12. Multiply Injured Patient Flashcards
What percentage of deaths due to trauma are potentially avoidable?
Up to 30%
What can be done to improve the deaths which could be avoided?
- Improve pre-hospital care
- Use Advanced Trauma Life Support (ATLS) principles
- Integration of Trauma Services
- Invest in Rehabilitatiion
- Clinical Audit and Research
When should Trauma management start?
From the Time of Injury:
- Golden Hour
- Platinum 10 minutes
What information should be conveyed, pre-hospital arrival?
- Time of Injury
- Mechanism of Injury
- Speed / Forces involved
- Ejection / Pedestrian
- Likely Serious Injuries
- Vital Signs
- Interventions Carried Out
What is a trauma team made up of?
- Emergency Department
- Anaesthetics
- Radiology
- Intensive Care Unit
- Surgical Specialties
What is the Primary Assessment Survey, in Trauma Assessment?
ABC:
Detects and Treats immediate threat to life
What does the ABC approach include?
Airway with C-Spine Control Breathing with O2 Circulation with Haemorrhage Control Disability Expose and Environment
What is assessed in “Airway with C-Spine Control”?
- Noises - Speech; Gurgling; Stridor
2. Visual - Swelling / Deformity; Vomit / Blood / Debris
How is “Airway with C-Spine Control” managed?
- Manoeuvers
- Suction
- Adjuncts
- Advanced Procedures
What is assessed in “Breathing with O2”?
- Look - Work of Breathing / Expansion . Effort
- Feel - Palpate / Percussion
- Auscultate
What is Clinically Assessed in “Circulation”?
- Heart Rate / Palpable Radial Pulse
- Blood Pressure / Pulse Pressure Narrows
- CRT
- Urine Output
- Confusion
What is Blood Test Results are Assessed in “Circulation”?
- Haemoglobin Levels
2. Serum Lactate
What is Imaging Results are Assessed in “Circulation”?
- Ultrasound
2. CT
What are the most common 5 sites for Blood Loss?
- Chest
- Abdomen
- Pelvis
- Long Bones
- Floor
What is considered when assessing “Circulation”?
Haemorrhage Control
What is considered in Volume Replacement in “Circulation”?
- I.V. Access vs I.O. Access
- Type of Volume
- Amount of Fluid
- Massive Transfusion Protocols
What needs to be monitored as Volume Replacement is being performed?
- Vital Signs
- Urine Output
- Lactate
What is the “Legal Triad” of Volume Replacement?
- Coagulopathy
- Acidosis
- Hypothermia
What is assessed in “Disability”?
- Alert, Voice, Pain, Unconscious (AVPU)
- Glasgow Coma Score
- Pupils
- Tone and Reflexes
What is included in “Expose and Environment”?
- Expose to allow a full examination
2. The cover to keep warm
What does “DEFG” often stand for, in this setting?
Don’t Ever Forget Glucose
What Bedside tests are often done in Trauma cases?
- ECG
- Arterial Blood Gas
- Urine Dipstick
What investigations are done very quickly, once the patient arrives in the Hospital Setting?
- X-Ray / CT Scan - C-Spine, Chest, Pelvis
2. Ultrasound - Pneumothorax
What is included in the Secondary Survey?
Meticulous Head to Toe examination to identify all injuries and plan management
What are the options for Transfer and Further Management?
- Theatre - Operative Management
- Interventional Radiology - Control of Bleeding
- Intensive Care Unit - ICP monitoring, Ventillation, Continued Resuscitation
