenced by tracheal deviation AWAY from the affected side). * Intrathoracic pressure also increases as a result which overcomes the pressure of venous return. This leads to reduced cardiac output and poor perfusion.

What are the signs and symptoms of a TPT

- Increased PIPs (ventilator)/stiff bag - Decreased ETCO2 (Capnography to be standard issue) - Poor perfusion or increased HR +/- decreased BP - Increased JVP - Decreased conscious state in the awake pt - Tracheal shift (late sign) - Low Spo2 on supplemental O2 (late sign)

How many bones does the skull have?

What is a primary head injury

- Initial insult - Coup/contra - coup injury

What is a secondary head injury

- delayed (minutes to days) - Oedema/vasodilation/increased ICP - Decreased Na+/K+ pump

How do you calculate CPP?

- CPP = MAP - ICP

What are two major influences of ICP

- hypoxia + hypercapnia increased CO2 will reduce blood flow (vasodilation) Decreased CO2 will increase blood flow

How do you decrease the risk of secondary HI

Correct - hypoxia - hypercapnia - hypotension - hypovolaemia

What are some neuroprotective measures?

- Aim SBP >120 - SpO2 >94% - ETCO2 35-40 - HOB 30 degrees

What does 5HEDS stand for?

Blunt head trauma with a GCS 13-15 either with or without LOC/amnesia with ANY 5 - any LOC > 5 mins H - skull # (depressed, open or BOS) E - vomiting more than once D - neurological deficit S - seizure

What are 3 different types of SCI

- direct mechanical injury - tissue degeneration (within hours sof the injury) - complete spinal cord transection

What nerve controls the diaphragm and where is it located

- the phrenic nerve - C3, C4, C5

Injury about what vertebrae will lose sympathetic response

Where does the vagus nerve exit?

- BOS - AKA parasympathetic nerve

Define neurogenic shock

caused by sudden loss of the autonomic nervous system signals to the smooth muscle in in vessel walls. This can result from severe Central Nervous System (brain and spinal cord) damage. With the sudden loss of background sympathetic stimulation, the vessels suddenly become relaxed, resulting in sudden decrease in peripheral vascular resistance (vasodilation) and decreased blood pressure. The vagus nerve remains intact (exits the BOS) and so becomes the Dominant nerve.

What are some S&S of spinal trauma

- HYPOTENSION- due to venous pooling and decreased venous return - BRADYCARDIA – due to unopposed parasympathetic response - PARALYSIS – damage to motor nerves - PRIAPRISM – neurological and vascular causes - PARADOXICAL RESPIRATIONS – loss of innervation to the thoracic musculature - PARATHESIA – damage to sensory nerves.

How much blood can you loose from the ribs, radius/ulna, humerus, tib/fib, femur, pelvis

* ribs = 100-150mls * radius/ulna = 150-250 * humerus - 250 mls * tib/fib = 500mls * femur = 1000mls * pelvis = 1.5-3L

What are the aims of fracture/dislocation management

* Control External haemorrhage * Apply good splinting practises * resolve neurological or vascular compromise (where possible) * Use judicious analgesia