Trauma Management Flashcards by Vaishnavi Gupta

Cause of death immediately after trauma

Severe head injury (mc)

Transection of great vessels

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Cause of death within 1 hour of injury

Airway obstruction 
Tracheobronchial injury 
Open pneumothorax
Tension pneumothorax
Acute circulatory failure
Hemothorax 
Cardiac tamponade

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Color coding red in triage means

Urgent intervention

Airway obstruction
Tracheobronchial injury 
Open pneumothorax
Tension pneumothorax
Acute circulatory failure
Hemothorax 
Cardiac tamponade

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Death after days following trauma can be due to

Delayed head injury

Sepsis

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What is Golden hour and platinum minutes following trauma

1 hr following trauma

1st 10 min after trauma - Platinum minutes

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What is multiple and mass casuality event

Multiple casuality event when number of injured don’t overwhelm medical facilities

Mass casuality event when it overwhelms medical facilities

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Color coding of triage

Principle of triage

Red
Yellow
Green 
Black 
Principle - to save as many as pt possible in little time

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Yellow
Green
Black category of triage include

Yellow- admitted and stabilised
Fracture and moderate head injury

Green walking wounded
Minor bruise laceration

Black dead bodies, moribund pt

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Principle of ATLS

A airway
B breathing
C circulation
D disability mgt

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Advanced cardiac life support principle

CAB
Circulation
Airway
Breathing

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Principle of trauma management during war fields

cABCD

c - control exsanguinating hemorrhage

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Before arriving hospital information collected from ambulance driver and pt

Driver 
M mech of injury
I  injury
S sign and symptoms
T treatment given

Patient 
A allergy
M medical condition
P past history
L last meal 
E event leading to trauma

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Secondary survey in ATLS is done for and how

Done to search for all injury
By log roll to see back injury
Minimum 4 people
In limb fracture 5 people required

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Ist step of ATLS

Cervical spine stabilisation

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How to transfer pt of cervical spine injury

Done on hard board
Supine position strap head thorax pelvis
Prone position- done in unconscious pt to prevent aspiration

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Criteria used to assess C spine injury

Nexus criteria
Canadian C spine rule
American Spinal Injury Association impairment scale

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When to use hard Philadelphia collar and image Cervical spine acc to nexus criteria

N neuro deficit
E alcohol intoxication
X extremely distracting injury
U unable to give history
S spinal tenderness

If any feature present both above mentioned steps have to performed

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Danger sign during airway assessment

What if danger sign are present

Unable to speak
Comatose pt
Pt with GCS less than equal to 8
Non purposeful movement

If present intubation orotracheal /nasotracheal

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Emergency mgt due to failure of orotracheal intubation

Definitive mgt

Emergency Needle cricothyroidotomy

Definitive tracheostomy

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3rd to 5th ribs are most commonly fractured during

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CPR

Most uncommon rib fracture

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1st rib

Most common cause of death in blunt thoracic trauma

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Tracheo bronchial injury

Most common cause of death in penetrating thoracic trauma

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Pulmonary laceration leading to hemothorax

Most common site of rupture of thoracic aorta

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Distal to ligamentum arteriosum

Strapping is management of rib fracture | T/F

False | Adequate analgesia is mgt

``` Rta Pulse 100/min BP 90 O2 84 RR 22 Decrease breath sounds on right and hyper resonant note on percussion Diagnosis ```

``` Tachycardia Hypotension Low 02 Hyperventilating Hyper resonant- pneumothorax with unstable vitals Diagnosis Tension Pneumothorax ```

55yr old male breathless vitals stable | Decrease breath sounds on right side and hyper resonant note on percussion

Simple pneumothorax

``` PR 110/min BP 90 Distend neck vein Muffled heart sounds Triad? Diagnosis? ```

Beck triad | Cardiac tamponade

Cardiac tamponade is a ______ diagnosis supported with ____

Clinical diagnosis supported with FAST/EFAST

Cardiac tamponade is an indication for emergency room thoracotomy T or F

False | It is indication for emergency thoracotomy

``` Correlate Injury with neck trauma zone Pt sustain injury below cricoid Most exposed zone Most surgically accessible zone Injury to base of skull ```

Zone 1 2 2 3

Intercostal block to insert chest tube should be given along ?

Lower border of rib as neurovascular bundle runs here

Where are chest tubes inserted

``` Inserted in triangle of safety Boundaries Ant - ant axillary fold Post -post axillary fold Apex axilla Base 5th intercostal space ```

To determine correct position of chest tube investigation

Chest xray in which all holes of tubes are inside thoracic cavity

Indication of a normally functioning tube

Oscillation of fluid with breathing

When to remove chest tubes

Lung expands and breath sounds are presen Output less than 100cc in 24hrs At peak of inspiration when pt holds breath

Most common thoracic trauma in adults

Rib fracture

If first rib is fractured suspect injury of

Subclavian vessel Brachial plexus Apex of lungs

flail chest Def Mc cause of death in flail chest Mgt

ATLS def - fracture of 2 or more consecutive ribs at 2 or more places Pulmonary contusion mc cause of death Mgt analgesic and oxygenation If pO2 less than 60 - IPPV if it fails surgical correction

What is tension pneumothorax and its difference from simple pneumothorax

Tension pneumothorax - pneumothorax with rapid hemodynamic compromise Simple no hemodynamic compromise

Most common cause of tension pneumothorax

Pulmonary laceration Others - Tracheo bronchial injury Open pneumothorax

What is sucking wound on chest wall

Open pneumothorax where wound is 2/3 circumference of trachea One way valve is formed

Pathogenesis of tension pneumothorax

Air accumulation causes lung collapse of same side Hyperinflation of opposite side Mediastinal shift causes compression over heart Hemodynamic changes

Clinical feature of pneumothorax

Respiratory rate increase Heart rate increases stroke volume decrease = CO decrease JVP increase Percussion- hyper resonant

eFast sign of tension pneumothorax

Stratosphere sign Bar code sign Sea shore sign

Emergency needle thoracocentesis is done for | Site of this procedure

Pneumothorax In adult 5 th intercostal space in mid axillary line In children 2nd ICS in mid clavicular line

What is hemothorax | source of blood

Accumulation of blood in pleural space | Intercostal vessels

Indication for emergency thoracotomy

Output more than 1.5 litre blood at time of ICT Insertion | More than 200cc/hr for 3 consecutive hrs

Indication for emergency room thoracotomy

Open cardiac massage Massive air leak Massive bleeding

Trauma Management Flashcards

(49 cards)