Trauma Assessment Flashcards
(30 cards)
What is ATLS?
approach to injured patients. It emphasizes the greatest threat to life first, and that a lack of a definitive diagnosis should not impede treatment.
ATLS emphasizes that injury kills in a certain reproducible pattern:
- airway first
- breathing next
- loss of circulating blood volume
- intracranial bleed
What is the ABCDE approach?
A: airway (with cervical spine protection)
B: breathing
C: circulation
D: disability–> neuro status
E: exposure (remove clothing) and environment (temp control)
What is the primary survey?
your ABCDEs
Describe the process of trauma management?
- prep
- triage
- primary survey
- resuscitation if needed
- adjuncts to primary survey if needed
- secondary survey (head to toe eval and history)
- adjuncts to secondary surey
- continued post resuscitation monitoring and reevaluation
- definitive care
How are patients treated based on the primary survey? what info is important?
- injuries sustained
- vital signs
- injury mechanism
Describe “a”
airway. must eval while protected cervical spine
describe “B”
breathing and ventilation, maximize oxygenation and c02 elimination.
Describe “c”
circulation with hemorrhage control:
- Blood volume and cardiac output: check level of consciousness, skin color, and pulse.
- bleeding
Describe “D”
• Disability (Neurologic evaluation) • Establish level of consciousness o AVPU method • A Alert • V responds to Vocal stimuli • P responds to Painful stimuli • U Unresponsive to all stimuli o Glasgow Coma Scale • Check pupillary size and reaction
Describe “e”
Exposure/Environment Control
• Completely undress the patient by cutting off garments
• Cover with warm blankets or external warming device
• Warm IV fluids
If resuscitation is needed…describe “a”
Primary Survey – A
• Protect airway and secure when potential exists for compromise
• Jaw thrust or chin lift maneuvers
• Nasopharyngeal airway in conscious patient or oropharyngeal airway in unconscious patient
• Consider need for definitive airway
o Endotracheal tube
o Surgical airway
RESUSCITATION: describe “b”
Definitive control of airway with endotracheal intubation – nasally or orally
• Compromised airway due to mechanical factors
• Ventilatory problems
• Unconsciousness
• Tension pneumothorax, flail chest, etc.
• Supplemental oxygen for every injured patient
RESUSCITATION: describe “c”
Control bleeding
• Direct pressure
• Operative intervention
• Establish two large-caliber IV lines (14 or 16 g)
• Rapid administration of fluids (2 – 3 liters) – Ringer’s lactate is initial crystalloid solution (see “Level 1” machine to the left)
• If unresponsive to initial fluids, give blood (O negative if you don’t know what their blood type is)
What are adjuncts to primary survey: assessment and resuscitation?
Adjuncts to Primary Survey and Resuscitation
• X-rays and Diagnostic Studies
• Use judiciously and do not delay resuscitation
• AP chest x-ray and AP pelvis x-ray
• Lateral cervical spine x-ray
• FAST Ultrasound (Focused Assessment with Sonography for Trauma)
o FAST has essentially replaced Diagnostic Peritoneal Lavage
When can you begin secondary survey?
o Secondary Survey does NOT begin until:
• Primary Survey (ABCDEs) is completed
• Resuscitative efforts are well established
• The patient is demonstrating normalization of vital functions
What is secondary survey?
Secondary survey = Head-to toe evaluation of the trauma patient
• More complete history and physical examination
• Includes reassessment of all vital signs
• Each region of the body is completely examined
Includes a complete neurological exam
• Include Glascow Coma Scale score (if not done in the Primary Survey)
o Additional x-ray studies as indicated
o Special procedures (e.g. specific radiologic evaluations and laboratory studies)
Describe secondary survey: HISTORY:
o Include history of mechanism of injury
• Obtain from: patient, prehospital personnel, family
o AMPLE mnemonic is useful for this purpose
• A Allergies
• M Medications currently used
• P Past illnesses/Pregnancy
• L Last meal
• E Events/Environment related to the injury
o Mechanism of Injury
• Obtain information from prehospital personnel
• Note direction and amount of energy force
• Classify injury into three broad categories
• Blunt – Falls, MVC, Penetrating – GSW, stab wounds, impalement, Other – burns / cold / chemicals /radiation / electrical shock, et
What do you need to be aware of on secondary survey PE?
DISTRACTING INJURIES!
SELF ADMINISTERED ANESTHESIA!
Where does the secondary PE begin?
the HEAD
Patients with___________ or _____ ____ should be presumed to have an unstable cervical spine injury
Patients with maxillofacial or head trauma should be presumed to have an unstable cervical spine injury.
- Immobilize neck until complete evaluation is done and injury has been excluded
- Absence of Neuro deficit does NOT exclude C-spine injury. Treat as if patient has C-spine injury until radiography is complete.
What can distended neck veins indicate?
cardiac tamponade or tension pneumothorax
What are the signs of a tension pneumothorax?
- Signs of tension pneumothorax
- Decreased breath sounds
- Hyperresonance to percussion
- Shock
- Treatment - Immediate chest decompression with chest tube or needle
- Auscultation
- Pneumothorax - listen high in anterior chest wall (air will rise to top)
- Hemothorax – listen at posterior bases (blood will accumulate at bottom)
What is Beck’s triad and what disease is it associated with?
Cardiac Tamponade:
o Low SBP / Narrow pulse pressure
o Distended neck veins
o Muffled heart sounds
