Trauma Flashcards
(13 cards)
Main trauma criteria
- All patients with major trauma should be taken directly to royal Perth hospital where possible
- Condition appears imminently life threatening, diversion to nearest appropriate ED for stabilisation
- Obvious spinal, pregnant or major pelvic traumas all directly to RPH, unless stabilisation at closest ED needed
- Burns taken to Fiona Stanley, if also with trauma consider which is more life threatening
- All country hospital transfers to major trauma hospital
- Paediatric age less than 14 including burns should go to PCH
Injury criteria
* Suspicion of multiple rib fractures, severe pain, restraint abrasion/contusion, evidence of blunt impact
* Significant injuries involving more than one body region
* 2 or more proximal long bone fractures
* Amputation/ crush injury proximal to hand and foot
* Crushed, de-gloved or mangled limb or extreme open fracture
* Suspected spinal fracture and/or spinal cord injury
* Suspected open and/or depressed skull fracture
* Penetrating injuries to head, neck, chest, abdomen, pelvis, axilla or groin
High risk criteria
* Fatality on scene whereby the patient was same vehicle
* MBA >30km/h with injury
* MVA >60km/h with injuries
* Partial or complete ejection
* Fall >3 m
* Pedestrian or cyclist with speed impact >25km/hr
* Entrapment with compression
* Cabin intrusion
* Explosion
Major trauma guidelines
Scene assessment
Catastrophic haemorrhage control
C-spine consideration
Airway management
Oxygen
Further haemorrhage control
Manage fracture and dislocation
IV fluids
Secondary survey
Cardiac monitor
Prevent hypothermia
Abdomen trauma
Blunt or penetrating trauma that may involve one or more of the major organs contained in the abdominal cavity.
Presentation = pain, tenderness, nausea/vomiting, bruising, guarding or rigidity
Risk = assess tenderness, guarding and rigidity by gentle palpation of all four quadrants, shoulder tip pain may indicative of pathology in the abdomen
Treatment:
* c-spine consideration
* Trauma managements
* Haemorrhage control
* Airway/ventilation
* Oxygen
* Cover exposed organs
* Immobilisation of impaled objects
* Secondary survey
* Cardiac monitoring
* Pain replied
* Advance airway
Burns
Injury caused by thermal and non thermal causes. Caused by electricity, heat, chemicals, lights, radiation or friction
>16 Fiona Stanley
<15 PCH
Presentation= airway burns seen as soot in nasal and mouth, cough, hoarseness, black sputum, difficulty breathing & swallowing, blistering around mouth and tongue and scorched hair, eyebrow or facial hair.
Risk = inhalation injury, % of TBSA, site and depth of wound
Treatment:
* C-spine
* Airway
* Oxygen therapy
* Rule of 9s to calculate %
* Cool for 20 minutes
* Salbutamol
* Vascular access
* Pain relief
* Cardiac monitor
* Consider debridement
* Direct to burn unit adult >15%TBSA, child >10%, less than 18 months >8%
Formulas 2ml X %TBSA X weight in kg = 50% first 8 hours, 50% next 16 hours
Inhalation induces airway oedema and rapid deterioration
Compartment syndrome = pain, pallor, paresthesia, pulselessness or >2 seconds CRT or cool/cold limb
Crush injury
Crush injury= tissue injury as a result of prolonged compressive forces applied to an area of body, most commonly limbs
Compartment syndrome = increased pressure within a muscle, due to the non elastic nature of the fascia, leading to reduced circulation distal to the injury. If left untreated this can result in tissue ischaemic and necrosis
Crush syndrome = systemic manifestation of crush injury as result of tissue destruction, results in destruction of myoctes release of myoglobin, potassium and uric acid upon referfusion. Can further deteriorate into rhabdomyolysis leading to hypovolaemia, hyoerkalaemia, metabolic acidosis and acute kidney failure resulting in death.
Presentation:
* Hypovolaemia
* Compartment syndrome
* Shock
* Hyperkalaemia (peak T waves no p wave, wide QRS, sine wave)
* Dysrhythmia
Do not delay transport
Treatment:
* C-spine
* Catastrophic haemorrhage
* Airway/ventilation
* Oxygen
* Secondary survey
* IV access and fluid
* Ondansetron
* Pain relief
* Cardiac monitoring
Eye injury
Leading cause of visual impairment and blindness in <45. Protect from further injury and avoid secondary injury from increased intraocular pressure during transport to appropriate hospital.
General symptoms = pain, redness, tears, impaired vision, photophobia, haemorrhage, fluid loss from eye
Arc eye/welders flash = hx of poorly protected/unprotected exposure ti high intensity light source, delayed in onset of pain typically hours, redness of eyes with photophobia and complain of something in the eye
Blunt eye = orbital bony wall is relatively thin thus suspectibke go fracture from transfer of mechanical energy
Retinal detachment= traumatic or non traumatic, floating specks, colloquially “floaters”, flashes of light in one or both eyes, and curtain like shadows
Penetrating = abnormal shape globe, loss of vision, squashed globe, ocular contents protruding from globe, laceration, prolapsed tissue, hyphaemia, and chemosis.
Chemical = alkali cause rapid and deep eye injuries from liquefactive necrosis, acid cause significant injury however less severe, painful, blurred vision and redness
Treatment:
* Prophylactic ondansetron
* Avoid manipulating eye
* Do not remove object from eye in foreign body penetrating
* Irrigate with saline in chemical
* If bleeding place pressure around eye avoiding pressure to the globe
* Pain relief
Haemorrhage
Catastrophic bleeding must be priority. Assess external, chest, abdomen, pelvis and long bones
Consider hypovolaemia = pallor, cool peripheries, anxiety, altered Gcs, increase RR and tachycardia
May decompensated into bradycardia
Permissive hypotension 70 SBP, TBI 110 SBP, general <90
Treatment:
* External management = Direct pressure CAT, TPOD
* Airway
* Oxygen
* Cardiac monitoring
* Vascular access
* Fluid therapy
* TXA
* Pain relief
Neck wounds = do not sit patient up, apply pressure with broad pad and hand
Limb trauma
Any injury to one or more limbs.
Presentation= localised pain or tenderness, loss of function, limitation of motion, guarding, bizarre angulation, deep lacerations or exposed bone, crepitus, altered distal pulses and sensation, amputation.
Principles of splinting = external haemorrhage, support injury, immobilise above and below injury, re evaluation neurovascular before and after, manage as fracture up until proven otherwise
Treatment:
* Haemorrhage control
* Splinting and wound dressing
* Soft tissue injury (RICE)
* Amputated part wrap in sterile gauze, place in airtight container and put container on ice
* Cardiac monitor
* Vascular access
* Pain relief
Pelvic
TPOD is considered time critical, often associated with other injuries. Consider in high velocity MVA, long fall >3 m, and crush types of injury.
Presentation: significant mechanism with signs of haemodynamic compromise HR>100, SBP <90 or Gcs <13, deformity, bruising, haemorrhage, limb shortening or rotation, paraesthesia, loss of power to lower limb, and undifferentiated hypotension
Do not log roll
Treatment
* TPOD
* Airway/ventilation
* Oxygen
* Secondary
* Cardiac monitor
* Vascular access
* Fluid
* Pain relief
* Txa ?
Pneumothorax
Secondary to breach between the visceral and parietal pleura and considered to be under tension when significant respiratory and/or cardiovascular compromise exists, lead to cardiac arrest if untreated
Acts as a one way valve trapping air and increasing pressure in pleural cavity.
Presentation:
Awake = progressive respiratory deterioration, falling Spo2, tachypnoea, tachycardia, respiratory distress, agitation, reduced breath sounds
Ventilated = rapid cardiorespiratory collapse, immediate Spo2 decrease, decreased bp, tachycardia, increased ventilation pressure, reduced breath sounds
Pre terminal signs = decreasing respiratory rate, hypotension, decreasing Gcs when on o2, Spo2 <92 when on o2, tracheal deviations, distended neck vein
Treatment:
* Airway and ventilation
* Pain relief
* Cardiac monitor
* Consider needle thoracocentesis in arrest, consider ASMA if conscious
Spinal
Injury to spinal cord, vertebrae or both. Above injury neurological function intact, below absent or diminished
Hypotension and bradycardia = neurogenic shock
NEXUS criteria (conscious and cooperative = stabilisation or lanyard, neurodeficit & high risk = immobilisation)
SPEED tool (movement score & sensory score of foot, cervical tenderness, hand grip)
Treatment:
* If TBI and cervical injury cannot be ruled out when possible position 15 degrees to maximise cerebral drainage
* Use of head blocks to immobilise
* Do not triple airway
* Spinal precautions when speed <1, Gcs<15, spinal pain, neurological deficits, mechanism of injury
* Semi rigid collar in unconscious when mechanism if injury suggests cervical involvement OR neurological symptoms suggestive of spinal cord injury
* Neurological symptoms suggestive of injury include tingling, numbness or weakness in any extremities
* Complete speed assessment
* Anti emetic
* Pain relief
* Cardiac monitor
* Scoop stretcher, spider harnesses
Thoracic
Injury to chest wall, lungs, pleura, thoracic great vessels, diaphragm, heart, trachea, bronchus and oesophagus
Presentation:
* Trachea deviation
* Wounds, bleeding or bruising
* Surgical emphysema
* Laryngeal crepitus
* Haemoptysis
* Venous engorgement
* Pneumothorax, tension pneumothorax, haemothorax or flail chest
Treatment:
* C-spine consideration
* Airway and ventilation support
* Oxygen
* Immobilisation of any impaled objects and positioning
* Cover open chest wounds with occlusive dressing taped down on three sides to allow air escape but not enter chest
* Secondary survey
* Pain relief
* Cardiac monitoring
* In arrest can needle decompress
* Closed injury stabilise with positioning
TBI
Head injury or intracranial injury is the result of physical trauma causing brain damage and can result from closed or penetrating head injury.
Presentation:
* Mechanism of injury suggests
* Abnormal behaviour or deteriorating mental status
* Asymmetric or non reactive pupils
* Visual disturbances/headache
* Seizures
* Possible csf leakage
* Raccoon eyes/ battle signs
* Systolic hypertension, bradycardia, abnormal respiration (Cushing triad)
Treatment
* C-spine
* Haemorrhage control
* Airway/ventilation
* Oxygen
* Secondary survey
* 30 degree head elevation (contraindicated in hypovolaemia patient)
* Vascular access
* Fluid
* BSL
* Ondansetron
* Ketamine for combative TBI
110mmHg SBP, >90% Spo2, 30 degree head elevation, >4 BSL
