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Flashcards in Trauma Deck (90)
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1

ABCs

Airway (with C spine precautions - assume C spine injury until proven otherwise)

Breathing and vent

Circulation/Control of hemorrhage

Disability (neuro status)

Exposure/Environment control

Foley

2

Airway and C-spine

Assess patency

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

3

Patent airway

speaks in full sentences
B/l breath sounds

Just give O2

4

Urgent airway

Has patent airway now but maybe not forever. Will need intervention soon

Expanding hematoma

Cutaneous emphysema (rice crispies in skin)

Give BVM

5

Emergent airway

GCS

6

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

7

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

8

Disability

Rapid neuro exam

Establish pupillary size and reactivity and level of consciousness using AVPU or GCS

9

AVPU

Alert
Verbal
Pain
Unresponsive

10

Exposure/Environment/Extra

Undress the patient

11

Foley

Contraindicated when transection of urethra is suspected like in pelvic fracture. If suspected get retrograde urethrogram first

Examine prostate and genitals before foley insertion

12

Gastric intubation

NGT or OGT may reduce aspiration risk. If cribiform is fractured used OGT

13

IV fluid

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

14

Shock in the trauma setting

Hemorrhage
Tension Pneumo
Pericardial Tamponade
Contractility issues
Vasomotor

15

Hemorrhage signs

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

16

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
Hyperresonant
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)

17

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

Dx: FAST

Tx: Pericardialcentesis

18

Contractility issues signs

Pt will have engorged neck veins

Also with pulm edema

Dx = Echo or FAST

Tx = medically manage

19

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

20

Secondary survey

Stage in trauma eval after all the ABC business

Get trauma history (AMPLE history)

Allergies
Meds/Mechanism of injury
PMH/Pregnant?
Last meal
Events surrounding mechanism of injury

Head to toe eval

21

How is body water distributed?

2/3 intracellular
1/3 extracellular
- 1/4 intravascular
- 3/4 extravascular

22

Basilar skull fracture

Look for Battle sign - bruising around eyes and behind ears

Runny nose - that's CSF actually coming out!

Get CT

23

Epidural hematoma

MMA breaks and starts to bleed. Space btw skull and dura fills with blood. Will get big enough and push on brain.

Initial LOC
Lucid period
Death

"Walk, talk, and die syndrome"

Dx: Get CT (lens-shaped)
Tx: Craniotomy

"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."

24

Acute subdural

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.

25

Chronic subdural

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)
Tx: Craniotomy

This is why all patients with dementia should get a CT

26

Why should all patients with dementia get a CT?

Could just be chronic subdural hematoma

27

Ways to reduce ICP

Hyperventilation
Raise head of bed
Mannitol

28

Concussion

Sports injury
LOC
Amnesia (retrograde)

CT is normal

Tx: Go home but only if patient has family to keep them up. Keep them awake for 24 hrs

29

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

30

Neck zones

Zone 1 = lowest. Below cricoid and above clavicle (most conservative)

Zone 2 = middle (lots of surgery here)

Zone 3 = above angle of mandible (some surgery)