17- Trouma & ER Refrence Flashcards
What does the CCrISP three-stage assessment process help with?
Defining the acuity of patients, identifying underlying problems, determining necessary interventions, and establishing the frequency of patient reviews
What does CCrISP help with in managing surgical patients?
Performing organized simultaneous resuscitation, diagnosis, and definitive treatment
What are “track and trigger” systems used for in hospitals?
To aid in the recognition of deteriorating patients, such as the National Early Warning Score (NEWS)
What is the role of the CCrISP course and three-stage assessment process?
To properly assess acutely unwell patients, plan their subsequent care, and ensure simultaneous resuscitation and diagnosis
What should be done for patients who are relatively stable but at risk of deterioration?
They should be re-evaluated and have their management plan updated at least twice daily
When should the three-stage assessment process be applied to patients?
During scheduled ward rounds and in the event of deterioration
What is the CCrISP system of assessment used for?
To determine whether patients are stable or unstable and guide attention to detail in treatment
What is the predictable pattern of life-threatening illnesses?
Obstruction of the airway kills more quickly than lung problems, which kill more quickly than isolated hemorrhage
What does the immediate management process prioritize?
Assessment and treatment of the airway, breathing, circulation, dysfunction of the CNS, and exposure of the patient for full assessment
What are the steps of the ‘Look, Listen and Feel’ clinical assessment for airway obstruction?
Look for central cyanosis, abnormal breathing patterns, use of accessory muscles, tracheal tug, changes in consciousness, and obvious obstructions. Listen for abnormal sounds. Feel for air flow on inspiration and expiration
What precaution should be taken when performing airway maneuvers in patients with a risk of cervical spine pathology?
Maintain manual in-line immobilization of the cervical spine
What should be the immediate goal if objective signs of airway obstruction are present?
To secure the airway, provide adequate oxygenation, and prevent hypoxic brain damage
What are some simple methods to obtain an airway?
Chin lift or jaw thrust to open the airway, suction to remove secretions, and insertion of an oral Guedel airway or a soft nasopharyngeal airway
How can you determine respiratory distress or inadequate ventilation?
Using the ‘Look, Listen and Feel’ technique
What should you look for during breathing assessment?
Central cyanosis, use of accessory muscles, respiratory rate, equality and depth of respiration, sweating, raised jugular venous pressure (JVP), chest drains, and paradoxical abdominal movement
What should you do if signs of immediately life-threatening conditions are present?
Identify and treat them without delay, such as tension pneumothorax, massive haemothorax, open pneumothorax, flail chest, and cardiac tamponade
What should you listen for during breathing assessment?
Noisy breathing, coughing to clear secretions, ability to speak in complete sentences, abnormal breath sounds, heart sounds, and rhythm
What should you feel for during breathing assessment?
Equality of chest movement, position of the trachea, presence of surgical emphysema or crepitus, paradoxical respiration, and tactile vocal fremitus if indicated
What should you consider as potential diagnoses during breathing assessment?
Bronchial obstruction, bronchoconstriction, pulmonary embolism (PE), cardiac failure, and unconsciousness
What should you do if the patient is tiring to the point of respiratory arrest?
Assist ventilation with a bag/mask and perform necessary airway maneuvers until help arrives
What should be considered as the primary cause of circulatory dysfunction in surgical patients?
Hypovolaemia
What is the first step in assessing a patient with circulatory dysfunction?
Rapidly exclude haemorrhage and establish adequate venous access
What is the recommended fluid challenge for normotensive patients?
10ml/kg of warmed crystalloid
What is the recommended fluid challenge for hypotensive patients?
20ml/kg