Flashcards in Trauma Deck (46):
A method to eval airway
1- have pt speak- patency and to evaluate for voice change and stridor
2- evidence of pooling secretions or cyanosis
GCS for intubation
GCS of 8 or less requires intubation
Important note for intubation
ALWAYS MAINTAIN C-SPINE IMMOBILIZATION
A patent airway DOES NOT mean adequate ventilation! Ventilation requires:
Percussion with hyper-resonance
Percussion with dullness
subcutaneous emphysema might indicate
JVD in trauma may indicate
tension pneumothorax or cardiac tamponade
Tension Pneumothorax presents as
worsening of a simple pneumothorax
formation of a 1-way valve at the point of a rupture in the lung
Hypotension in a Tension Pneumothorax is due to
↑ intrathoracic pressure ↓ preload
Loss of left heart blood flow due to loss of pulmonary vasculature to affected lung
Compression of mediastinum
Tension pneumothorax is a CLINICAL diagnosis and _______ are not appropriate in this setting.
If tension pneumothorax is suspected, immediate needle decompression is undertaken
Tension Pneumothorax needle decompression treatment details
-4-16 gauge long angiocath
-midclavicular line, 2nd intercostal space
-over the rib to avoid neurovasculature
Massive Hemothorax definition
A systemic or pulmonary vessel disruption leads to:
> 1500 mL blood loss initially
> 400 cc per hour for 2 hours
Consider a massive hemothorax with?
pts in shock w/ no breath sounds and/or percussion dullness.
massive hemothorax treatment
placing a large (36 f) chest tube
possibly a trip to the OR for hemorrhage control.
If a radial pulse is palpable, it suggests a systolic blood pressure of at least?
80 mm Hg
if femoral or carotid are palpable, these suggest a systolic blood pressure of at least?
60 mm Hg
ATLS Classifications of hemorrhagic shock considers?
ATLS Class of hemorrhagic shock that requires blood products
Class 3 and Class 4 (blood loss 30%, >40%)
Reasons in shock--> dont mount a tachycardic response
-Beta blockade/ Calcium channel blockade
-Children/ young adults
Assess mental status via the AVPU scale
_________ will present as a “blown pupil.” .
Paralysis of parasympathetic fibers of CN III
Lowest GCS score
Adjuncts to the Primary Survey
Standard Trauma X-rays
FAST Exam (Focused Assessment Sonography in Trauma)
FAST Exam four views
Any blood detected during the FAST exam may represent
*negative FAST does not exclude injury
Primary Survey address
-A: Airway Maintenance with CERVICAL SPINE protection
-B: Breathing and Ventilation
-C: Circulation with hemorrhage control / shock assessment
-D: Disability: Neurological
The 2o Survey not started until all aspects of the 1o survey addressed + vitals addressed
Secondary Survey history
Start with the AMPLE history:
Events / Environment / Mechanism of injury
Secondary Survey physical
head to toe directed assessment
Motor/ Strength Grading
0: Total paralysis
1: Palpable/visible contraction
2: FROM w/gravity eliminated
3: FROM against gravity
4: FROM, less than normal strength
5: Normal strength
A __________ is most important lab in trauma patient
Type and Crossmatch
Type O blood rules
-Type O Negative- women
-Males may receive O Positive blood
Type-specific blood processing time/ details
ABO and Rh only tested
10 minute processing
Standard Trauma X-rays
AP chest + AP pelvis cxr as adjuncts to the 1o survey
C-Spine X Rays: lateral view (detects 80% fractures), AP, open mouth “Odontoid” view, and obliques
EKG is especially important for?
fall, drowning, syncope or single car MVA
_________ imaging if concern for urethral injury.
Diagnositic Peritoneal Lavage
-98% sensitive for bleeding /detect bowel injury (often missed on CT)
-replaced by US
-performed when intra-abdominal bleeding
Diagnositic Peritoneal Lavage is considered positive if it returns
Gross blood (10 ml)
> 100,000 RBCs/mm3
> 500 WBCs/mm3
+ Gram stain
Bacteria, bile, feces
To clear the cervical spine/ remove collar, they must have the following:
-Alert, not intoxicated
-Absence of neck pain
-Absence of midline neck tenderness
-Absence of distracting injury
-Absence of sensory /motor complaint
A tracheobronchial tree disruption will present on physical as....
-may notice that after placing a chest tube, the lung refuses to inflate
A pulmonary contusion may initially present as
-IV fluids--> pulmonary edema and hypoxia worsens
-Rx by proper O2 and ventilation + maintaining normovolemia.
blunt cardiac injury
difficult to ddx.
only sign may be an abnormal ECG
-Echocardiography may show a hypokinetic heart.
-Rx= medicating dysrhythmias that affect hemodynamics
immediately fatal, but those who survive may show a widened mediastinum on CXR.
traumatic aortic disruption caused by rapid acceleration/ deceleration causing a tear
Cullen’s sign / Grey-Turner’s sign are both associated with __________
Cullen’s sign =periumbilical bruising
Grey-Turner’s sign = flank bruising
compartment syndrome presentation
- Pulseless (late finding).