11 - Trauma Flashcards
When a trauma comes in what are some important questions to ask the ambulance crew?
- Location of injury
- Events before injury
- Mechanism of injury
- Ability to walk after injury?
- Last meal eaten?
- PMHx?
- Tetanus status?
- Normal mobility status?
- Occupation?
- Dominant hand?
What are some questions to ask paramedics specifically if there has been a RTA?
- Collision speed?
- Airbags deployed?
- Wearing seatbelt?
- What seat in car?
- Injuries/fatalities of other passengers?
- What stopped the car?
- Was the patient trapped?
What are some worrying signs with trauma?
- Shock
- Tachypnea
- Reduced GCS
- Significant mechanism
Before/during examination of trauma patients what is important to consider?
Pain relief!!!!
What is a significant mechanism of injury in trauma?
- Fall >1m or 5 stairs
- Axial load to head e.g diving
- High speed RTA
- Rollover RTA
- Ejection from a vehicle
- Bicycle collision
What trauma injuries require immediate senior input?
- Neurovascular compromise
- Involving deep structures e.g tendons
- Wounds in cosmetic/sensitive areas
- Open fracture
- Displaced fractures
- Fractures with skin tenting
- Dislocation of major joints
What is the likely cause of death following trauma?
Immediately: brain or high spinal injuries, cardiac or great vessel damage.
Early hours:splenic rupture, sub dural haematomas and haemopneumothorax
Days: sepsis or multi organ failure
Before inserting an NG tube or nasopharyngeal airway, what contraindication do you need to check for?
Basal skull fracture
What are the different ways of describing simple wounds?
- Puncture
- Incisional (sharp objects)
- Laceration(blunt trauma)
- Abrasion
When taking a history for a simple wound what are some questions to ask?
- Mechanism
- Foreign bodies
- Contamination with naure
- Tetanus status
What do you need to look at when examining a simple wound?
- Site, size, type of wound
- Distal senssation
- Cap refill
- Movements
- Depth
- Foreign bodies
Use local anaesthetic when examining
What investigation should be done if you suspect a foreign body in a wound?
X-ray
How should you manage a simple wound?
- Clean with saline or sterile water
- Consider antibitoics and tetanus boost
- Primary closure (glue, steristrips, sutures)
- Delayed primary closure (if likely infected)
What are some common thoracic injuries in trauma patients?
How do you treat a haemothorax in a trauma patient?
How do you investigate a cardiac contusion in a trauma patient and what are the risks with this?
What are some common organs injured in the abdomen in trauma?
- Liver (stab)
- Spleen
- Abdominal aorta (deceleration)
- Small bowel (gun shot wound)
What is the first imaging done for trauma?
US!!
FAST scan to look for internal bleeding
What is the difference between concussion and a contusion?
Localised damage that can be viewed on imaging with contusion. Concussion is wide spread
What symptoms have to be present to diagnose concussion?
- No structural damage
- General neuro symptoms
- NO focal neuro symptoms
What are the symptoms of concussion and what is the likely recovery period?
- Confusion (e.g unaware of surroundings, delay in answering questions, blank expression)
- Headache
- Dizziness
- Nausea
- Loss of balance
- Visual changes/photophobia
- Memory issues
Can take 1-4 weeks to resolve
What is post-concussion syndrome?
(Think scott)
Persisting symptoms >1 month of concussion beyond the normal time for recovery. Need to rest and minimise stress. Symptoms include:
- irritability
- headache
- fatigue
- anxiety/depression
- dizziness
What is chronic traumatic encephalopathy?
Repeared concussions leading to cognitive declien and eventual dementia and agression
Common in boxers and rugby players
What are the two subtypes of traumatic brain injury?
Primary: immediate damage due to force e.g focal (contusion/haematoma) or diffuse (diffuse axonal injury)
Secondary: due to hypoxia from processes like cerebral oedema, ischaemia, infection, tonsillar or tentorial herniation
What is a diffuse axonal injury?
Occurs as a result of mechanical shearing following deceleration, causing disruption and tearing of axons
Poor prognosis, usually unconsciousness
What observations do you need to be cautious of in a head injury?
Cushing’s Reflex
Heart rate
Blood pressure
When a patient has had a head injury, what are some important questions to ask them?
- Mechanism of injury?
- LOC?
- Seizures?
- Vomiting?
- Amnesia?
- Blood/fluid from nose or ears
- Headache
- Any anticoagulation
What is the criteria for a head CT in head injuries and at what time frame?
On examination what is important to look at in head injuries?
- GCS
- Pupils
- Neurological exam
- Fractures of skull
- Signs of basal skull fracture (ears, eyes, nose)
What is whiplash and how does it present?
Neck sprain caused by a sudden movement of the head forwards, backwards or sideways
Usually gradual onset pain and stiffness, not present immediately after injury
Tender paravertebrally > midline
How is whiplash managed?
- Advise will get worse before better
- Rest for 48h then gradual return to activities
- NSAIDs and paracetamol
- Local heat
What scenarios do you need to immobilise a C-spine and ensure you have a CT neck before examining?
- Significant mechanism of injury
- Head injury with neck pain
- Collapsed with suspected c-spine injury
What is the controversy around c-spine immobilisation?
Increases risk of aspiration and increases difficulty of airway management
What do the following pupil reflexes mean in a head injury?
If there is raised ICP in an extradural haematoma, what can you do before surgery?
- Give IV mannitol/furosemide
- Maintain BP sys no less than 100
- Head elevation
Why does CT head become less sensitive over time to diagnose intracranial bleeds?
The blood haemolyses!!
If still suspect SAH do lumbar puncture
How can you tell the difference between a traumatic tap and xanthochromia?
Traumatic tap will dilute over the three vials you take but xanthachromia will not. Also traumatic tap will have normal opening pressure but xanthochromia may be raised
