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Trauma + Orthopaedics > 1: Trauma > Flashcards

1: Trauma Flashcards

1
Q

What is Advanced trauma life support

A

systemic approach guiding how to manage patient following trauma. It is a systemic approach that priorities life-threatening injuries.

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2
Q

What are the 4 phases of ATLS

A
  1. Primary survey
  2. Resuscitation phase
  3. Secondary survey
  4. Definitive phase
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3
Q

Explain the primary survey

A

Life-threatening injuries should be identified and managed. Uses C, ABCDE approach

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4
Q

What is resuscitation phase

A

Continued management of problems identified in primary survey

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5
Q

What is the secondary survey

A

Using investigations to identify other less severe injuries

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6
Q

What is definitive care phase §

A

Early management of injuries identified after stabilisation. Eg. reduction of fractures

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7
Q

What indicates major trauma

A
  • vehicle ejection
  • other person died in collison
  • fall from >2m
  • person vs. car
  • high-speed road collision
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8
Q

What investigations may be indicated in ATLS

A
  • Blood glucose
  • SpO2
  • FBC
  • U+E
  • G+S, Cross match, Coagulation studies
  • X-ray
  • Urinalysis
  • ABG
  • ECG
  • CT
  • Fast scan
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9
Q

Which patients should have G+S, Cross-match and coagulation profile

A

Those who are at risk of major haemorrhage

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10
Q

When should urinalysis be ordered

A

If abdominal trauma

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11
Q

When is an ECG ordered

A

> 50y or chest trauma

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12
Q

When is a CT ordered

A

Head + neck injuries

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13
Q

When may a FAST scan be ordered

A

Look for free fluid in peritoneal or pericardial cavities

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14
Q

What are 3 methods to address airway control

A

Chin Lift
Jaw thrust
Oropharygneal airway

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15
Q

What fluids are given

A

1L 0.9% Saline

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16
Q

When are IV Abx given in ATLs

A

If open wound

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17
Q

When is IVIg given in ATLS

A

If open wound

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18
Q

what is a tension pneumothorax

A

air continually enters the pleural space but is unable to leave, increasing pressure

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19
Q

why is a tension pneumothorax life-threatening

A
  • 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

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20
Q

how is a tension pneumothorax managed initially

A

16G wide-bore cannula is inserted into the 2nd intercostal space mid-clavicular line

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21
Q

what should replace the 16G cannula

A

Chest drain

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22
Q

what is the ‘safe triangle’ for chest drain insertion

A

lateral border of pec major, lateral border of lattisimus dorsi and 5th intercostal space

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23
Q

List 7 complications of chest trauma

A
  • Isolated rib fracture
  • Multiple rib fractures
  • Flail chest
  • Haemothorax
  • Pneumothorax
  • Ruptured diaphragm
  • Sternal fracture
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24
Q

How is an isolated rib fracture identified

A

clinically: localised tenderness of the chest wall

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25
Q

How is a simple isolated rib fracture managed

A

analgesia

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26
Q

What mechanism of injury commonly causes sternal fractures

A

RTA: acceleration-decceleration injury

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27
Q

How will patients with sternal fractures present

A

tenderness over anterior sternum

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28
Q

What is a flail segment

A

more than 3 ribs fractured in 2 places

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29
Q

How is a flail segment identified

A

the segment will move paradoxically with respiration. It will move inwards on inspiration and outwards on expiration

30
Q

What % of ruptured diaphragms occur on the left side

A

75%

31
Q

What causes diaphragmatic rupture

A

abdominal crush injuries - causing abdominal organs to pass into thorax

32
Q

What is the mortality of chest trauma

A

10%

33
Q

how is the chest assessed as part of ATLS

A

key life-threatening injuries are assessed during the primary survey. Less severe injuries are assessed in secondary survey

34
Q

what is the mneumonic to remember what chest trauma to look for

A

ATOM FC

35
Q

what chest complications should be looked for in primary survey

A 
Airway obstruction 
Tension pneumothorax 
Open pneumonothorax 
Massive haemothorax 
Flail chest 
Cardiac tamponade
36
Q

What is a massive haemothorax

A

bleeding into pleural space sufficient to cause hypovolaemic shock

37
Q

what causes haemothorax

A

laceration of the lung, intercostal or internal mammary artery

38
Q

how will a patient present in haemothorax

A

reduced breath sounds

dull to percussion

39
Q

what investigation is used for haemothorax

A

CXR

40
Q

how will haemothorax appear on CXR

A

Increased shadowing under the affected lung

41
Q

what is the management of haemothorax

A
  • Oxygen
  • Cross-match and G+S
  • IV fluids
  • Chest drain
42
Q

What is the main traumatic complication of abdominal injury

A

Haemorrhage

43
Q

When may life-threatening haemorrhage be identified

A

During ‘Circulation’ stage of primary survey

44
Q

When are focused assessment and sonography for trauma (FAST) scans indicated

A

To detect free-fluid, also good for liver and spleen injuries

45
Q

What are FAST scans poor for

A
  • Diaphragm
  • Bowel
    • pancreatic injuries
46
Q

When is a CT scan used in abdominal trauma

A

to detect free-fluid and organ damage.

47
Q

Which patients is a CT scan only suitable for

A

haemodynamically stable patients

48
Q

When may a retrograde urethrogram be performed

A

if urethral injury

49
Q

What are the indications of laparotomy

A
  • blunt trauma in haemodynamically unstable patient
  • hypotension with penetrating wound
  • bleeding from stomach, rectum, GU
  • gunshot
  • free air on CT
50
Q

what are the most common traumatic injuries from blunt abdominal trauma

A
  • spleen rupture

- liver injury

51
Q

if blunt abdominal trauma disrupts the ribs what may it lead to

A

intra-abdominal haemorrhage

52
Q

what injury is common in children with blunt abdominal trauma

A

duodenal haematoma

53
Q

which organs do gunshot wounds commonly affect

A

Small bowel
Liver
Colon

54
Q

which organs do stab wounds commonly affect

A

Small Bowel
Liver
Diaphragm

55
Q

What are two symptoms of intra-abdominal haemorrhage

A
  • ‘lap-belt’ bruising sign

- grey-turner’s sign

56
Q

what does ‘grey-turners’ sign indicate

A

retroperitoneal haemorrhage

57
Q

why does generalised abdominal pain, guarding and rigidity occur

A

peritonism - due to blood irritating the peritoneum

58
Q

if a liver haematoma is present how will it present

A

ecchymosis over right upper abdomen/chest and referred pain to the shoulder

59
Q

what are signs of intrabdominal bleeding

A

signs of hypovolaemia: delayed capillary refill, tachycardia, hypotension

60
Q

if abdominal trauma has occurred what imaging modalities may be used

A
  • FAST scan (liver, spleen, free-fluid)
  • CT
  • Laparotomy
61
Q

Explain nice guidelines on fluid resuscitation

A
  1. A patients fluid needs are assessed. Using capillary refill, BP, HR, RR, Temperature of peripheries
  2. Give patient 500ml crystalloid over 15m
  3. Use ABCDE to re-assess
  4. If still requires fluid. Give bolus 250-500ml. Then re-assess.
  5. If given >2000, seek expert help.
62
Q

What are responders

A

Individuals who demonstrate physiological improvement to initial fluid

63
Q

What are transient responders

A

Individuals who initially show physiological improvement to fluid and then deteriorate

64
Q

What are non-responders

A

Individuals who show continued deterioration despite fluid

65
Q

What are the indications for a urethral catheter

A

patient is unable to pass urine

66
Q

What are two contraindications of urethral catheters

A
  1. Patient can pass urine by them-selves

2. Urethral trauma

67
Q

What are 5 indications for suprapubic catheters

A
  1. Urethral injuries
  2. Urethral obstruction
  3. BPH
  4. Bladder neck mass
  5. BPH
  6. Prostate cancer
68
Q

What are 4 contraindications of suprapubic catheters

A
  • Coagulopathy
  • Previous lower abdominal surgery or pelvic surgery (due to adhesions)
  • Pelvic cancer
69
Q

What are 4 causes of burns

A
  • Thermal
  • Chemical
  • Electrical
  • Radiation
70
Q

What are the two types of thermal heat

A

Wet heat

Dry heat

71
Q

Are acid or alkali burns worse and why

A

Alkali - as they case liquefactive necrosis, which progresses even after irrigation

Trauma + Orthopaedics (11 decks)

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