Trauma Flashcards
(56 cards)
How should airway be assessed in the primary survey?
Airway
Check for airway compromise Ask pt. a question Stridor Orofacial injury or burns Visualise airway and use suction if necessary
Manoeuvres to open airway
Jaw thrust
Adjuncts if compromise / potential compromised
NPA: gag reflex present
OPA: no gag reflex (stop tongue swallowing)
Emergency Airways
Needle cricothyroidotomy or surgical cric
Definitive Airways (no risk of aspiration) Endotracheal tube Tracheostomy
How should C-spine be managed in primary survey?
Maintain in-line cervical support to keep neck stable
Place pt. in hard-collar and sandbags c¯ tape
How should breathing be assessed in primary survey?
SpO2 Inspection of chest Position of trachea RR and chest expansion Breath sounds, vocal resonance Percussion ABG
What are the signs of tension pneumothorax?
Respiratory distress JVP and BP Tracheal deviation + displaced apex air entry and VR Hyperresonant percussion
How is tension pneumothorax managed?
immediate decompression
Insert large-bore venflon into 2nd ICS, midclavicular
line.
Insert ICD later
How are open sucking chest wounds managed?
Convert to closed wounds by covering with damp
occlusive dressing stuck down on 3 sides.
What should be done under circulation in primary survey?
Two-large bore cannulae (14/16G) in each ACF
FBC, U+E, x-match (6U), clotting, VBG
How is circulation assessed in the primary survey?
Inspection: pale, sweaty, active bleeding
Vascular status: BP, HR, JVP, heart sounds, cardiac
mon
End-organ: consciousness, UO
how is disability assessed in the primary survey?
Assess consciousness using AVPU or GCS
Pupil responses
How is exposure assessed in the primary survey?
Completely undress pt.
Perform log-role and PR
Feel for high riding prostate (urethral rupture)
Look for bleeding
Prevent hypothermia
What should be covered under the history of the secondary survey?
AMPLE
Allergies Medication PMH Last ate / drunk Events
What investigations should form part of the secondary survey?
Trauma series
C-spine: lat + peg
CXR
Pelvis
FAST scan (Focussed Assessment c¯ Sonography in
Trauma)
CT: when pt. is stable.
How should c-spine radiographs be assessed?
Views
Lateral
AP
Open-mouth Peg view
Adequacy
Must see C7-T1 junction
May need swimmer’s view c¯ abducted arm
Alignment: 4 lines Ant. vertebral bodies Ant. vertebral canal Post. vertebral canal Tips of spinous processes
Bones: shapes of bodies, laminae, processes
Cartilage: IV discs should be equal height
Soft tissue
Width of soft tissue shadow anterior to upper
vertebrae should be 50% of vertebral width.
What is the indication for clinical clearance of the c-spine?
Indication: NEXUS Criteria Fully alert and orientated No head injury No drugs or alcohol No neck pain No abnormal neurology No distracting injury
How is the c-spine clinically cleared?
Examine for bruising or deformity
Palpate for deformity and tenderness
Ensure pain-free active movement
What is the indication for radiological clearance of the c-spine?
Pt. doesn’t meet criteria for clinical clearance
What are the modalities for radiological clearance of the c-spine?
Radiograph initially
- Clear if normal radiograph and clinical exam
CT C-spine if abnormal radiograph or clinical exam
What is neurogenic shock?
Disruption of sympathetic nervous system
What are the causes of neurogenic shock?
Spinal anaesthesia
Hypoglycaemia
Cord injury above T5
Closed head injuries
How does neurogenic shock present?
Hypotension
Bradycardia
Warm extremities
How is neurogenic shock managed?
Vasopressors: vasopressin and norad
Atropine: reverse the bradycardia
What is spinal shock?
Acute spinal cord transection
Loss of all voluntary and reflex activity below the level
of injury
How does spinal shock present?
Hypotonic paralysis
Areflexia
Loss of sensation
Bladder retention
What are the differentials in life-threatening chest injuries?
ATOMIC Airway obstruction Tension Pneumothorax Open pneumothorax (sucking) Massive haemothorax Intercostal disruption and pulmonary contusion Cardiac Tamponade
