1: Trauma Flashcards
What is Advanced trauma life support
systemic approach guiding how to manage patient following trauma. It is a systemic approach that priorities life-threatening injuries.
What are the 4 phases of ATLS
- Primary survey
- Resuscitation phase
- Secondary survey
- Definitive phase
Explain the primary survey
Life-threatening injuries should be identified and managed. Uses C, ABCDE approach
What is resuscitation phase
Continued management of problems identified in primary survey
What is the secondary survey
Using investigations to identify other less severe injuries
What is definitive care phase §
Early management of injuries identified after stabilisation. Eg. reduction of fractures
What indicates major trauma
- vehicle ejection
- other person died in collison
- fall from >2m
- person vs. car
- high-speed road collision
What investigations may be indicated in ATLS
- Blood glucose
- SpO2
- FBC
- U+E
- G+S, Cross match, Coagulation studies
- X-ray
- Urinalysis
- ABG
- ECG
- CT
- Fast scan
Which patients should have G+S, Cross-match and coagulation profile
Those who are at risk of major haemorrhage
When should urinalysis be ordered
If abdominal trauma
When is an ECG ordered
> 50y or chest trauma
When is a CT ordered
Head + neck injuries
When may a FAST scan be ordered
Look for free fluid in peritoneal or pericardial cavities
What are 3 methods to address airway control
Chin Lift
Jaw thrust
Oropharygneal airway
What fluids are given
1L 0.9% Saline
When are IV Abx given in ATLs
If open wound
When is IVIg given in ATLS
If open wound
what is a tension pneumothorax
air continually enters the pleural space but is unable to leave, increasing pressure
why is a tension pneumothorax life-threatening
- increase in pressure causes lung to collapse
- also causes ‘kinking’ of the great vessels impeding return to the heart and cardiac output leading to cardiac arrest
how is a tension pneumothorax managed initially
16G wide-bore cannula is inserted into the 2nd intercostal space mid-clavicular line
what should replace the 16G cannula
Chest drain
what is the ‘safe triangle’ for chest drain insertion
lateral border of pec major, lateral border of lattisimus dorsi and 5th intercostal space
List 7 complications of chest trauma
- Isolated rib fracture
- Multiple rib fractures
- Flail chest
- Haemothorax
- Pneumothorax
- Ruptured diaphragm
- Sternal fracture
How is an isolated rib fracture identified
clinically: localised tenderness of the chest wall
How is a simple isolated rib fracture managed
analgesia
What mechanism of injury commonly causes sternal fractures
RTA: acceleration-decceleration injury
How will patients with sternal fractures present
tenderness over anterior sternum
What is a flail segment
more than 3 ribs fractured in 2 places
How is a flail segment identified
the segment will move paradoxically with respiration. It will move inwards on inspiration and outwards on expiration
What % of ruptured diaphragms occur on the left side
75%
What causes diaphragmatic rupture
abdominal crush injuries - causing abdominal organs to pass into thorax
What is the mortality of chest trauma
10%
how is the chest assessed as part of ATLS
key life-threatening injuries are assessed during the primary survey. Less severe injuries are assessed in secondary survey
what is the mneumonic to remember what chest trauma to look for
ATOM FC
what chest complications should be looked for in primary survey
Airway obstruction Tension pneumothorax Open pneumonothorax Massive haemothorax Flail chest Cardiac tamponade
What is a massive haemothorax
bleeding into pleural space sufficient to cause hypovolaemic shock
what causes haemothorax
laceration of the lung, intercostal or internal mammary artery
how will a patient present in haemothorax
reduced breath sounds
dull to percussion
what investigation is used for haemothorax
CXR
how will haemothorax appear on CXR
Increased shadowing under the affected lung
what is the management of haemothorax
- Oxygen
- Cross-match and G+S
- IV fluids
- Chest drain
What is the main traumatic complication of abdominal injury
Haemorrhage
When may life-threatening haemorrhage be identified
During ‘Circulation’ stage of primary survey
When are focused assessment and sonography for trauma (FAST) scans indicated
To detect free-fluid, also good for liver and spleen injuries
What are FAST scans poor for
- Diaphragm
- Bowel
- pancreatic injuries
When is a CT scan used in abdominal trauma
to detect free-fluid and organ damage.
Which patients is a CT scan only suitable for
haemodynamically stable patients
When may a retrograde urethrogram be performed
if urethral injury
What are the indications of laparotomy
- blunt trauma in haemodynamically unstable patient
- hypotension with penetrating wound
- bleeding from stomach, rectum, GU
- gunshot
- free air on CT
what are the most common traumatic injuries from blunt abdominal trauma
- spleen rupture
- liver injury
if blunt abdominal trauma disrupts the ribs what may it lead to
intra-abdominal haemorrhage
what injury is common in children with blunt abdominal trauma
duodenal haematoma
which organs do gunshot wounds commonly affect
Small bowel
Liver
Colon
which organs do stab wounds commonly affect
Small Bowel
Liver
Diaphragm
What are two symptoms of intra-abdominal haemorrhage
- ‘lap-belt’ bruising sign
- grey-turner’s sign
what does ‘grey-turners’ sign indicate
retroperitoneal haemorrhage
why does generalised abdominal pain, guarding and rigidity occur
peritonism - due to blood irritating the peritoneum
if a liver haematoma is present how will it present
ecchymosis over right upper abdomen/chest and referred pain to the shoulder
what are signs of intrabdominal bleeding
signs of hypovolaemia: delayed capillary refill, tachycardia, hypotension
if abdominal trauma has occurred what imaging modalities may be used
- FAST scan (liver, spleen, free-fluid)
- CT
- Laparotomy
Explain nice guidelines on fluid resuscitation
- A patients fluid needs are assessed. Using capillary refill, BP, HR, RR, Temperature of peripheries
- Give patient 500ml crystalloid over 15m
- Use ABCDE to re-assess
- If still requires fluid. Give bolus 250-500ml. Then re-assess.
- If given >2000, seek expert help.
What are responders
Individuals who demonstrate physiological improvement to initial fluid
What are transient responders
Individuals who initially show physiological improvement to fluid and then deteriorate
What are non-responders
Individuals who show continued deterioration despite fluid
What are the indications for a urethral catheter
patient is unable to pass urine
What are two contraindications of urethral catheters
- Patient can pass urine by them-selves
2. Urethral trauma
What are 5 indications for suprapubic catheters
- Urethral injuries
- Urethral obstruction
- BPH
- Bladder neck mass
- BPH
- Prostate cancer
What are 4 contraindications of suprapubic catheters
- Coagulopathy
- Previous lower abdominal surgery or pelvic surgery (due to adhesions)
- Pelvic cancer
What are 4 causes of burns
- Thermal
- Chemical
- Electrical
- Radiation
What are the two types of thermal heat
Wet heat
Dry heat
Are acid or alkali burns worse and why
Alkali - as they case liquefactive necrosis, which progresses even after irrigation
