2 - MASCAL And Trauma Flashcards
Trimodal death distribution?
- Second to minutes
- Minutes to hours
- Days to weeks
*all after injury
Seconds to minutes
Massive internal trauma
Transected vessels
Intracranial injuries
Minutes to hours
Blood loss injuries Spleen/liver lac Subdural/epidual hematoma Hemo/pneumo Pelvic fx
Days to weeks
Sepsis
MODS
Triage cats
Immediate
Delayed
Minimal
Expectant
Immediate patients
Airway obstruction or compromise
Tension PTX
Uncontrolled hemorrhage
Blunt/penetrating plus shock
Threatened limb loss
Amputations
Ways to stop major bleeding
Tourniquets
Direct pressure
Hemostatic dressings
Methods to secure airway
OPA
NPA
Supraglottic
Intubate
Delayed
Wounded but stable
Need surgery but no signs of shock
Facial fx or injury but no airway compromise
Globe injuries
Non-life threatening burns
Stable vitals but need higher level of care
Minimal
Minor lacs
Minor burns
Small bone fx
Normally can perform self-care
These patients often overwhelm resources in early stages of MASCAL
- walking wounded
Expectant
No vitals
Transcranial GSW with coma
Shock
Severe burns
High spinal cord injuries
Problem with treating expectant patients
You need to focus on patients you can actually save
Is triage done once you assign a category to someone?
No, gotta keep reassessing
Tourniquets can loosen or fall off, bandages can migrate, gotta check pulses, assess breathing and ventilation
Document care given, stay on top of it as the even unfolds
Primary survey
X - stop blood loss
A - airway
B - breathing
C - circulation
D - disability
E - exposure
2 most rapid causes of death
Loss of airway
Massive bleeding
Steps of “easy” primary survery
Talk to your patient
Get them naked
Roll them over
Get a CXR
Control of persistent hemorrhage not responding to direct pressure and not amenable to tourniquet?
Hemostatic bandage (i.e. Quick-Clot, Combat Gauze)(usually impregnated with kaolin)
What type of injuries may cause delayed presentation of respiratory difficulties?
Burns or chemical inhalation injury
Zones of the neck
Zone 1 -sternal notch to cricoid membrane - CXR, CT angio, EGD, bronch
Zone 2 - cricoid membrane to mouth - SURGERY if hard signs, otherwise CTA, EGD, bronch
Zone 3 - mouth - CT-head, CT-angio, direct laryngoscopy
Hard signs of Zone 2 injury
Crepitus Hoarse Bloody cough/saliva Dyspnea Drool Stridor Dysphagia Expanding hematoma Stroke Excessive bleeding HOTN
How to size NPA?
Nare to ear lobe
When to not give NPA?
Basilar skull fx
OPA
Measure from corner of mouth to ramus
Insert then rotate 180
Supraglotic airway
Inserted blind
Seats at epiglottis and prevents gastric inflation
Doesn’’t work if intact gag reflex
Chest asymmetry, consider
Flail chest
What is a flail chest?
Series of rib fx’s in two or more places
Paradoxical movement of the ribs during respiration
Tension PTX txt?
Needle decomp - 14G 8cm angiocath @ 2-3 ICS MCL
Open PTX
Sucking chest wound
One-way valve
Commercial chest seal
As a rule, what is not performed during a MASCAL?
CPR - move onto someone you can actually help
GCS
EVM / 456
Super quick snapshot of mental status/disability:
AVPU
Dilated pupil?
Ipsilateral injury
Lateral gaze with dilated pupil?
Brain stem herniation through tentorium cerebelli
Exposure
Get em naked
Head to toe, then logroll onto side to check back
Features of a good triage area (field)
Proximity to LZ or ground evac area
One-way flow of traffic (vehicles and patients)
Easily identified and marked
Well-lit, open and covered
Dedicated casualty recorders (PAD)
Sufficient manual labor
Treatment in the triage area?
No - just assign them a category and keep em moving
9-line and MIST
Slide 27 (dunno if it’s testable)
Did you hear about the guy who invented the knock knock joke?
He was given the NO Bell prize
