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Flashcards in Trauma Deck (18):

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 


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



  • 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



  • 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



  • 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



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



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


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




  • 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)


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%)


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


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


Intra-abdominal trauma management 

Postive FAST - laparascopy or laparotomy follows CT 


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 - 


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 


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


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


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