1.1 MTB Step 3 - Trauma (ABCs) Flashcards
Cards Complete Day 1: 4/30/19 * Day 2: 5/2/19 * Day 3: 5/10/19 * Day 4: 5/30/19 Day 5: 6/29/19
AIRWAY
Under which (2) Situations is Establishing and Securing the Airway ALWAYS the First Step in Management?
- Acute Trauma
- Change in Mental Status / Altered Mental Status (AMS)
AIRWAY
What is the Most Common Indication for Intubation in a Trauma patient?
Altered Mental Status (AMS)
AIRWAY
What is the Preferred Method of Securing an Airway in a Trauma patient?
Orotracheal Intubation
AIRWAY
What is the Best Way of Securing an Airway in a Trauma patient with Cervical Spine Injury?
-
Best Answer = Flexible Bronchoscope
* Orotracheal Intubation with Manual Cervical Immobilization can still be performed but is not the best answer.*
AIRWAY
What is the Best Way of Securing an Airway in a Trauma patient with Extensive Facial Trauma and Bleeding into the Airway?
Cricothyroidotomy
Listen for Gurgling Sounds
BREATHING
What should you ALWAYS check in a Trauma patient to assess Breathing Quality?
Oxygen Saturation
BREATHING
If a Trauma patient has a Persistent Oxygen Saturation < 90%, what are (2) things you should do next?
- Arterial Blood Gas (ABG)
- Determine likely causes of Hypoxia based on the history
BREATHING
“A 55-year-old woman presents with profuse watery diarrhea of 4 days’ duration and syncope 2 hours ago. She was recently treated with antibiotics for an uncomplicated UTI. She has 20 bowel movements per day without blood and feels lightheaded. The patent does not remember losing consciousness and denies any post-syncope symptoms. Placement of a Foley Catheter in the ED yields no urine output.”
What is the Most Likely Diagnosis?
Hypovolemic Shock
- Common findings in patients with Hypovelic Shock are Unstable Vital Signs; Organ Dysfunction such as Low Urine Output; Cold, Clammy extremities; and Lightheadedness.
- This patient is in Hypovolemic Shock caused by Intravascular Volume Loss.
- The lack of volume decreases the Cardiac Output (CO) because of Lack of Preload.
- The Systemic Vascular Resistance (SVR) Increases in an effort to compensate for the diminished cardiac output and maintain perfusion to the vital organs.
CIRCULATION
CHEST TRAUMA
What are the (3) Common Types of Circulatory Disturbances found in the Trauma setting?
- Hypovolemic Shock
- Pericardial Tamponade
- Tension Pneumothorax (PTX)
CIRCULATION
CHEST TRAUMA
Of the (3) Common Types of Circulatory Disturbances found in the setting of Trauma, which is the Most Common Type of Hemorrhagic Shock?
Hypovolemic Shock
Look for a Source of Bleeding - the patient may lose a large volume of blood in the Abdomen or Thigh following Diaphyseal Fracture of the Femur.
CIRCULATION
CHEST TRAUMA
Do the following Values INCREASE or DECREASE in a patient with Hypovolemic Shock?
- Right Atrial Pressure (RAP)
- Pulmonary Capillary Wedge Pressure
- Cardiac Index
- Mixed Venous Saturation
- Systemic Vascular Resistance (SVR)
- Right Atrial Pressure = DECREASED
- Pulmonary Capillary Wedge Pressure = DECREASED
- Cardiac Index = DECREASED
- Mixed Venous Saturation = DECREASED
- Systemic Vascular Resistance = INCREASED
CIRCULATION
CHEST TRAUMA
What are the Must Know Equations for the following Measurements?
- Cardiac Output (CO)
- Stroke Volume (SV)
- Total Peripheral Resistance (TPR)
- Blood Pressure (BP)
- CO = SV x HR
-
SV = EDV - ESV
- therefore, CO = (EDV - ESV) x HR
- TPR = MAP - Mean Venous Pressure
- BP = CO x TPR
- *EDV = End Diastolic Volume**
- **ESV = End Systolic Volume***
- ***MAP = Mean Arterial Pressure****
CIRCULATION
CHEST TRAUMA
Which (2) Causes of Circulatory Disturbance can BOTH result from THORACIC Trauma?
- Pericardial Tamponade
- Tension Pneumothorax (PTX)
CIRCULATION
CHEST TRAUMA
What is a common Physical Manifestation of the (2) Causes of Circulatory Disturbance that result from THORACIC Trauma?
Distended Neck Veins
- High Central Venous Pressure (CVP)
CIRCULATION
CHEST TRAUMA
What are (2) Steps in the Management of Pericardial Tamponade?
- Focused Assessment with Sonography in Trauma (FAST)
- Immediate Pericardiocentesis (if unsuccessful, proceed with Pericardial Window)
CIRCULATION
CHEST TRAUMA
- What is the Most Common Clinical Manifestation for Tension Pneumothorax?
- What are (3) Exam Findings in Tension Pneumothorax?
Clinical Manifestation:
- Respiratory Distress
Exam Findings:
- Tracheal Deviation
- Absent Breath sounds
- Hyperresonance on Percussion
CIRCULATION
CHEST TRAUMA
What are the next (2) Steps in Management for a patient with suspected Tension Pneumothorax?
- Immediately place a Large-Bore Needle or IV Catheter into the Pleural Space at the 2nd Intercostal Space
- Then place a Chest Tube
*Never wait for a CXR for diagnosis*
CIRCULATION
CHEST TRAUMA
What is the First Step in Management of a Hypotensive Trauma?
Identify and Control the Site of Bleeding.
**Do NOT be distracted by Head Trauma or Dilated Pupils in a Hypotensive Trauma patient. Intracranial bleeds are NEVER the cause of Hypotensive Shock.**
CIRCULATION
ABDOMINAL TRAUMA
“A 24-year-old man presents to the ED with 3 Stab wounds to the Abdomen. He was Intubated in the field for airway protection and a Focused Assessment with Sonography in Trauma (FAST) performed. Blood Pressure is 70/30 mmHg and Pulse is 140 bpm. On exam, 3 penetrating wounds covered by abdominal pressure pads are noted.”
What is the Best NEXT Step in Management of this patient?
IV Fluids
- This patient is in Hemorrhagic Shock and requires Immediate Resuscitation.
- The Best form of Venous Access = 2 Large-bore IVs in the Periphery and/or Central Venous Access.
- Applying Direct Pressure to the Abdomen
CIRCULATION
ABDOMINAL TRAUMA
What are (4) Steps in the Management of Abdominal Trauma patients?
- Apply DIRECT LOCAL PRESSURE when the site is visible.
- FLUID RESUSCITATION is Always the Best Next Step in Management in a patient who is Hemodynamically Unstable.
- In Preparation for Immediate Exploratory Laparotomy, do the following:
- 2 Large-bore IVs
- Fluids & Blood products
- Type & Screen
- Foley Catheter
- IV Antibiotics
- If Surgery is needed (e.g., Blunt Trauma), Fluid Resuscitation is Also Diagnostic.
- If the patient responds promptly, then they are probably no longer bleeding.
CIRCULATION
PRACTICE QUESTION
“A 9-year-old child is brought to the ED by his school teacher. The child is in severe respiratory distress, has difficulty swallowing, and appears to have swollen eyes and lips. The child’s teacher says he was throwing rocks at a beehive while playing outside during recess. His BP is 88/40 mmHg, and his heart rate is 120 bpm. The child is unable to speak, and physical exam reveals bilateral wheezing and tachycardia.”
What is the Most Likely Diagnosis?
Anaphylactic Shock
CIRCULATION
VASOMOTOR SHOCK
What are (4) Clinical Manifestations of Vasomotor Shock?
- Hypotension
- Tachycardia
- Warm
- Flushed
CIRCULATION
ANAPHYLACTIC (VASOMOTOR) SHOCK
What are (3) things to Look For in the History of a patient with Anaphylactic (**Vasomotor**) Shock?
- Medication use (e.g., penicillin allergy)
- Spinal Anesthesia
- Allergen exposure (e.g., bee sting)
CIRCULATION
BASIC SCIENCE CORRELATE
“On exposure to a foreign substance, IgE binds to the antigen, forming an antigen-antibody complex.”
What does this Complex do?
- This Ag-Ab complex Activates the High-affinity receptor for the Fc region of Immunoglobulin E (Fc E RI), leading to Mast Cell and Basophil degranulation and the release of Inflammatory mediators such as Histamine.
- These mediators cause Vasodilation, Bronchoconstriction, Tachycardia, and Swelling.
CIRCULATION
VASOMOTOR SHOCK
Which (2) Treatments are considered the First Step in Management for a patient with Vasomotor Shock?
Vasoconstrictors
and
Fluids
CIRCULATION
SHOCK
Describe the Flowchart for Shock (PCWP change vs. CO change)
See Pic
TRAUMA TO LOCALIZED SITES
- Where should ALL Trauma patients with Damage to Internal Organs go?
- What should you do if the case describes an Object Embedded in the patient?
- Operating Room (OR)
- NEVER Remove it in the ER or at the scene of the accident. Remove in the OR.
CIRCULATION
CHEST TRAUMA
- What is a unique finding on ECG for Pericardial Tamponade?
- What is a unique finding on Physical Exam for Pericardial Tamponade?
- ECG: Electrical Alternans
- Vital Signs: Pulsus Paradoxus
