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Trauma Flashcards

(45 cards)

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1
Q

What are the percentages for different mechanisms of injury?

A
  • Fall < 2m = 59%
  • Falls > = 11%
  • RTA = 15%
  • Assault = 5%
  • Other = 10%
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2
Q

Describe what is trauma

A

-Any external force applied to the body which results in injury
-High amount of morbidity in working age and the elderly
=Loss of income, pain, prolonged bed rest etc.
-Leading cause of death and disability in first 4 decades of life
-50% of Orthopaedics is dealing with consequences of trauma

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3
Q

What is a fracture?

A

A disruption in bone continuity

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4
Q

What is a dislocation?

A

Complete loss of continuity of 2 bones forming a joint

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5
Q

What is subluxation?

A

Partial loss of continuity of 2 bones forming a joint

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6
Q

What is comminution?

A

Multiple fragments

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7
Q

What does antra-articular mean?

A

Fracture extends into a joint

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8
Q

What is a fracture dislocation?

A

A dislocated joint with associated fracture

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9
Q

What causes a fracture?

A
  1. Injury mechanism that exceeds maximum force the bone can withstand leading to a fracture (normal bone, abnormal force)
  2. Comorbidity that increase risk of fracture after injury
  3. Comorbidity that increases risk of injury
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10
Q

Describe comorbidity that increases risk of fracture after injury

A 
-Congenital
=Osteogenesis imperfecta (brittle bones)
-Acquired
=Metabolic (Rickets/osteomalacia)
=Degenerative (Osteoporosis)
=Tumour
Abnormal bone, normal force
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11
Q

Describe comorbidity that increases risk of injury

A

-Visual impairment
-Alcohol/drug use
-Neuropathy
-Balance disorder
-Epilepsy
Normal bone, abnormal force, increased risk of trauma

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12
Q

Which fractures need fixed?

A

-Only the minority
=Anything which would cause suffering and prolonged bed rest e.g. hip fracture, femur, tibia
=To prevent long term complications or loss of function e.g. malunion or nonunion
-Major trauma patients with open fractures or long bone injuries need early intervention

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13
Q

What is the assessment map?

A 
A Airway (+ C-spin control)
B Breathing
C Circulation
D Disability
E Exposure
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14
Q

What do we look for in Airways?

A

-Talking?
-Noises
=Snoring
=Stridor
=No noise…
-Physical blockage
=Food, blood, vomit, tongue= at risk
-Evidence of injury
=Face, oropharynx, neck

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15
Q

How do we treat airway obstruction?

A

-Suction
-Remove foreign body
-High flow O2
-Basic manoeuvres
+ C-spine control
-Airway adjuncts
-Definitive airway
– don’t forget the neck
ATLS teaches the ‘live long and prosper sign’ either side of the patient’s ears

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16
Q

What do we look for in Breathing?

A
  • Colour of patient – pink, blue…
  • Work of breathing – hard, shallow
  • Evidence of injury – bruising, wound
  • Observations – SpO2, RR, pulse, BP
  • Chest symmetry
  • Air entry
  • Percussion note
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17
Q

How is thoracic cavity different in trauma from health?

A
  • In health – thoracic cavity full of lung
  • In trauma – thoracic cavity full of something else
  • OR a disrupted ‘shell’/ rib cage
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18
Q

What is Tension Pneumothorax?

A
  • Internal ‘one-way valve’

- Pressure on mediastinum= decreased venous return to the heart= cardiac arrest

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19
Q

Describe the presentation of a tension pneumothorax

Study These Flashcards
A
  • Decreased breath sounds on affected side
  • Increased percussion note (hyper-resonant)
  • Engorged neck veins
  • Reduced lung expansion
  • Deviation of trachea to opposite side
20
Q

How do we treat tension pneumothorax?

Study These Flashcards
A
  • High flow oxygen, needle decompression in 2nd intercoastal space
  • Definitive chest drain
  • Sternal angle, 2nd intercostal space
21
Q

Describe an open pneumothorax

Study These Flashcards
A
  • ‘sucking chest wound’
  • External ‘one-way valve’
  • Air passes into the cavity through path of least resistance
  • Treat with oxygen and three-sided dressing
  • Definitive chest drain – 4th or 5th intercostal space, mid-clavicular line
22
Q

What is Flail Chest?

Study These Flashcards
A
  • 2 or more ribs fractured in 2 or more places
  • Separation of a segment of the thoracic cage that is then unable to contribute to lung expansion
  • Paradoxical movement of a segment of the chest wall
  • Indrawing on inspiration
  • Moving outwards on expiration
23
Q

What do we look for in Circulation?

Study These Flashcards
A
  • Colour of patient – pink, blue…
  • Work of breathing – hard, shallow
  • Evidence of injury – wound, blood loss
  • Observations – SpO2, RR, pulse, BP
  • Heart sounds
  • Pulses
  • Peripheral circulation - CRT
  • Mental state – cerebral perfusion?
24
Q

What is Cardiac tamponade?

Study These Flashcards
A
  • Pericardium is a ‘fixed’ sac (like the skull)
  • Small pressure increase (from blood) has big effect
  • Pericardiocentesis
  • Under ultrasound guidance
25
What is Beck's Triad?
- Hypotension: decreased stroke volume - Jugular venous distension: impaired venous return to the heart - Muffled heart sounds: fluid inside the pericardium
26
What is a massive haemothorax?
``` >1500 mls of blood in pleural cavity -decreased breath sounds, respiratory compromise (=‘B’) -large volume loss (= ‘C’) -needs a chest drain (B) AND fluid resuscitation due to SHOCK (C) ```
27
What is Shock?
-End-organ dysfunction =due to inadequate oxygen availability for tissues (perfusion) =cardiac, GI, neurology, renal… -Demand for O2 increased as delivery decreases
28
What are the types of shock?
- Anaphylactic - Cardiogenic - Haemorrhagic - Neurogenic - Septic
29
Which types of shock affect supply and demand of oxygen?
Decrease delivery: anaphylactic, cardiogenic, haemorrhagic, neurogenic Increase demand: septic
30
Describe haemorrhagic shock
- Most common in trauma - Body’s balance between blood loss and compensation - Four classes based on blood volume (70kg person has circulating volume of 5L= 70ml/kg)
31
Describe the 4 classes of haemorrhagic shock
1. <15% blood loss (<750ml), pulse <100, normal BP, >30 ml/hr urine output 2. 15-30% (750-1500), 100-120, normal BP, 20-30 ml/hr 3. 30-40% (1500-2000), 120-140, decreased BP, 5-15 ml/hr 4. >40% (>2000), >140, decreased BP, neg
32
What trends develop in haemorrhagic shock?
-Through classes 1 to 3, the body compensates, but trends develop: RESPIRATORY RATE – increases as lactic acid rises PULSE – tachycardia; heart rate increases to compensate for falling stroke volume BLOOD PRESSURE – remains fairly constant URINE OUTPUT – falls with renal vasoconstriction PERIPHERIES – cool with vasoconstriction MENTAL STATE – increasing confusion / agitation with reduced cerebral perfusion
33
What happens to compensation in class 4?
By class 4, compensation reaches ‘overload’ RESPIRATORY RATE – falls with fatigue PULSE – tachycardia reaches maximum, chest pain due to myocardial ischaemia BLOOD PRESSURE – drops dramatically URINE OUTPUT –negligible PERIPHERIES – cold, mottled MENTAL STATE – confused, comatose
34
Describe fluid resuscitation
``` STOP THE BLEEDING =haemostasis is the most effective resuscitation -Initial fluid bolus (10-20ml / kg) -Low thresh-hold for blood products= RBC, platelets, FFP -Tranexamic acid promotes clotting -Assess the response -Permissive hypotension =low BP is better in trauma =just enough to keep cerebral perfusion =not enough to start bleeding again =roughly 80mmHg systolic ```
35
What do we look for in Disability?
``` -GCS =best response in eye opening, verbal responses and motor, total out of 15 -AVPU scale =alert, verbal, pain or unresponsive -Temperature -Blood Glucose ```
36
What do we look for in Exposure?
-Full examination of the patient -While keeping them warm =clotting is temperature dependent -Common sites to miss injuries: =Back of head =Back =Buttocks =Perineum =Axillae =Skin folds
37
What are the life threatening conditions in trauma?
``` Airway Obstruction Tension Pneumothorax Open Pneumothorax Massive Haemothorax Flail Chest Cardiac Tamponade ```
38
What occurs during secondary survey?
-Patient ABC stabilized - any change = review -Systematic ‘top to toe’ examination with log roll =Head, face, eyes, ears, nose and throat =Neck =Chest =Abdomen =Pelvis =Back =Extremities =All wounds
39
What occurs during tertiary survey?
- Repetition of the secondary survey - Over several days - Broken pinky may be missed initially but still important!
40
What questions are to be considered when examining peripheral injuries?
- Where is it? - What side? - Which bone? - Open or closed? - Blood supply to leg? - Nerve supply? - What was the environment?
41
Describe open fractures
``` -Bone penetrates skin =Bone can go back in! -Skin penetrated from outside -Prompt management is imperative -Increased risk of infection ```
42
How do you treat any fracture?
``` -4 ‘R’s of fracture management =Resuscitate =Reduce =Restrict =Rehabilitate ```
43
Describe A and E management
``` -IV antibiotics =Early as possible =Cefuroxime 1.5g TDS =Clindamycin (pen allergy) =Gentamicin if heavy contamination -Anti Tetanus =No tetanus within 5yrs- give booster -Splint or Cast =Correct length and alignment =Get the bone back in =Tamponade bleeding vessels -Sterile saline soaked dressing ```
44
Describe surgical management
``` Within 24 hours or sooner… -Primary =Wound debridement (Dead tissue = culture for bacteria) =Skeletal stabilisation (IM nailing) (External fixation) - +/- Secondary =Tissue inspection and further debridement =Wound closure ```
45
Overview of open fracture assessment and treatment
- Fracture with break of dermis in same area - Carefully examine the wound - Sterile saline dressing - Realign and splint wound - IV abx and Tetanus - Surgical referral

Locomotor (20 decks)

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