Trauma, Burns, and Sepsis Flashcards
(85 cards)
How is the initial airway evaluation performed? What signs are looked for?
determine whether the airway is clear or obstructed.
If a patient can talk, the airway is patent, at least at that particular moment.
Signs of airway obstruction include stridor, hoarseness, and evidence of increased airway resistance such as respiratory retractions (retraction of the soft tissues between the ribs during inspiration) and use of accessory respiratory muscles.
- Clear visually
- gag reflex indicates that the upper airway is most likely clear.
How are trauma patients evaluated initially in the ED?
primary survey for trauma patients. Most clinicians reassess patients again before proceeding to the secondary survey
Continual reassessment - is necessary during trauma surveys, looking for cardiovascular instability and other Significant changes, particularly neurologic changes.
ATLS initial evaluation recommends?
Airway
Breathing (ventilation)
Circulation
Disability (neurologic deficit)
Environment; expose patient (i.e., remove all clothing)
Blunt trauma may lead to what complication? How should it be managed?
Blunt trauma may also cause laryngeal edema, which may be mild when the patient is first admitted to the emergency department but become worse in the next few minutes or hours.
Hoarseness, a change in voice, or stridor are clues to this condition. If laryngeal edema is suspected, intubation is necessary, before airway obstruction occurs.
What are the indications for intubation?
–Laryngeal edema
- inadequate respiratory effort
- severely depressed mental status
- a Glasgow Coma Score of eight or less
- inability to protect the airway
- severely compromised respiratory mechanics
Treatment for simple pneumothorax?
treatment is insertion of a large-diameter chest tube. It is important to insert a finger into the pleural space prior to inserting the tube to be certain that it is in the correct space.
What is the management of a chest tube?
Youwouldplaceawatersealwithsuctionandtoallowreinflationofthelung. Serial CXRs are necessary. Removal of the tube may occur when the lung is fully inflated and no fur ther air leak is apparent.
examination indicates a laceration on the chest wall that penetrates through to the lung and “sucks” air as it moves in and out
during respiration. What is it? What is the treatment?
sucking chest wound. It should be sealed with an occlusive dressing, and a chest tube should be inserted at a different location.
After insertion of the chest tube and repeating the CXR, the lung does not fully inflate.
Either the chest tube is in the wrong location or not functioning properly. Tubes can be erroneously inserted into the subcutaneous tissues, have air leaks at their connections, or “clot off”
After insertion of a chest tube, a large amount of air continues to leak into the chest tube over the next 6 hours, and the lung remains only partially inflated.
major airway injury with disruption of a bronchus or the trachea . sometimes apparent on bronchoscopy, requires a thoracotomy and partial lung resection to repair the injury.
Can a small pneumothorax be observed
As long as it is small. Uncomplicated. Not enlarging there is no chest injury. There is no fluid in the plural space
If a surgery is required, a chest tube is always necessary, otherwise a small pneumothorax may turn into a tension pneumothorax.
You clear the airway of the patient in Case 1 2.1 . Absent breath sounds in the right chest are notable. The patient has a BP of 80/60 mm Hg. Distended neck veins are present.
hypotension and absent breath sounds, the suspected problem is a tension pneumothorax.
Treatment for tension pneumothorax?
If immediate insertion of a chest tube is not possible, needle aspiration of the left chest is nec essary. With a diagnosis of tension pneumothorax, the patient should experience immediate improvement in BP.
A patient presents with hypotension, normal breath sounds, distended neck veins. What is it? What is the treatment?
Pericardial tamponade. or myocardial contusion (usually causes arrhythmias)
Emergent pericardiocentesis or pericardial ultrasound examination, if immediately available in the trauma resuscitation unit, is necessary.
After initial drainage, the patient should go to the operating room for a pericardiaI window and examination of the pericardial contents to stop the source of bleeding
How is the initial blood loss estimated based on the patients presentation?
Blood losses of less than 15 % cause few physiologic changes;
losses of 15%-30% cause mild changes, including tachy cardia and increased pulse pressure.
Losses of 30%-40% cause severe changes in vital signs including hypotension, tachycardia, and decreased mentation.
Which stage of hemorrhage requires a blood transfusion?
Patients who suffer blood losses of 15%-30% (Class II) usually require blood transfusion, and those who suffer blood losses of 30%-40% (Class III) almost always require transfusion.
How is the adequacy of resuscitation determined?
Signs of adequate initial resuscitation include acceptable urine output and improvement in heart rate, mental status, and BP.
Other physiological variables to follow: anaerobic metabolism as measured by correction of lactic acidosis and normalization of venous oxygen saturation.
What do you do if a patient remains hypotensive despite adequate fluid resuscitation?
When a patient continues to remain hypotensive and unstable despite adequate fluid resuscitation, the most important priority is a search for the underlying cause. Urgent laparotomy or thoracotomy may be indicated.
Can a closed head injury cause hypotension?
A closed head injury typically does not cause hypotension as a result of the Cushing reflex.
Explain the Cushing reflex?
ischemic brain sends a sympathetic nervous system message to the peripheral circu lation to vasoconstrict, which maintains a normal or increased BP and thus regulates per fusion to the brain. Bradycardia also results, because the vagus nerves are unaffected by this message and respond to the increased BP with parasympathetic stimulation to the heart, causing the decreased heart rate.
How do you evaluate a cervical spine when the patient is awake and alert?
Cervical spine precautions include neck immobilization with a collar or a board, as used by paramedics. If no stabilization is in place, it is necessary to maintain in-line cervical stabilization
palpation of the neck along the posterior aspect to detect
tenderness, deformity, or other abnormalities. In addition, a rapid assessment of the basic motor and sensory function of the arms and legs is necessary.
Ask the patient to move his fingers and toes.
Lateral cervical spine radiograph
How do you evaluate the cervical spine of a patient who is comatose?
Cannot clear the cervical spine. Some surgeons will order a cervical spine MRI
The patient has loss of neurological function below the neck
neurologic deficits, radiologic abnormalities, or cervical spine tenderness are present, then a cervical spine injury should be suspected.
continued cervical spine precautions, a neurosurgical consultation, complete evaluation with imaging, and immediate administration of steroids to maximize recovery of the neurologic loss due to damage caused by edema to the adjacent areas of the spinal cord. Intubation requires extreme caution
Patient has priapism after a motor vehicle accident. What is it?
Priapism is a finding in patients with a fresh spinal cord injury. Other findings include loss of anal sphincter tone, loss of vasomotor tone, and bradycardia due to loss of pe ripheral sympathetic activity and intestinal ileus.
