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Flashcards in Trauma Deck (18):
1

Death from injury occurs in 1 or 3 time periods 

  • First peak - witihin seconds to minutes 
  • second peak - within minutes to several hours 
  • third peak - after several hours to weeks, sepsis and mutli organ failure 

2

Golden hour 

refers to the period when medical care can make the maximum input on death and disability. It implies the urgency and not a fixed time period of 60 min

3

Airways 

  • Protect spinal cord with immobilisation devices
  • Access airway for patency (if patient can speak airway is not compromised)
  • Consider foreign body and facial, mandibular, r tracheal fractures if unconscious.
  • Perform chin lift/jaw thrust.
  • Consider nasopharyngeal/oropharyngeal airway
  • If unable to maintain airway, secure a definitive airway (orotracheal, nasotracheal, cricothyroidotomy

4

Breathing 

  • Administer high flow O2 using a non-rebreather mask
  • Inspect for chest wall expansion, symmetry, respiratory rate, and wounds
  • Percuss and auscultate the chest
  • Look for tracheal deviation and surgical emphysema
  • Identify and treat life threatening conditions: tension pneumothorax, open pneumothorax, flail chest with pulmonary contusion, massive haemothorax

5

Circulation 

  • Look for shock
  • Hypotension usually due to blood loss. Think: chest, abdomen, retroperitoneal (blood on the floor and four more)
  • Control external bleeding with pressure
  • Obtain IV access with two 12G cannulae, send blood for cross match
  • Commence bolus of warmed ringers lactate: unmattec, type-specic blood only for immediate life threatening blood loss

6

Disability 

  • Perform rapid neurological examination
  • AVPU method:
    • Alert
    • Responds to Vocal stimuli
    • Painful stimuli
    • Unresponsive to all stimuli
  • Glasgow coma scale
  • Glucose

7

Exposure 

  • Expsoure
    • Undress patient for further examination
    • Prevent hypothermia by covering with warm blankets

8

Secondary survey 

  • Constant reassessment of all vital signs
  • Take history – AMPLE
    • Allergy
    • Medication
    • Past medical history
    • Last meal
    • Events of the incident
  • Head to toe physical examination

9

Pneumothorax 

 

  • Depends on size and severity
  • In context of trauma, always managed by chest drain
  • Inserted into triangle of safety on affected side (ie 5th intercostal in midaxillary line)

10

Intra-abdominal trauma Causes 

Blunt trauma most frequently are spleen (45%), liver (40%) and retroperitonal haematoma (15%)

Penetrating trauma 

  • Stab wounds and low veolicty gun shot wounds
  • Cause damage by laceration or cutting; stab wounds commonly involve the liver (40%), small bowel (30%) diaphragm (20%)

11

History and physical exam of intra-abdominal trauma 

  • History
    • Patient, other passengers, observersm police and emergency personnel
    • Mechanism of injury- seat belt usage, steering wheel deformitis, speed
    • Pre-hospital condition
  • Physical exam
    • Inspect anterior abdomen, perineum, and log roll to inspect posterior abdomen
    • Palpate abdomen for tenderness, involuntary muscle guarding, rebound tenderness
    • Asculate for bowel sounds

12

Investigations of intra-abdominal trauma 

  • Blood and urine sample – raised serum amylase
  • Radiogrpah- free air
  • FAST (focused abdominal sonography for trauma)
    • Imaging of four Ps (Pouch of Morrison, pouch of douglas, perisplenic and pericardium)
  • CT
    • Investigation of choice haemodynamically stable patients where there is not apparent indication for laparotomy

13

Intra-abdominal trauma management 

Postive FAST - laparascopy or laparotomy follows CT 

14

Glasgow coma scale 

EYES (4 letters) 

  • nil 
  • in response to pain 
  • in response to speech 
  • spontaneous 

MOTOR (5 letters) 

  • nil 
  • extension 
  • abnormal flexion 
  • flexion away from pain 
  • localises pain 
  • obeys commands 

VERBAL (6 letters) 

  • nil 
  • sounds 
  • inapproriate words 
  • confused sentences 
  • orientated fully - 

15

How to use glasgow coma scale 

  • Minor head injury 13-15 - monitor, if supervised and GCS 15 then discharge, may need CT if remains 14 or lower at 1hr after admission 
  • moderate head injury -9-130 CT head, intervene as necessary 
  • severe head injury (GCs8 r less) - intubate, ct, neurosurfical intervention 

16

Types of head injury 

  • Scalp lacerations – Close laceration
  • Skull fractures – CT, Observe, may need surgery
  • Epidural haematoma – Neurosurgeons
  • Subdural haematoma – Neurosurgeons
  • Contusion – Observation/Neurosurgeons
  • Intracerebral Haemorrhage – Usually observe +/- neurosurgeons
  • Diffuse Brain Injury

17

Primary surgery of vascular trauma 

  • Apply direct pressure to open haemorrhaging wound
  • Carry out aggressive fluid resuscitation
  • A rapidly expanding haematoma suggest significant injury
  • Realign and splint any associated fracture
  • Immobilise dislocated joint

18

Secondary survey of vascular trauma 

  • Identify life threatening limb
  • Look for hard or soft signs of vascular injury
    • Hard signs- massive external blood loss, expanding or pulsatile haematomaa, absent or diminished distal pulses, and a thrill or audible continuous murmur
    • Soft sings- History if active bleeding at the accident scene, proximity of penetrating or blunt trauma to a major artery, small non pulsatile haemoatoma
  • Immediate operative intervention for hard signs