Flashcards in Trauma Deck (90)
Airway (with C spine precautions - assume C spine injury until proven otherwise)
Breathing and vent
Circulation/Control of hemorrhage
Disability (neuro status)
Airway and C-spine
use jaw thrust or chin lift initially to open it up
Clear foreign bodies
Insert oral or nasal airway when needed
Intubate obtunded/unconscious patients
Surg airway = cricothyroidotomy - when unable to intubate
speaks in full sentences
B/l breath sounds
Just give O2
Has patent airway now but maybe not forever. Will need intervention soon
Cutaneous emphysema (rice crispies in skin)
Breathing and ventilation
Do they need ventilations or a ventilator?
Monitor SpO2 and End tidal CO2 (for intubated patients should be about 40)
What might alter ventilation?
Hemothorax, pneumothorax, flail chest, pulm contusion
Normal RR 12-20
Control of hemorrhage
2 large bore IVs (14 or 16 gauge)
Draw blood samples at time of IV catheter placement
Assess cap refill, pulse, skin color
Control life-threatening bleeds using direct pressure
Are they in shock?
- sys BP
Rapid neuro exam
Establish pupillary size and reactivity and level of consciousness using AVPU or GCS
Undress the patient
Contraindicated when transection of urethra is suspected like in pelvic fracture. If suspected get retrograde urethrogram first
Examine prostate and genitals before foley insertion
NGT or OGT may reduce aspiration risk. If cribiform is fractured used OGT
Start with up to 2L of isotonic crystalloid (NS or LR)
Peds should get IV bolus 20cc/kg
3:1 rule. Total amount of crystalloid volume needed acutely to replace blood loss.
Use warm fluids whenever possible
Shock in the trauma setting
Bleeding patient with flat neck veins. Low Hgb/Hct. High HR (compensation)
Dx: May beed to do FAST
Tx: 2 large bore IV
Dump fluid and blood into them (T/C, IVF, Blood). Fix the hole. All on the way to the OR
Tension pneumo signs
Hole in pleura creates a flap. When pt breathes in, air gets into pleural space. When they exhale it gets trapped
Affected lung collapses. Replaced inside the space with air.
Air compresses IVC
Engorged neck veins
Absent lung sounds on affected side
Induces tracheal deviation away from affected side
#1 - needle decompression in 2nd IC space (goal is to relieve IVC not re-inflate lung). This is NOT a chest tube.
F/u with chest tube (thoracostomy)
Pericardial tamponade signs
RV is looser/floppier than LV so it collapses. We cannot fill. Basically a diastolic HF.
Engorged neck veins
Clear lung sounds
Beck's triad = distant heart sounds, JVD, hypotension
Contractility issues signs
Pt will have engorged neck veins
Also with pulm edema
Dx = Echo or FAST
Tx = medically manage
Vasomotor shock signs
Normal response to shock is to increase SVR therefore preload, HR, contracility issues generally cause cold extremities
HERE, we get vasodilation leading to warm extremities despite low BP.
Dx: depends on mechanism
TX: give back what they're lacking (ANS tone) with vasopressors
Stage in trauma eval after all the ABC business
Get trauma history (AMPLE history)
Meds/Mechanism of injury
Events surrounding mechanism of injury
Head to toe eval
How is body water distributed?
- 1/4 intravascular
- 3/4 extravascular
Basilar skull fracture
Look for Battle sign - bruising around eyes and behind ears
Runny nose - that's CSF actually coming out!
MMA breaks and starts to bleed. Space btw skull and dura fills with blood. Will get big enough and push on brain.
"Walk, talk, and die syndrome"
Dx: Get CT (lens-shaped)
"Epi was a horrible class that I thought would be easy. I'm glad I can look at it through the lens of time now."
Young patient. May be sign of abuse in baby.
Usually need a HUGE trauma like MVAs.
Blood fills btw brain and dura
Course = trauma then coma then death
Dx: CT (crescent shaped).
Tx: Keep ICP low (hypervent, raise bed head, mannitol). Pray.
Older patients or alcoholics
Shrunken brain = stretched veins. Tearing of bridging veins from minor trauma or an old trauma maybe weeks ago.
HA then progressive dementia.
Dx: CT (crescent shaped)
This is why all patients with dementia should get a CT
Why should all patients with dementia get a CT?
Could just be chronic subdural hematoma
Ways to reduce ICP
Raise head of bed
CT is normal
Tx: Go home but only if patient has family to keep them up. Keep them awake for 24 hrs
Diffuse Axonal Injury
Patient who had angular trauma like a car accident where car spun a lot
Presents with coma
CT shows blurring of grey-white junction
Tx = pray