Trauma Flashcards
Why might you need to tighten your first tourniquet?
Vasoconstriction response after major trauma
How long does it take for irreversible limb ischemia to occur after tourniquet application?
About 2 hours
What is RIP(P)AS and what is it used for?
Assessment of breathing
Resp. rate
Inspection
Palpitation
(Percussion)
Auscultation
Saturations
What acronym is used for life threatening thoracic injuries?
TOMCAT
Tension pneumothorax
Open pneumothorax
Massive haemothorax
Cardiac tamponade
Airway obstruction
Tracheobronchial tree injury
What are the main signs for tension pneumothorax?
Tachypnoea
Unequal chest expansion
Hyper-resonant
Absent breath sounds
Reduced saturations
Possible tracheal deviation
Why is tracheal deviation especially concerning with a suspected pneumothorax?
Is it a late sign
What treatment and management is important for tension pneumothorax?
High flow oxygen
Spontaneously ventilating patient
-Needle thoracocentesis
Ventilated patient
-Finger thoracostomy
-Chest seal
What are the limitations to filtered chest seal dressings?
Filters become blocked resealing the wound causing more tension
Where is a tracheobronchial tear most likely to occur?
Within one inch of the carina
What is the mortality rate of pelvic fractures?
10-30% or up to 50% if shocked
What are the possible local and systemic complications of pelvic #?
Local:
Soft tissue injury
Urinary and reproductive system damage
MSK damage
Neurovascular damage
Systemic:
Shock
Sepsis
What are the 4 main objectives for management of pelvic fractures?
Prevent re-injury from pelvic motion
Decrease pelvic volume
Tamponade bleeding
Decrease pain
When would you consider a pelvic binder in the absence of specific symptoms and signs in that area?
For any suggestive MOI or other injuries requiring large forces it must be considered
The reliability of clinical information in this environment may be poor - have a high index of suspicion
Which part of C-ABCDE does pelvic binder fall into?
C - Cat Hem
Why do you not spring or rock the pelvis?
It dislodges clots, promotes further bleeding and could cause more bleeding
How much blood can you loose into your pelvic cavity, why?
True pelvic volume is 1.5L (stable pelvis) HOWEVER you can loose your entire blood volume. Volume lost increases with structural disruption. It is a wide open space, significant pressure to tamponade the bleeding will not be able to build
What percentage of pelvic fractures are venous/arterial bleeds?
Venous - 90%
Arterial - 10%
What is the purpose of pelvic binders, which bleeds are they more likely to be effective against?
Binders decrease pelvic volume following pelvic fracture and may improve biomechanical stability reducing mortality and transfusion requirements. More effective against venous and cancellous bone bleeding. Binders will not control arterial bleeds
Apart from a pelvic binder, how else can you immobilise a patient to decrease pelvic volume?
Immobilise the legs (tie feet together with blankets inbetween)
What can you use in placement of a pelvic binder if it is not available or will not fit?
A bed sheet
What are signs and symptoms of pelvic #?
MOI
Pain (Pelvis/Lower back/Groin)
Incontinence/urge to pass urine
Gross haematuria
Asymmetry of Anterior Superior Iliac Spine
Feet position
Shock of unknown cause
What is maximum amount of log rolls you want to perform on a patient with a suspected pelvic fracture?
10-15
When would you place a pelvic binder on a patient who is presenting as a NOF#?
High MOI
Patient is haemo-dynamically unstable
What are the long term effects of pelvic trauma?
Increased incidence of thrombophlebitis
Intra-pelvic compartment syndrome
Continued bleeding from fracture or injury to pelvic blood vessels
Associated bladder, urethral prostate or vaginal damage is common
Associated thoracic and abdominal injuries occur in 10-20%; massive internal haemorrhage may occur
Sexual organ dysfunction
Where are the majority of your glycogen stores?
In the muscles
What produces the most red blood cells, why is this relevant for trauma?
The bones, specifically red bone marrow in the trabecular bone. Fractures can lead to catastrophic haemorrhage even without vascular damage
What are the possible complications of fractures?
Internal bleeding (+compartment syndrome)
External bleeding
Infection (e.g. osteomyelitis)
Nerve damage (+/- loss of function)
Tissue damage
What are the priorities of fracture management?
Control blood loss
Expose (Clothing, jewellery etc.)
Access neurovascular system
Splintage/immobilisation
Analgesia
Open fractures - rinse with water or saline and cover (photo first)
Retraction of bone under skin (with documentation)
What is the Brisance effect?
The shattering effect or explosive blasts
What is compartment syndrome?
Increased pressure within a closed osteofascial compartment leading to impaired circulation. It is a surgical emergency
What are the characteristics of extradural haematomas?
Bleeding between the skull and the dura mater
Arterial bleed – high pressure, rapid expansion
85% associated with skull fracture
Requires rapid decompression
Good prognosis if evacuated as an emergency
Blood trapped between the skull and dura, showing the classic biconvex (bow-shape) outline on the right of the brain (left as viewed). Some mid-line shift.
What is central cord syndrome?
Central cord syndrome (also known as central cervical cord syndrome) is the most common form of an “incomplete spinal cord injury”—one in which the spinal cord’s ability to transmit some messages to or from the brain is damaged or reduced below the site of injury to the spinal cord.
Presents with:
Sensory loss - Cape like distribution (upper extremities and thorax with sacrum spared)
Motor loss - Weakness that is more prominent in the upper extremities than lower extremities)
Autonomic regulation - Loss of bowel and bladder. Orthostatic hypotension may also be seen
What is Brown-Sequard syndrome?
A rare type of incomplete SCI usually seen in penetrating trauma, including knife and gunshot wounds.
It can also occur with the loss of vascular supply due to a herniation or oedema to a hemisection.
Presents with:
Ipsilateral loss of motor function, ipsilateral loss of sensation, and proprioception and contralateral loss of pain and temperature
Symptoms are due to a lesion involving the corticospinal, dorsal column, and spinothalamic tracts, respectively
What is anterior cord syndrome?
A rare incomplete SCI that accounts for approximately 1–3% of spinal injuries, it is caused by decreased vascular perfusion to the anterior spinal artery, which supplies the anterior 2/3 of the spinal cord or increased direct pressure on the spinal cord caused by compression trauma or “over-flexion.”
First signs are bilateral loss of motor function, pain, and temperature sensation, which is dominant to lower extremities
Also acute severe back pain, loss of neurologic function (bladder and bowel)
What is posterior cord syndrome?
An incomplete spinal injury that affects the posterior aspect of the spinal cord containing dorsal column fibers.
Typically involves loss of proprioception and vibratory sensation with preserved motor function
Presents with:
Sensation of “electric shocks” running down their spine (Lhermitte’s sign)
Causes include vascular compromise to the posterior spinal artery, trauma, multiple sclerosis (MS), vitamin B12 deficiency, and syphilis
What are the differences between spinal and neurogenic shock?
Neurogenic shock means the entire nervous system is in shock
Spinal shock – just the spinal system is affected
What is the ASIA impairement scale?
What is the muscle strength scale?
Plus NT (not testable due to immobilisation/pain/refusal)
What is the Decreasing Spinal cord Perfusion pressure scale?
What kind of pelvic fractures may result from anterior-posterior compression?
Open book/sprung pelvis
- Broken symphysis
What kind of pelvic fractures may result from lateral compression?
Windswept pelvis
-internal rotation of one or both of the hemi-pelvises
What kind of pelvic fractures may result from vertical shear?
Malgaigne fracture/bucket handle fracture
-disruption of bony ring and vertical displacement of a hemi-pelvis
