Trauma & Burn 1 Flashcards
(50 cards)
1
Q
Abdomen (secondary survey)
A
- Inspect/auscultate
- palpate/percuss
- reevaluate
- special studies
2
Q
Perineum (secondary survey)
A
Contusions, hematomas, laceration, urethral blood, pelvic fx
*Ppl die from pelvic fx
3
Q
Pelvis (secondary survey)
A
- Pain on palpation
- Leg length unequal
- Instability
- Do not rock pelvic. Pelvic blood loss is huge!
4
Q
Compartment syndrome: what to look for
A
- Out of proportion pain
- Weak or absent of palpation
5
Q
Neurologic exam: what to report to neurosurgery
A
The best neurologic exam
6
Q
How to assess C-spine
A
- Pt is awake & alert
-
7
Q
How do you minimize missed injuries?
A
- High index of suspicion
- Frequent reevaluation and monitoring
8
Q
How do I know the airway is adequate?
A
- Patient is alert and oriented.
- Patient is talking normally.
- There is no evidence of injury to the head or neck.
- You have assessed and reassessed for deterioration.
9
Q
Signs and symptoms of airway compromise
A
- High index of suspicion
- Change in voice / sore throat
- Noisy breathing (snoring and stridor)
- Dyspnea and agitation
- Tachypnea
- Abnormal breathing pattern
- Low oxygen saturation (late sign)
10
Q
Protective airway reflexes
A
- Ability to cough
- Ability to swallow
- Oropharyngeal airway
- Nasopharyngeal airway
11
Q
How do I manage the airway of a trauma patient?
A
- Chin lift maneuver/jaw thrust
-
12
Q
How do I predict a potentially difficult airway?
A
- Maxillofacial trauma and deformity
- Mouth opening
- Anatomy
- Beard
- Short, thick neck
- Receding jaw
- Protruding upper teeth
13
Q
Definitive Airway – Easy
A
- Oral intubation (medication assisted)
- suction, back-up *coricoid pressure is no longer needed
- Maintain c-spine immobilization - Plan for failure:
- Gum elastic bougie
- LMA/LTA
- Needle cricothyroidotomy
- Surgical airway
14
Q
Induction agent for rapid sequence intubation
A
Ketamine
- Increase BP (ideal)
15
Q
Definitive Airway – Difficult
A
- Get help
- Be prepared
- Consider rapid sequence intubation vs. awake intubation
- Maintain c-spine immobilization - Consider use of:
- Gum elastic bougie
- LMA / LTA
- Surgical airway
- Other advanced airway techniques, eg, fiberoptic intubation
16
Q
How do I know the tube is in the right place?
A
- Visualize it going through the cords
- Auscultation
- CO2 detector
17
Q
What is shock?
A
Inadequate profusion at cellular level
18
Q
S/Sx of shock
A
- Alteration in level of consciousness, anxiety
- Cold, diaphoretic skin
- Tachycardia
- Tachypnea, shallow respirations
- Hypotension
- Decreased urinary output
- In ICU always monitor trend. You don’t rely on one point of values
19
Q
What is the cause of the shock state? (hypovolemic shock)
A
- Blood loss
- Fluid loss
20
Q
What is the cause of the shock state? (nonhemorrhagic shock)
A
- Tension pneumothorax
- Cardiac tamponade
- Cardiogenic
- Septic
- Neurogenic
21
Q
Tension pneumothorax
A
- Clinical diagnosis, not by x-ray
2. Immediate decompression: Needle, chest tube
22
Q
Frail chest management
A
- Analgesia
-Intubate as indicated
-
23
Q
Cardiac tamponade: S/Sx
A
- Narrowing systolic & diastolic BP
- Distended neck veins
- Muffled heart sounds
- Pulseless electrical activity
24
Q
Basilar skull fracture: S/Sx
A
- Racoon eye
- Battle sign
25
Primary survey: ABCDE
```
Airway w/ spinal protection
Breathing w/ adequate oxygenation
Circulation w/ hemorrhage control
Disability
Exposure/Environment
```
26
Who needs special consideration when trauma occur?
Elderly, pediatric, pregnant women
27
How to assess and ensure adequate oxygenation and ventilation?
RR
Chest movement
Air entry
SpO2
28
How to assess for organ perfusion?
- Level of consciousness
- Skin color and temp.
- Pulse rate and character
29
Circulatory management methods
Control hemorrhage, restore volume, reassess Pt
| *Watch out for elderly, children, athletes, meds
30
How do you assess for disability
Baseline neuro eval
| 1. GCS score 2. pupillary response
31
How do you assess for exposure/environment?
Completely undress the Pt
32
Resuscitation: 5 points
1. Protect and secure airway
2. Ventilate and oxygenate
3. Stop bleeding
4. Vigorous shock Tx
5. Prevent hypothermia
33
Dx tools for blunt abdominal trauma (BAT)
FAST (focused assessment w/ sonography in trauma)
34
Secondary survey (definition)
Complete Hx and physical examination
| 1. Hx; 2. PE; 3. Neuro exam; 4. Dx tests; 5. reeval
35
When do you start the secondary survey
Primary survey is completed
ABCDEs are reassessed
Vital functions are returning to normal
36
How do I minimize missed injuries
High index of suspicion
Frequent reeval and monitoring
*Think of what do you do in ICU
37
When should the transfer occur
ASAP after stabilizing measures are completed:
Airway and ventilatory control
Hemorrhage control
38
How do I know the airway is adequate
Pt is A&O
Pt is talking normally
No evidence of injury to the head or neck
Assessed and reassessed for deterioration
39
S/Sx airway compromise
1. High index of suspicion
2. Change in voice/sore throat
3. Noisy breathing (snoring and stridor)
4. Dyspnea and agitation
5. Tachypnea
6. Abnormal breathing pattern
7. Low SpO2 (late sign)
40
Airway management: Basic techniques
Chin-lift maneuver
| Jaw-thrust maneuver
41
Airway management: basic adjuncts
Oropharyngeal airway
| Nasopharyngeal airway
42
How do you know the tube is in the right place (Airway confirmation)
Watch the chest
Auscultation; SpO2; CO2 detector
CXR (definitive)
43
What is shock
Generalized state of hypoperfusion
Inadequate O2 delivery --> catecholamines and other responses --> anaerobic metabolism --> cell dysfunctinon --> cell death
44
Shock: S/Sx
Altered LOC, anxiety; cold, diaphoretic skin; tachycardia; tachypnea, shallow resp.; HoTN; decreased urinary output
45
Two causes of shock state
Hypovolemic: blood/fluid loss
*Trauma Pts often 2/2 blood loss
Nonhemorrhagic: tension pneumothorax, cardiac tamponade, cardiogenic, septic
46
How do you locate the bleeding
Physical exam
| Diagnostic adjuncts: CXR, FAST, pelvic X-ray
47
Technique for stop bleeding
```
Direct pressure/tourniquet
Angio-embolization
Reduce pelvic volume
Splint fx
Operation
```
48
Class 1 hemorrhage: Definition, S/Sx, what to give
750 mL BVL (15%)
S/Sx: slightly anxious, normal BP, HR < 100 bpm, RR wnl, urinary output 30 mL/hr
Crystalloid
49
Class 2 hemorrhage: Definition, S/Sx, what to give
750-1500 mL BVL (15-30%) loss
S/Sx: anxious, BP wnl, HR > 100 bpm, decreased pulse pressure, RR 20-30/min, urinary output 20-30 mL/hr
Crystalloid, ?blood?
50
Immediately life-threatening chest injuries (6)
1. Larygeotracheal injury/airway obstruction; 2. Tension pneumothorax; 3. Open pneumothorax; 4. Flail chest and pulmonary contusion; 5. massive hemothorax; 6. cardiac tamponade
