Trauma pt eval Flashcards Preview

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Flashcards in Trauma pt eval Deck (37):
1

Most common causes of Trauma Mortality?

CNS injury (1/2)
Exsanguination

2

Exacerbating factors in Trauma Mortality? (3)

Warfarin
Low Glascow Coma rating
Old age

3

Immediate death from Trauma U result of? (4)

(death at scene)
Disruption of:
Great vessels
Heart
Lungs
Major body cavity

4

Early death from trauma U result of?

(w/i 4 hrs of injury)
CV or pulmonary collapse

5

Late death from trauma U result of?

(days to wks post)
sepsis
multiorgan failure

6

Level I Trauma Center provides?

Tertiary care
24 hr in-house surgeons + promptly available specialists

7

Level II Trauma Center provides?

Initiates definitive care
24 hr surgeon + specialty except for cardiac or microvascular surgery, dialysis

8

Level III Trauma Center provides?

Assessment, resuscitation, stabilization, intensive care
24 hr ER docs and general surgeons

9

Level IV Trauma Center provides?

Advanced traumatic life support prep for transfer
24 hr ED and labs

10

Level V Trauma Center provides?

Eval, stabilization, diagnostics, prep for transport
After hr protocols

11

ATLS includes? (4)

1) initial eval
2) resuscitation
3) stabilization
4) transfer

12

Initial Eval of trauma includes? (4)

Stabilization
Identification of life-threat injury
Initiate support
Rapid organization of definitive care or transfer

13

Primary Eval must assess and address?

Airway
Breathing
Circulation
Disability
Exposure

14

End-organs are? (4)

Brain
Heart
Kidneys
Eyes

15

Airway management includes? (5)

1) Assess conscious pt (w/ question)
2) Protect airway/cervical spine of unconscious pt
3) Observe (signs of difficulty)
4) Inspect mouth/throat (obstacles)
5) Inspect/palp anterior neck

16

Tracheal Intubation used to?

How?

Mechanical ventilation

Endotracheal tube passed b/w vocal cords,
Requires direct visualization of cords,
Tube tip placed 1/2 b/w clavicle and carnia (trach spit into bronchi)

17

Cricothyroidotomy is?

insertion of tube thru incision in cricothyroid membrane

18

Breathing/Ventilation management includes? (6)

1) O2
2) Chest wall inspection (asymm/paradox mvmt)
3) Auscultate (apices and axillae)
4) Palpate (crepitus/deformity)
5) CXR for unstable pt
6) r/o pneuom/hemothorax, tamponade

19

Treatment when signs of pneumothorax?

hypoTN, dyspnea, ipsilateral ↓ breath sounds

Needle Decompression:
2nd ICS @ MCL
5th ICS @ MAL

Tube thoracostomy:
immediately follows needle decomp
5th ICS, MAL

20

Vent treatment when unstable pt?

anticipate pneuno/hemothorax

Tube thoracostomy

21

Circulation management includes? (5)

1) Palpate central pulses (carotid/femoral)
2) Observe for external hemorr
3) Place IV catheters
4) Blood typing
5) Determining exact BP not necessary

22

Arterial Hemorrhage management?

Manual pressure
Proximal compression
Elevation
Hemostatic agents

23

Venous hemorrhage management?

Direct pressure

24

Tx for pts w/o central pulse?

emergency thoracotomy

25

Disability/Neuro management includes? (4)

1) Eval level of consciousness / Mental status
2) Pupil size, symm, light response
3) Motor/Sensory
4) Imaging

26

Exposure/Environment Control includes?

1) Visualize entire body
2) Hypothermia

27

If pt is hemodynamically unstable, next step after primary survey?

Skip 2° survey
Send right to angio or major trauma center

28

2° Survey in trauma includes? (3)

Head to toe exam (fingers and tubes in every hole)

Detailed hx (of traumatic event and of pt's medical hx)

X-Ray/CT

29

Common Misses in trauma:

Blunt Abd?

Penetrating Abd?

Thoracic?

Extremity?

Blunt abd trauma:
hollow viscus
pancreatoduo
diaphrag

Penetrating abd trauma:
rectal or urethral

Thoracic trauma:
pericardial tamponade
aortic injuries
esophageal perf

Extremity trauma:
fractures
vascular disruption
compartment synd

30

2° Survey: C-Spine management

Clear (no x-ray needed) if:
non-tender
alert
not intoxicated
no distracting injury

If can't clear, do CT
*neg CT AND tenderness, still cannot clear

31

2° Survey: Tube considerations?

Foley:
blood at meatus
pelvic fracture

NG Tube:
mid face fractures

32

2° Survey: Abdomen?

Diagnostic Peritoneal Lavage
CT
US

33

Most frequently injured organ w/ penetrating trauma?

liver

34

Most frequently injured organ w/ blunt abd trauma in adults?

Spleen

35

What vaccines recommended w/ loss of spleen?

pneumo
h. flu
meningococc

36

Common result of splenectomy?

thrombocytosis

37

2° Survey: Chest? (6)

Crepitus
Tenderness
JVD (SVC compression)
Tracheal deviation (tension pneumothorax)
Respiratory effort
CXR