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
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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
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AVPU
Alert
Verbal
Pain
Unresponsive
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Exposure/Environment/Extra
Undress the patient
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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)
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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
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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
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How is body water distributed?
2/3 intracellular
1/3 extracellular
- 1/4 intravascular
- 3/4 extravascular
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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
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Why should all patients with dementia get a CT?
Could just be chronic subdural hematoma
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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
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