Flashcards in Trauma Deck (57):
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Primary survey
Airway , breathing, circulation
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Indications for nasotracheal intubation
conscious, + gag reflex
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indications for orotracheal/ endotracheal intubation
unconscious or semi-conscious, +/- gag reflex, apnea, AMS, inhalation injury, hematoma, facial bleeding, soft tissue swelling or aspiration. AMS is most common reason for needing intubation
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indications for cricothyroidotomy
it is a surgical airway, done when attempts to obtain endotracheal airway have failed. also indicated if extensive facial injuries make endotracheal impossible. Not indicated in its
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indications for intubation
inadequate respiratory effort, severely depressed mental status, GCS
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indications for decompression
tension pneumothorax, open pneumothorax, flail chest, hemothorax, traumatic diaphragmatic hernia, major airway injury
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Carotid pulse should be
60 mmHg
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Femoral pulse should be
70 mmHg
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Radial pulse should be
80mmHg
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Class I shock
Pulse 30 cc/hr
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Class II shock
Pulse >100, BP Dec, RR 20-30, UOP 20-30cc/hr
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Class III shock
Pulse 120, BP dec, RR 30-40, UOP 30-40 cc/hr
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Class IV shock
Pulse >140, BP dec, RR >35, UOP scant
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consider giving PRBC/blood
when you have given >4L crystalloid fluid, or if have given 2 L and still unstable or bleeding
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RSI induction agent for normotensive pt
Thiopental 3-5mg/kg
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RSI induction agent for hypotensive pt
Etomidate .3 mg/kg or Midazolam or ketamine. want smaller doses
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signs of uncal herniation
ipsilateral unilateral sluggish and dilated pupil, contralateral hemiparesis
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signs of central herniation
bilateral motor weakness, pinpoint pupils b/l, decreased consciousness
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what to do if herniating
hyperventilated to PaCO2
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Neck Zone I
subclavian vessels, brachiocephalic v. common carotid a, aortic arch, jugular v, trachea, esophagus, lung apices, C-spine, spinal cord, cervical nerve roots
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Neck Zone II
carotid a. vertebral a. jugular v. pharynx, larynx, trachea, esophagus, C spine and spinal cord. Most carotid a. injuries are associated with zone II.
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Neck Zone III
salivary and parotid glands, esophagus, trachea, vertebral bodies, carotid arteries, jugular veins, CN 9-12
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sign of myocardial contusion
Ventricular dysrhythmias, atrial fibrillation, sinus bradycardia, bundle branch block.
Transient sinus tachycardia is NOT a sign of myocardial contusion
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Becks triad
distended neck v, muffled heart sounds, hypotension
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abdomen zone I
Central hematoma. retroperitoneal. includes the great vessels, pancreas and duodenum. goes to surgery.
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abdomen zone II
flank hematoma. often secondary to renal parenchymal injury. if stable can just observe. expanding hematoma warrants OR
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abdomen zone III
pelvic hematoma. observed in stable pt or in a blunt trauma. Exploration is warranted if there is a penetrating injury.
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Stable patient with penetrating abdominal wound gets
a laparoscopy
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unstable patient with penetrating abdominal wound gets
a laparotomy
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An immediate positive DPL
aspiration of >10mL blood
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If negative initial DPL
instill 1L NS, pt rocked side to side, gravity drain. + off >100k RBC/cubicmm, bile, fecal matter, or amylase
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splenic injury that is ok to observe
Grade III and below
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splenic injury that goes to OR
Grade IV and V
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splenectomy pts need immunizations for
diplococcus, meningococcus, haemophilus
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Grade V splenic laceration
completely shattered spleen
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Grade V splenic vascular injury
hilar vascular injury or hematoma >2cm and expanding
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Grade IV splenic hematoma
Ruptured intraparenchymal hematoma with active bleeding
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Grade IV splenic laceration
involves segmental or hilar vessels- devascularization of >25% spleen
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Grade III splenic or liver hematoma
Subcapsular, >50% surface area or ruptured sub capsular hematoma >2cm or intraparenchymal hematoma >2cm
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Grade III splenic or liver Laceration
>3cm parenchymal depth or involving the trabecular vessels
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Grade II splenic or liver hematoma
Sub capsular, not expanding, 10-50% of surface area or intraparenchymal not expanding and
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Grade II splenic or liver Laceration
Capsular tear, active bleeding, 1-3 cm into the parenchyma
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Grade I splenic or liver hematoma
sub capsular, non expanding,
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Grade I splenic or liver laceration
Capsular tear, non-bleeding,
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Grade VI vascular liver injury
hepatic avulsion
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Grade V vascular liver injury
juxtahepatic venous injuries
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Grade V liver laceration
Parenchymal disruption > 58% hepatic lobe
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Grade IV liver hematoma
ruptured parenchymal hematoma with active bleeding
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Grade IV liver laceration
parenchymal disruption involving 25-50% of lobe
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Liver injury that can be observed
if pt is stable
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Liver injury that goes to the OR
Ex-lap needed for Grade IV-VI
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Hard signs of vascular injury
Absent pulses, pulsatile hemorrhage, thrill or bruit, acute ischemia
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Soft signs of vascular injury
proximity to a known vessel, minor hemorrhage, small hematoma, associated nerve injury
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if ABI >1
they are low risk for major vascular injury--> observation
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If ABI
they are intermediate risk for major vascular injury --> Arteriography
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Compartment syndrome
Pain, Pallor, Paresthesias, Paralysis, Pulselessness, Perishing cold
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