Trauma - Initial trauma management Flashcards
(114 cards)
1
Q
What is the major cause of death in the first four decades of life?
A
Trauma
Trauma is also the 3rd most major cause of death overall.
2
Q
What age group has the highest injury rate?
A
15-24 years
This age group experiences the highest rate of injuries.
3
Q
In which age group is the highest death rate from injury observed?
A
75-84 years
This group shows the highest mortality rate due to injuries.
4
Q
What is the male to female ratio of trauma deaths?
A
2:1
This indicates a higher incidence of trauma deaths in males compared to females.
5
Q
What is the leading cause of injury in children under 5?
A
Falls
This age group is particularly vulnerable to falls.
6
Q
What are the leading causes of mortality in children under 5?
A
Drowning, burns, and MVA
MVA stands for motor vehicle accidents.
7
Q
What is the leading cause of injury in teens to 20s?
A
MVAs (38%)
Motor vehicle accidents are also the leading cause of mortality in this age group.
8
Q
What percentage of mortality in teens to 20s is caused by MVAs?
A
75%
This highlights the significant impact of motor vehicle accidents on this demographic.
9
Q
In the elderly, what are the leading causes of injury and mortality?
A
Falls and burns
These are critical safety concerns for the elderly population.
10
Q
What percentage of trauma cases in NZ/Australia are due to falls?
A
50%
Falls are a major contributor to trauma in these regions.
11
Q
What percentage of trauma cases in NZ/Australia are due to MVAs?
A
35%
Motor vehicle accidents also play a significant role in trauma cases.
12
Q
What percentage of trauma cases in NZ/Australia are due to penetrating injuries?
A
8%
This includes injuries from stabbings and gunshots, which are less prevalent compared to the USA and developing countries.
13
Q
What is the time frame for immediate trauma deaths?
A
Seconds to minutes (50% of deaths)
Immediate deaths are primarily due to major vessel disruption and CNS disruption.
14
Q
What percentage of trauma deaths occur in the ‘golden hour’?
A
35% of deaths
The ‘golden hour’ refers to the critical time frame of 1-2 hours post-injury.
15
Q
List the types of injuries that commonly lead to early trauma deaths (within 1-2 hours).
A
- Head injuries (subdural / extradural)
- Chest injuries (haemopneumothorax)
- Abdominal injuries (liver, spleen)
- Multiple injuries with major blood loss (including # femur & # pelvis)
These injuries are critical and require immediate medical intervention.
16
Q
What are the causes of late trauma deaths (days or weeks after injury)?
A
- Brain death
- Organ failure
- Sepsis
These complications can arise after the initial trauma and significantly impact survival.
17
Q
True or False: Major vessel disruption is a cause of early trauma deaths.
A
True
Major vessel disruption is one of the leading causes of immediate trauma deaths.
18
Q
Fill in the blank: The time frame referred to as the ‘golden hour’ is _______.
A
1-2 hours
This is the critical period during which timely medical treatment can significantly affect survival outcomes.
19
Q
What is the primary focus of pre-hospital preparation?
A
Airway, control of external bleeding, immobilisation, transport to appropriate hospital transferee
These are critical steps to stabilize a patient before reaching a medical facility.
20
Q
What does the trauma team require for effective operation?
A
Equipment, lab, radiographer, personal protective equipment
These resources are essential for the trauma team’s efficiency and safety.
21
Q
What does MIST stand for in the context of patient handover?
A
Mechanism, Injuries, Signs and symptoms, Treatment
MIST is used to ensure comprehensive communication during patient handover.
22
Q
What information is obtained for triage under the ‘MIST’ framework?
A
Age, time, mechanism, injuries, signs, treatment so far
This information helps prioritize patient care effectively.
23
Q
What does the ‘M’ in MIST represent?
A
Mechanism
It includes details like when, what, where, speed, height, restraint, equipment, damage, and medical events.
24
Q
What does the ‘I’ in MIST represent?
A
Injuries
This includes pain, deformity, injuries, and injury patterns.
25
What does the 'S' in MIST represent?
Signs and symptoms
## Footnote
This includes vital signs such as heart rate, respiratory rate, blood pressure, oxygen saturation, and Glasgow Coma Scale.
26
What does the 'T' in MIST represent?
Treatment
## Footnote
This includes details about tubes/lines, medications and response, and immobilizations.
27
What vital signs are included in the 'S' of MIST?
HR, RR, BP, O2 stats, GCS
## Footnote
These vital signs are crucial indicators of a patient's condition.
28
Fill in the blank: The 'M' in MIST refers to the _______.
Mechanism
29
Fill in the blank: The 'I' in MIST refers to _______.
Injuries
30
Fill in the blank: The 'S' in MIST refers to _______.
Signs and symptoms
31
Fill in the blank: The 'T' in MIST refers to _______.
Treatment
32
What types of information are included under 'Treatment' in MIST?
Tubes/Lines, Medications and response, Immobilizations and dressing
## Footnote
This section details the interventions already performed on the patient.
33
What is the primary survey in emergency care?
Simultaneous assessment & treatment.
## Footnote
The primary survey is a crucial step in emergency care where the patient's condition is quickly assessed and treated at the same time.
34
Should the primary survey be repeated?
Yes, never hesitate to repeat the primary survey.
## Footnote
Repeating the primary survey ensures that any changes in the patient's condition are promptly addressed.
35
What should be inspected to assess airway patency?
Airway patency, potential occlusion or compromise
## Footnote
Consider factors like foreign bodies, facial fractures, neck injuries, burns, and inhalation injuries.
36
What anatomical differences are present in children that affect airway management?
Larger tongue, larynx more anterior, shorter trachea
## Footnote
These differences can complicate airway management in pediatric patients.
37
List the indications for a definitive airway.
* Inability to maintain oxygenation and protection of airways
* Apnoea
* Inability to maintain adequate oxygenation by face mask O2
* Inability to maintain a patent airway by other means
## Footnote
These indications highlight critical situations where airway intervention is necessary.
38
What GCS score indicates the need for ventilation due to head injury?
GCS ≤ 8
## Footnote
A low Glasgow Coma Scale score suggests severe impairment and the need for airway protection.
39
Fill in the blank: An inability to maintain a patent airway by other means indicates the need for a _______.
[definitive airway]
40
True or False: A burn can potentially compromise the airway.
True
## Footnote
Burns can lead to swelling and airway obstruction, requiring careful assessment.
41
What are potential airway compromise factors to consider?
* Burns
* Inhalation injury
* Alkali ingestion
* Haematoma (craniofacial injuries)
* Stridor
## Footnote
These factors can indicate the need for urgent airway management.
42
What is a critical reason for needing airway protection?
Protection from aspiration of blood or vomit
## Footnote
Aspiration can lead to severe complications, making airway protection vital.
43
What is the first priority in airway management?
Protect c-spine always
44
How should the c-spine be maintained?
Maintain c-spine in neutral position with manual immobilisation
45
What should be done if the collar needs to be removed?
Someone should be dedicated to maintaining immobilisation
46
What is the first step in clearing the airway?
Removal of foreign body (FB)
47
What is a method to clear secretions from the airway?
Suction
48
What should be done if the patient vomits?
Safely manoeuvre patient laterally
49
What are the airway manoeuvres that can be used?
Chin lift/Jaw thrust safe with potential c-spine injury
50
What should be done before attempting any definitive airway?
Pre-oxygenate
51
Which type of airway is preferred for a responsive patient?
Nasopharyngeal airway
52
Why is the nasopharyngeal airway preferred over the oropharyngeal?
It is better tolerated and less likely to induce vomiting
53
What is the first step post intubation?
CO2 detection
54
What should be checked after intubation?
Breath sounds
55
How should the tube be secured after intubation?
Secure tube with tie
56
What is the first step in assessing 'b' breathing?
Expose neck and chest
## Footnote
This allows for a visual examination of the breathing mechanics and potential obstructions.
57
What does oxygenation refer to in the context of breathing assessment?
O2 stats probe
58
What should be observed for during the assessment of breathing?
Symmetrical chest wall movement
## Footnote
This indicates proper lung function and absence of significant injury.
59
What is auscultation used for in assessing breathing?
To assess air entry
## Footnote
This helps identify abnormal lung sounds indicating potential issues.
60
What are signs of tension pneumothorax or massive hemothorax?
* Dilated neck veins
* Tracheal deviation
* Dull or hyperresonant sounds
## Footnote
These signs indicate serious thoracic complications that require immediate attention.
61
What does chest wall trauma include?
Open injuries
## Footnote
Open injuries can compromise breathing and require urgent evaluation.
62
What is flail chest?
A condition where multiple adjacent ribs are fractured
## Footnote
This leads to paradoxical movement of the chest wall, affecting ventilation.
63
What is the primary goal in the management of 'b' breathing?
Oxygenate
## Footnote
This involves ensuring adequate oxygen delivery to the patient.
64
What flow rate should oxygen be delivered at via a Hudson mask?
10-12L/min
## Footnote
This flow rate is essential for effective oxygenation.
65
What method is used to ventilate a patient if required?
Bag-valve mask
## Footnote
This is a common method for providing positive pressure ventilation.
66
What are the two treatments for pneumothorax or haemothorax?
* Needle thoracentesis
* Tube thoracostomy
## Footnote
These procedures are used to relieve pressure in the chest cavity.
67
What is the management of an open pneumothorax?
Seal open pneumothorax
## Footnote
This is crucial to prevent further air from entering the pleural space.
68
What is the predominant cause of preventable post-injury death?
Haemorrhage
69
What should be assumed in cases of hypotension until proven otherwise?
Hypotension due to haemorrhage
## Footnote
This assumption is vital for prioritizing treatment in trauma situations.
70
What is the first step in assessing 'c' circulation?
Identify external source of exsanguinating haemorrhage
## Footnote
Recognizing the source of bleeding is essential for effective management.
71
What are the methods to determine where blood loss is occurring internally?
Chest - CXR, Abdomen - FAST, Pelvis - Pelvic x-ray/examination, long bone
72
What does 'Blood on the floor and four more' refer to?
It refers to assessing external bleeding at the site or on the floor
## Footnote
This phrase highlights the importance of checking for visible blood loss.
73
What parameters are assessed to determine the degree of volume loss or circulatory shock?
HR, BP, Peripheral perfusion
## Footnote
Peripheral perfusion includes skin colour and temperature.
74
What caution should be taken regarding heart rate (HR) assessment?
Caution with β-blockers
## Footnote
β-blockers can mask tachycardia, which is a key indicator of shock.
75
What are the three steps to the management of 'c' circulation?
1. Control sources of exsanguinating haemorrhage
2. Gain venous access
3. Resuscitation
## Footnote
Each step is critical in managing severe bleeding and ensuring patient stability.
76
How should external sources of exsanguinating haemorrhage be controlled?
1. Direct manual pressure
2. Pressure proximal to exsanguination
3. Use of a pneumatic splitting device
4. Avoid tourniquets
## Footnote
These methods help to stop or slow down the bleeding effectively.
77
What is the management for identified internal sources of bleeding?
1. Chest - chest tube
2. Abdomen - laparotomy
3. Pelvis - pelvic binder and possibly angiography/operation
4. Long bone - traction
## Footnote
Prompt surgical intervention may be necessary for internal bleeding.
78
What is the recommended venous access for resuscitation?
IV (2x large bore catheters)
## Footnote
Large bore catheters facilitate rapid fluid resuscitation.
79
What investigations should be performed during resuscitation?
1. Blood tests
2. VBG
3. CBC/U&E/glucose/cogas
4. Troponin, hCG, EtOH
5. Cross-match
## Footnote
These tests help assess the patient's condition and guide treatment.
80
What is the initial resuscitation fluid recommendation for adults?
2L warmed normal saline (NS)
## Footnote
Pediatric dosage is 20ml/kg.
81
What does the Cochrane review state about albumin and colloids in resuscitation?
No evidence that albumin or colloids improve survival
## Footnote
This suggests a preference for crystalloids in initial resuscitation.
82
What should be prioritized after initial crystalloid resuscitation?
Give type-matched blood as soon as possible
## Footnote
Early blood transfusion can be crucial in managing severe hemorrhage.
83
What are the categories of responders in resuscitation?
1. Rapid responders
2. Transient responders
3. Non-responders
## Footnote
Understanding the response helps determine further treatment needs.
84
What is the management for rapid responders?
Often require no more than crystalloids
## Footnote
These patients may stabilize quickly with minimal intervention.
85
What is required for transient responders?
May need blood in addition to crystalloids
## Footnote
They show temporary improvement but may not be stable long-term.
86
What is the immediate need for non-responders?
Need definitive source control immediately
## Footnote
These patients are in critical condition and require urgent intervention.
87
What are the criteria for adequate perfusion?
1. Keep atrial pressures within low normal limits
2. Give sufficient fluid to achieve adequate urine output
3. Maintain perfusion pressure
## Footnote
These criteria help ensure the patient's organs are adequately perfused.
88
What is the first step in a secondary survey if the patient is not stable?
Return to Primary and stabilize the patient
## Footnote
This emphasizes the importance of ensuring patient stability before proceeding with further assessment.
89
What does AMPLE stand for in the context of patient history?
* A - allergies
* M - medications
* P - Past illnesses / PREGNANCY
* L - last meal
* E - events / environment related to injury
## Footnote
AMPLE is a mnemonic used to gather critical patient history information.
90
What is included in a head-to-toe examination during a secondary survey?
Inspect head, neck, chest, abdomen, extremities, perineum, and perform a log roll
## Footnote
Comprehensive examination is crucial to identify any injuries across different body regions.
91
What should be assessed in the head and maxillofacial examination?
* Lacerations
* Fractures
* Thermal injuries
* Pupils
* GCS
* Cranial nerve function
* Signs of CSF leak
## Footnote
These assessments help identify serious head and facial injuries.
92
What signs should be inspected in the C-spine and neck?
* Blunt and penetrating trauma
* Tracheal deviation
* Use of accessory muscles
## Footnote
These signs indicate potential serious injuries that may require immediate attention.
93
What findings should be assessed in the chest examination?
* Blunt and penetrating injury
* Respiratory excursions
* Breath and heart sounds
* Tenderness
* Subcutaneous emphysema
* Hyperresonance and dullness
## Footnote
A thorough chest examination is essential to rule out life-threatening conditions.
94
What is included in the abdominal examination?
* Signs of blunt and penetrating trauma
* Bowel sounds
* Tenderness
* Guarding
* Gravid uterus
## Footnote
These assessments help identify internal injuries or bleeding.
95
What should be assessed in the perineum examination?
* Contusions
* Lacerations
* Urethral bleeding
* Rectal bleeding
* Vaginal lacerations
## Footnote
Evaluation of the perineum is critical in trauma cases to identify potential injuries.
96
What are the components of a musculoskeletal examination?
* Inspect for blunt or penetrating trauma
* Palpate for tenderness and abnormal movement
* Evaluate peripheral pulses
* Inspect and palpate spine
## Footnote
This examination focuses on identifying fractures and soft tissue injuries.
97
What is the purpose of the tertiary survey?
To identify missed injuries through a complete review after initial resuscitation and operative intervention
## Footnote
Typically occurs within 24 hours after admission and requires the patient to be awake and responsive.
98
What does the Injury Severity Score relate to?
It relates the Abbreviated Injury Scale (AIS) score to patient outcomes
## Footnote
This scoring system helps in assessing the overall severity of multiple injuries.
99
What is a dangerous mechanism of injury involving a pedestrian?
Pedestrian thrown/run over or auto-pedestrian injury with impact >8kph
## Footnote
Recognizing these mechanisms is important for triaging trauma patients.
100
Fill in the blank: The secondary survey includes taking a detailed _______.
AMPLE Hx
## Footnote
This history is crucial for understanding the patient's medical background and current condition.
101
True or False: The tertiary survey is conducted before the patient is extubated.
False
## Footnote
The tertiary survey is only performed once the patient is extubated and free from sedating medications.
102
What factors should be emphasized in the comprehensive review of the medical record during the tertiary survey?
* Mechanism of injury
* Pertinent co-morbid factors such as age
## Footnote
This review is crucial for identifying any missed injuries that may require further investigation.
103
What should be done if the number of patients exceeds facility capacity during triage?
Manage patients with the greatest chance of survival first
## Footnote
This approach prioritizes resources for those most likely to benefit from intervention.
104
What does the assessment of 'd' disability involve?
Awareness (cerebral function) and arousal (brainstem function)
## Footnote
Includes the Glasgow Coma Scale (GCS), checking pupils for size and reactivity, and assessing gross neurology/spinal injury.
105
What is the purpose of checking pupils during disability assessment?
To assess size and reactivity
## Footnote
Pupil reactions can indicate brain function and potential neurological issues.
106
What should be checked alongside disability assessment?
Blood sugar level (BSL) and other factors affecting level of consciousness (LOC)
## Footnote
Factors such as alcohol or drugs can significantly alter LOC.
107
What are the components of 'e' exposure in patient assessment?
Expose - Completely undress the patient
## Footnote
Includes log roll and PR exam while avoiding hypothermia.
108
What should be done to prevent hypothermia during patient exposure?
Warm the patient using warm blankets and warmed fluids
## Footnote
Cold patients can become coagulopathic and less able to utilize oxygen at tissues.
109
What adjuncts are included in the ABCDE assessment?
X-rays, CXR, pelvis, FAST, ECG
## Footnote
These adjuncts aid in further evaluation after initial ABCDE assessment.
110
What does FAST stand for in trauma assessment?
Focused Assessment with Sonography for Trauma
## Footnote
Used for abdominal and pericardial views.
111
What should be checked before inserting an IDC in trauma patients?
Ensure there is no blood at meatus or perineal injury
## Footnote
Blood presence can indicate potential urethral injury.
112
What are contraindications for IDC insertion?
* Suspected urethral injury
* Blood at penile meatus
* Perineal ecchymosis
* Blood in the scrotum/scrotal bruising
* High-riding or non-palpable prostate on PR
* Unstable pelvic fracture
* Inability to void
## Footnote
If any of these are suspected, a retrograde urethrogram should be performed.
113
What is the procedure for securing an IDC?
8Fr IDC secured in meatal fossa by balloon inflation to 1.5-2ml
## Footnote
15-20ml of undiluted contrast is instilled to visualize bladder.
114
What are the contraindications for NGT insertion?
Suspected cribriform plate fracture or facial fractures
## Footnote
Insertion in these cases can lead to serious complications.
