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Flashcards in Trauma Assessment & Management Deck (36):
1

Assessment and Management Priorities

Rapid primary survey
Resuscitation of vital functions
Detailed secondary survey
Initiate definitive care

2

Components of Primary Survey

A: airway and c-spine control
B: breathing and ventilation
C: circulation and hemorrhage control
D: disability (neuro status)
E: exposure (completely undress patient)

3

Airway and C-Spine Control

Open airway
Suction airway
Insert mechanical airway
Immobilize neck

4

Diagnostic Test for Clearing of C-Spine

Cross-table lateral C-spine film

5

Breathing

Look for chest movement
Patent airway does not equal adequate ventilation
Need oxygen and volume

6

3 Conditions that Compromise Ventilation

Tension pneumothorax
Open pneumothorax
Large flail section with pulmonary contusion

7

Circulation

Hypotension: assume hypovolemia
State of consciousness
Skin color
Pulse

8

How much blood loss must occur prior to becoming unconscious?

50% or more

9

How much blood loss must occur to having ashen, grey skin and white, drained extremities?

30% or more

10

How much blood loss must occur prior to losing carotid and femoral pulses?

50% or more

11

Primary Survey and Obvious Bleeding

Control via direct pressure

12

Disability Acronym

AVPU

13

What does AVPU stand for?

A: alert
V: verbal stimuli
P: pain stimuli
U: unconscious

14

Other Tests for Disability in the Primary Survey

Pupil size and reaction
Decrease in LOC

15

Exposure

Completely undress patients
Cut away clothing, shoes, etc.
Remove all field dressing and assess

16

Resuscitation Phase of Trauma Assessment and Management

Airway/ventilation/oxygenate
IV lines/warm fluids
Shock management
Manage life-threatening injuries
Foley catheter and NG tube

17

What EKG changes may indicate cardiac contusion?

Atrial fibrillation
PVCs
ST segment changegs

18

What EKG change may indicate tamponade, tension pneumothorax, or class IV hemorrhage?

PEA

19

What EKG change may be due to hypo perfusion or hypothermia?

Bradycardia

20

Secondary Survey: Head

Pupil size and reactivity
Fundi for hemorrhage
Lens for dislocation, evidence of conjunctival laceration or penetrating trauma
REMOVE CONTACTS
Maxillofacial trauma

21

Secondary Survey: Neck/C-Spine

All blunt injury to maxillofacial area
Absence of neurological deficit or pain does NOT rule out injury
All helmets must be removed while maintaining immobilization
Penetrating trauma through platysma should be assessed in the OR

22

Secondary Survey: Chest

Visually inspect
Palpate entire chest: ribs, clavicles, sternum
Auscultate chest: apex, bases

23

Secondary Survey: Abdomen

Recognize abdominal injury has occurred
Serial exams over several hours
Call surgeons early and frequently
FAST

24

Secondary Survey: Rectal Exam

Assess presence of blood in bowel lumen
High-riding prostate
Presence of pelvic fracture
Integrity of rectal wall
Quality of sphincter tone

25

Secondary Survey: Fractures

Visualize extremities
Palpate bones: tenderness, crepitation, abnormal movements
Document peripheral pulses and distal neurological status
Thoracic and lumbar spine injuries

26

Secondary Survey: Neurological

Motor and sensory check
Evidence of paralysis or paresis
Evidence of epidural/subdural hematoma, depressed skull fractures, or other intracranial injuries
Glascow Coma Scale

27

Eye Opening of Glasgow Coma Scale

4: spontaneous
3: speech
2: pain
1: none

28

Verbal Response of Glasgow Coma Scale

5: oriented
4: confused
3: inappropriate
2: incomprehensible
1: none

29

Motor Response of Glasgow Coma Scale

6: obeys commands
5: localizes to pain
4: withdraws from pain
3: flexion to pain
2: extension to pain
1: none

30

Definitive Care Phase

Comprehensive management
Fracture stabilization
Operative intervention
Stabilization and transfer

31

AMPLE History

A: allergies
M: medications
P: past illnesses/surgeries
L: last intake
E: events leading up to event

32

Energy Waves in Blunt Trauma

Extends from blunt trauma

33

Energy Waves in Missile Trauma

Extends lateral from missile trauma

34

Likely Frontal Impact Injuries

C-spine
Central flail chest
Myocardial contusion
Fractures spleen/liver

35

Likely Side Impact Injuries

Contralateral neck sprain or cervical fracture
Lateral flail chest
Pneumothorax
Acceleration injury to aorta
Fractured pelvis or acetabulum

36

Penetrating Trauma/GSW

Region of body
Distance of object from source
Temporary cavitation
Missile deformity after entering body
Tissues impacted