Trauma Flashcards
(40 cards)
GCS eyes
1-4 points 4 = opens spontaneously 3 = opens to voice 2 = opens to pain 1 = does not open
GCS Verbal
1-5 points 5 = oriented, conversant 4 = confused, disoriented 3 = inappropriate words 2 = incomprehensible sounds 1 = no sounds
GCS Motor
1-6 points 6 = obeys commands 5 = localizes pain 4 = flexion/withdrawal to pain 3 = decorticate 2 = decerebrate 1 = no mvmts
Shock Class 1
<15% blood loss. Some tachy, nml BP. Tx: minimal
Shock Class 2
15-30% loss. tachy, min. low BP. Tx: fluids
Shock Class 3
30-40% loss. very tachy. low BP, confusion. Tx: fluids and pRBCs
Shock class 4
> 40% loss. critical BP and HR. Tx: aggressive
SIRS criteria
T 38 (100.4)
HR >90bpm
RR >20 or aPCO2 12,000 or >10% bands
CXR: diffuse alveolar dz
- CHF!
- if not CHF, ARDS or multifocal PNA
CXR: diffuse interstitial dz
CHF until proven otherwise!
CXR: focal lung opacities DDx
PNA, atelectasis, contusion, neoplasm, infarction
trauma triad of death
hypothermia, coagulopathy, acidosis
hypothermia –> coagulopathy –> worsening acidosis –> damaged myocardium –> hypothermia
Trauma primary survey
D - GCS, AVPU
A - airway
B - breathing and ventilation (inspection, palpation, aucultation, percussion). 6 life-threatening thoracic conditions
C - HR, BP, pulses, UOP, MS, cap refill. hemorrhage control. Fluids (And pRBCs)
E - undress, prevent hypothermia
6 life-threatening thoracic conditions
Airway obstruction, TPtx, massive hemothorax, open pneumothorax, flail chest with pulm contusion, cardiac tamponade
Fluid resuscitation guidelines
3L LR for every 1L blood lost
1:1 pRBCs and FFP
AMPLE hx
allergies, meds, PMH, last meal, events leading up
Splenic injury scale
Grade I - Hematoma: subcapsular, 50 percent of surface area OR expanding, ruptured subcapsular or parenchymal hematoma OR intraparenchymal hematoma >5 cm or expanding. Laceration: >3 cm in depth or involving a trabecular vessel.
Grade IV - Laceration involving segmental or hilar vessels with major devascularization (ie, >25 percent of spleen).
Grade V - Hematoma: shattered spleen. Laceration: hilar vascular injury which devascularizes spleen.
Splenic injury management
unstable –> OR
Grade I -III: observe
IV- V: surgerize, embolize
Liver lac management
unstable --> OR High grade (>25% hepatic lobe, juxtahepatic venous injury, hepatic avulsion) = higher risk of injury
Neck zones
1 : below cricoid – assess (angio if stable). subclavians, lung, brachial plexus
2: cricoid to mandible – explore + doppler. or bronch, esophagoscope, CT
3: above mandible – assess (angio + triple endoscopy if stable). carotid
Retroperitoneal hematomas
Always look for pelvic Fx!
1: central hematoma: major vasc structure –> ex lap
2: flank: renal parenchymal injury
3: pelvic: stable –> observe. Angiography and embolyzation if hemorrhaging. Surgical exploration for penetrating trauma.
Fractures that require OR
- Depressed skull
- severely displaced/angulated
- any open fx (needs cleaning)
- femoral neck or intertrochanteric
Burn management
Rule of 9s = % BSA involved.
Kg x % BSA x 3-4 = fluid
Give 1/2 over 8hrs, rest over 16hrs
-No PO or IV abx
-silver sulfadiazine: doesn’t penetrate eschar and can cause leukopenia
-Mafenide: hurts like hell
-silver nitrate: doesn’t penetrate and causes hypo K and Na
Maintenance fluids
D5 1/2NS + 20 KCl (if peeing)
Up to 10 kg –> 100ml/kg/day
next 10 –> 50 mL/kg/day
all >20 –> 20mL/kg/day
If over 20, add 40 to weight gives mL/hr
