Trauma Flashcards by Izzy Burns

What does AMPLE stand for?

A - Allergies 
M - Meds + drugs 
P - PMH
L - Last meal 
E - events leading to an accident

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Primary Survery (3)

Full systems exam
Trauma Series Xray
FAST scan

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Trauma xray series (3)

C-spine
CXR
Pelvic XR

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What is a FAST scan

Focused abdominal sonography for trauma

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What type of injuries are pelvic disurptions usually associated with?

Visceral - bladder, urethral, rectal

Vascular - iliac aa/retroperitoneal vv

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Ix pelvic disruptions

Pelvic XR

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Mx pelvic disruptions (3)

Initially - pelvic splint
Arteriography
Surgery

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Haemorrhagic shock - blood loss (1-4)

1- <750/ 15%
2 - 750-1500/15-30%
3 - 1500-2000/30-40%
4 - >2000/>40%

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Haemorrhagic shock - HR (1-4)

1 - <100
2 - 100-20
3 - 120-40
4 - >140

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Haemorrhagic shock - BP (1-4)

1 - no change
2- no change
3 - decr
4 - decr

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Haemorrhagic shock - Pulse pressure (1-4)

1 - incr/no change
2- decr
3 - decr
4 - decr

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Haemorrhagic shock - RR (1-4)

1 - 14-20
2 - 20-30
3 - 30-40
4 - >35

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Haemorrhagic shock - Urine output (1-4)

1 - 30ml/hr
2 - 20-30mls/hr
3 - 5-15ml/hr
4- negligible

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Haemorrhagic shock - CNS (1-4)

1 - slightly anxious
2 - mildly anxious
3 - anxious/confused
4 - confused/lethargy

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What does ATOM FC stand for

Indicates common causes of life threatening chest injury 
A = Airway 
T = Tension pneumothorax 
O = Open pneumothorax 
M = Massive haemothorax
F = Flail chest 
C = cardiac tamponade

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Indications of airway compromise (3)

Stridor
Noisy breathing
Surgical emphysema

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Mx Airway

Head tilt/chin lift
Suction
temporary airway
ETT = definitive Mx

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Indications of tension pneumothorax (3)

Absent breathsounds
hyperresonant lung 1 side
Tracheal shift to NORM side

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Which way does the trachea shift in tension pneumothorax?

Towards the normal side

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Mx tension pneumothorax

Needle decompression 2 ICS MCL

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What is an open pneumothorax

A direct communication betw pleural cavity and environment

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Mx open pnuemothorax (3)

Asherman valve
Chest drain
Surgical closure

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What is a massive haemothorax

> 1500ml of blood

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Cause of massive haemothorax

Rib fracture –> vv injury

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PS Massive haemothorax (3)

Shock Dull percussion No breath sounds

Mx massive haemothorax

Large chest drain - 6ICS MCL Admit Thoractomy

What is flail chest

When chest wall disconnects from thoracic cage

Cause of flail chest

>2 rib fractures in >2 places

PS Flail chest (3)

Pain Withdrawal of chest on inspiration Rapid shallow breathing

Mx Flail chest

Intercostal anaesthesia Aggressive pulmonary toilet CPAP

Causes cardiac tamponade (2)

Penetrating trauma | Pericarditis

What is Beck's triad

Distended neck vv Distant heart sounds Decr BP

How is cardiac tamponade diagnosed

Echo

Mx cardiac tamponade (2)

Pericardiocentesis | Thoractomy

What is pulmonary contrusion

Blood is alveolar space

Cause of pulmonary contrusion

Blunt trauma

XR appearance pulmonary contrusion

Diffuse alveolar shadowing

What causees aortic disruption?

Acceleration-deceleration injury --> laceration by ligamentum arteriosum

PS aortic disruption (3)

Incr BP Tearing pain towards back Widened mediastinum

Mx aortic disruption

Fatal | Hence needs instant repair

What is Tracheobronchial or Oesophageal Disruption

Damage to bronchial tree

What Sx suggest Tracheobronchial or Oesophageal Disruption

Haemopytsis | Surgical emphysema

Mx Tracheobronchial or Oesophageal Disruption

Intubate and ventilate

Cause diaphragmatic disruption

Blunt/penetrating trauma

Mx diaphragmatic disruption

Laparotomy

What is myocardial contrusion

bruising of myocardium

Cause of myocardial contrusion

Steering wheels/sternal fracture

Ix myocardial contrusion

ECG | ECHO - rule out tamponade

Mx myocardial contrusion

Supportative

Most common abdo organ damaged: blunt trauma

Spleen

Most common abdo organ damaged: stab wound

Liver

Most common abdo organ damaged: Gun shot

Small bowel

What does a FAST scan do?

Detects free fl/organ haematomas and lacerations

-ve FAST

Less reliable than CT

+ve FAST

Can be done on less stable pt's

What 5 areas does the FAST scan focus on? (5 Ps)

``` Perihepatic Perisplenic Pelvic Pleural Pericardial ```

What are focal head injuries due to?

Mechanical force

What is cerebral contrusion?

Bruising of brain

Cause of cerebral contrusion ?

Countercoup injury

Cause of epidural haemorrhage?

Damage to middle meningeal aa q

Cause of subdural haemorrhage?

Damage to bridging of vv

What is Cushings reflex

Incr BR and decr HR in a brain injury | Late and terminal sign :(

Criteria for CT head (<8hrs) (5)

``` On warfarin LOC/Amnesia since injury + > +65 > Hx bleeding/clotting disorder > Dangerous injury mechanism > >30mins retrograde amnesia ```

Criteria for immediate CT head (<1h) (7)

``` GCS <13 initial assessment GCS <15 @ 2hrs admission Suspected skull fracture Basal skull fracture Post traumatic seizure Focal neuro defecit >1 ep vomiting ```

Battle's sign

Bruise located behind ear | Indicates basal skull fracture

Cerebral perfusion eq

= MAP - ICP

What value must MAP not fall below in ITU

How can you incr MAP

Fluids | Inotropes - Noradrenaline/vasopressin/ADH

How can you decr ICP

Avoid XS fl | Elevating head @ 30'

Ix - head injury patient

Beside: BM, ABG, GCS Lab: ETOL, FBC, U+E, clotting, G+S Image: CT brain+ spine

What are the 4 outcomes for neurosurgery patients

Urgent neurosurgery ICU Ward care Catastrophic - no chance of survival

GCS - eyes

4 - spontaneous 3 - to speech 2 - to pain 1 - no response

GCS - verbal

``` 5 - oriented to time, person + place 4 - confused 3 - inapprop words 2 - incomprehensible sound 1 - no response ```

GCS - motor

``` 6 - obey command 5 - moves to localised pain 4 - flexes away from pain 3 - abnormal flexion 2 - abnormal extension 1 - no response ```

PS Incr ICP (5)

``` Nocturnal headache, worse on movement Changes in mental state Vomiting NO nausea Pupil changes Papilloedenma ```

Causes Incr ICP (8)

``` Localised mass Neoplasm Abscess Foecal oedema Diffuse swelling 2' to infection/SAH, Reye's syndrome Disruption in CSF flow Obstructed venous sinus Idiopathic HTN ```

Mx incr ICP (7)

``` Avoid pyrexia Mx seizures CSF drainage Elevate head Analgesia + sedation Mannitol Hyperventilation ```

How do you drain CSF

Intraventricular catheter

Trauma Flashcards

(78 cards)