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Flashcards in Trauma Assessment and Management Deck (24):
1

Assessment and Management Priorities? 4

1. Rapid Primary Survey
2. Resuscitation of vital functions
3. Detailed Secondary Survey
4. Initiate Definitive Care

2

PRIMARY SURVEY? 5

A – Airway maintenance and C-spine control
B – Breathing and ventilation
C – Circulation and hemorrhage control
D – Disability: Neurological status
E – Exposure: Completely undress patient

3

Trauma Assessment and Management
PRIMARY SURVEY: Airway/C-Spine
1. Open airway, suction airway, insert mechanical airway; but do not do what?

2. Keep neck immobilized
You CANNOT immobilize the neck without what?

3. Assume IN ANY MULTI-TRAUMA PATIENT AND WITH ANY BLUNT INJURY ABOVE THE CLAVICLE?

1. do not hyperextend neck

2. complete spinal immobilization

3. ASSUME A CERVICAL FRACTURE

4

Trauma Assessment and Management
PRIMARY SURVEY: Breathing


Expose the patient’s chest
1. Need to be able to see what?
2. Patent airway does NOT ensure what?

3. Oxygen and volume need to be delivered so the what is optimal?
4. CANNOT insure adequate oxygen with just what? 2

5. Three conditions most often compromise ventilation?

1. chest movements

2. adequate ventilation

3. BMV device

4. simple mask or nasal cannula

5.
-Tension pneumothorax
-Open pneumothorax,
-Large flail section with pulmonary contusion

5

Trauma Assessment and Management
PRIMARY SURVEY: Circulation

1. Blood volume and circulation: Hypotension must be assumed to be what until proven otherwise?

2. Rapid assessment is based on 3 key factors?

3. Bleeding: Obvious external bleeding should be controlled during the primary survey… What is the best method?

4. What may be necessary for traumatic amputation?

1. hypovolemic

2.
-State of consciousness
-Skin Color
-Pulse

3. DIRECT PRESSURE

4. Tourniquet

6

Rapid assessment is based on 3 key factors
1. State of consciousness: How you can assess how much blood has been lost just on primary assessment?

2. Which symptoms = no significant hypovolemia? Which do?

3. If carotid and femoral pulse are present? If they are not?

1. When >50% blood volume is gone everyone is unconscious; therefore if they are awake, the brain is being perfused (less than 50%)

2. Pink skin of face and extremities means no significant hypovolemia; ashen, grey skin and white, drained extremities = at least 30% loss

3. Carotid or Femoral pulse present less than 50% loss; absent femoral and/or carotid pulse > 50% loss and death is imminent

7

Trauma Assessment and Management
PRIMARY SURVEY: Disability
1. Brief Neuro Exam? 4

2. Eyes?

3. Decrease in LOC during serial exams means decreased what?
-if so check? 3

4. Secondary survey for neuro includes?

1. “AVPU” is a useful acronym
Alert?
V responds to Verbal stimuli
P responds to painful stimuli
Unresponsive

2. Check pupillary size and reaction

3. Decrease in LOC during serial exams means decreased cerebral perfusion….
-check oxygenation, perfusion, and ventilation status

4. Glasgow Coma Scale is for secondary survey

8

Trauma Assessment and Management
PRIMARY SURVEY: Exposure

1. What should you do with the patients clothing?

2. Field dressings?

3. Remember, the ED is generally a cold place. What is the problem with this?

4. Following Primary Survey, keep patient covered with what?

1. All patients must be completely undressed. Cut awayall clothing, shoes etc

2. Remove all field dressings and look underneath

3. hypothermia will worsen shock states

4. blankets or use Bair Hugger except while doing specific exams or procedures

9

Trauma Assessment and Management
What is involved in the resuscitation phase?
5

1. Airway/Ventilate/Oxygenate

2. IV Lines/Warm Fluids

3. Shock Management

4. Manage life-threatening injuries

5. Foley catheter and NG tube may be placed if NOT contraindicated

10

How do we start shock management? 2

1. Control bleeding/Start IV access lines
2. Crystalloids

11

Trauma Assessment and Management
Resuscitation Phase

1. Supplemental O2 on all patients (sats >?)

2. Start two (2) large-bore (16g) IV lines
-Draw “rainbow” when starting IV lines
Bolus with what to treat shock while awaiting blood?

3. Hypovolemic shock is never treated with what?

4. Consider what after NS?

5. ECG monitoring on all patients; what changes may indicate cardiac contusion? 3

6. PEA may indicate what? 3

7. Bradycardia may be due to what? 2

8. NG tube and foley placement
-NO NG tube with possible what?
-NO Foley in males with what? 3

1. 90%

2. Bolus with 2-3L NS

3. vasopressors

4. type specific or O-neg blood

5.
-atrial fibrillation,
-PVCs, and
-ST segment changes

6.
-tamponade,
-tension pneumothorax or
-Class IV Hemorrhage

7.
-hypoperfusion or
-hypothermia

8.
-cribiform plate fractures
-blood at meatus or in scrotum or high-riding prostate

12

1. What must be done before the secondary survey is considered?

2. What is involved in this step?

1. Primary Survey must be accomplished and resuscitation phase started before any secondary survey is considered

2. This is where labs are drawn and diagnostic testing obtained

13

Secondary survey
1. Eyes? 6

2. Maxillofacial trauma: If no Airway obstruction, treatment for these injuries can wait how long?

3. Cribiform plate fractures – place NG through?

1. Eyes:
-Pupil size and reactivity
-fundi for hemorrhage
-lens for dislocation
-evidence of conjunctival laceration or penetrating trauma.
-Test VA by confrontation.
-Remove contact lenses.

2. Maxillofacial Trauma: 7-10 days.

3. mouth.

14

Trauma Assessment and Management
SECONDARY SURVEY
Neck/C-Spine

1. All blunt injury to maxillofacial area have what until proven otherwise?

2. Absence of what does NOT rule-out C-Spine injury?

3. Any/all sports or other helmets must be removed while maintaining what?

4. Penetrating trauma through the what should NOT be explored in the ED?

1. C-Spine injury

2. neurological deficit or pain

3. C-Spine immobilization

4. platysma

15

Trauma Assessment and Management
SECONDARY SURVEY

Chest
Visually inspect the entire chest (anterior and posterior)

1. Palpate the entire chest: such as? 3

Auscultate the chest
2. High on anterior chest for

3. Posterior bases for what?

4. Distant heart sounds may indicate what?

5. Neck veins may not be distended due to what?

6. and narrow pulse pressure may be only sign of what?


1.
-Feel each rib and follow its course
-Feel each clavicle
-Palpate the sternum for fracture or tenderness

2. pneumothorax

3. hemothorax

4. tamponade

5. hypovolemia

6. tamponade

16

Trauma Assessment and Management
SECONDARY SURVEY

Abdomen
Abdominal injuries may be occult and potentially dangerous

Specific diagnosis is not as important as recognizing that abdominal injury has occurred

1. Initial abdominal exam may be negative; what must be done after this?

2. Call surgeons on what timeline?

3. What has replaced DPL as a quick, noninvasive approach to detect free fluid (blood) in the abdomen?

1. serial abdominal exams over 1 - several hours must be done

2. early and frequently

3. FAST

17

Trauma Assessment and Management
SECONDARY SURVEY

Rectal Exam

Essential part of every secondary survey
What are we assessing with this? 5

1. Assess for presence of blood in bowel lumen
2. A high-riding prostate
3. Presence of pelvic fracture
4. Integrity of the rectal wall
5. Quality of sphincter tone

18

Trauma Assessment and Management
SECONDARY SURVEY
Fractures

1. Visualize extremities for what? 2

2. Palpate bones
Include what? 3

3. Document all what on extremities? 2

Don’t forget T and L spine injuries which may be masked

1. contusions or deformities

2.
-Checking for tenderness, crepitation, abnormal movements
-Anterior/Posterior pressure on iliac wings for pelvis
-Pressure over symphysis pubis

3.
-peripheral pulses and
-distal neurological status

19

Trauma Assessment and Management
SECONDARY SURVEY

Neurological
1. Comprehensive neuro exam including what? 2
2. Any evidence of paralysis or paresis suggests what?
-and you need to do what?

3. Any evidence of epidural/subdural hematomas, depressed skull fractures, or other intracranial injuries should be considered for what?

1. motor and sensory (check major dermatomes)

2. spinal cord injury
-keep the entire spine immobilized

3. transfer to nearest neurosurgeon ASAP

20

Trauma Assessment and Management
Definitive Care Phase
Comprehensive management is accomplished
1. Fracture _________ is obtained?
2. _________ intervention is done as needed?
3. Stabilization and arrangements made for transfer to what?

1. stabilization

2. Operative

3. tertiary center

21

Trauma Assessment and Management
HISTORY
SAMPLE

Ask about mechanism of injury
-Energy wave extends from what?
-Energy wave extends laterally from what?

AMPLE history is a useful mnemonic
S
A – Allergies
M – Medications currently taking
P – Past illnesses/surgeries
L – Last meal
E- Events/environment related to injury


-blunt trauma
-from missile trauma

22

Trauma Assessment and Management
HISTORY
Blunt trauma
1. what account for most blunt trauma?
2. Direction of impact determines what?

3. Talk to which personnel?
4. Patient’s injuries often “mirror” what?

5. Frontal impact, bent steering column, star windshield
may be signs that what injuries have happened? 4

6. Side impact: in car may lead to what? 5

1. Auto accidents

2. pattern of injuries

3. prehospital

4. the car’s damage

5.
-C-Spine injuries,
-Central flail chest,
-Myocardial contusion,
-Fractured spleen/liver

6.
-Contralateral neck sprain or cervical fracture,
-lateral flail chest,
-pneumothorax,
-acceleration injury to aorta,
-fractured pelvis or acetabulum

23

Trauma Assessment and Management
HISTORY

1. Restate the Primary survey?

2. Three main componenets in resuscitation?

1. PRIMARY SURVEY
-Airway and cervical spine control
-Breathing
-Circulation and hemorrhage control
-Disability: Brief Neuro Exam
-Exposure: Completely undress the patient

2. RESUSCITATION
-Shock management – IV lines with RL or NS
-Management of life threatening problems
-ECG monitoring

24

Trauma Assessment and Management
SUMMARY

What is involved in the secondary survey?
10

Secondary Survey
1. Head and skull
2. Maxillofacial injuries
3. Neck
4. Chest
5. Abdomen
6. Perineum/Rectum
7. Extremities – fractures
8. Complete neuro exam
9. Appropriate X-Rays, labs, special studies
10. “Tubes and fingers” in every orifice