3 - Emergency Flashcards
Discuss the assessment and management of major pelvic injuries
Commonly associated with massive hemorrhage
Signs - flank, scrotal, perianal swellling/bruising, open fracture, high riding prostate, blood at the meatus
Hemorrhage control and rapid fluid resuscitation must take place, along with pelvic stabilization
Definitive Operative Care, Angiography with embolization
Discuss the assessment and management of arterial hemorrhage
Assessment - Usually from penetrating trauma
Find the source of bleeding, discern pulse presence and quality of that pulse, Assess changes in doppler tone.\
Managemtent: Direct presssure, fluid resuscitation, reduction/splinting of associated fractures, Urgent operative care if needed
Discuss the assessment and management of crush syndrome?
Key symptoms?
aka - Traumatic rhabdomyolysis
toxic effect of noxious byproducts from injured muscles, due to prolonged compression of significant muscle mass
Major insult due to impaired perfusion, ischemia, and release of myoglobin and other toxic materials
May lead to acute renal failure
The urine is dark amber in color and positive for hemoglobin by dipstick (usually negative via microscopy
Management - IV fluid expansion, osmotic diuresis to maintain high tubular volume and urine flow, alkalinization of the urine with soduim bicarb to reduce myoglobin precipitation
Discuss the assessment and management of traumatic amputations?
What criteria is necessary for implantation?
Must be hemodynamically stable
Part can’t be grossly contaminated or crushed
The amputated part is quickly available
Note: Isolated finger amputations in the multiply injured trauma patient are a low priority
Discuss the assessment and management of compartment syndrome
End-stage of this is called volkmann’s ischemic contracture
Describe the correct sequence of priorities in assessing the multiply injured patients, including primary care and secondary survey
- Preparation -
- Triage
- Primary Survey
- Resuscitation
- Adjuncts to the primary survey/resuscitation
- Secondary survey
- Adjuncts to the secondary survey
- Postresuscitation monitoring and re-evaluation
- Definitive Care
Describe the two phases of the preparation stage of trauma care
Prehospital Phase - Notify recieving hospital, emphasis on airway/maintainence/control of external bleeding/shock, pick closest trauma center
In-hospital Phase - Advanced planning, trauma team ready and briefed
Describe the triage stage of trauma care
the sorting of patients based on the need for treatment and the available resources to provide that treatment
Describe the primary survey
Airway (and cervical spine protection)— always assume there is a cervical spine injury in multisystem trauma patients
Breathing and ventilation
Circulation with hemorrhage control - hypotension should be considered hypovolemic in origin until proven otherwise
Disability: Neurologic status (AVPU - Alert, Vocal Stimuli, Painful Stimuli, Unresponsive to all)
Exposure/Environmental control - cover with blanket to prevent hypothermia
*done simultaneously
Discuss the additional things that must be added during the primary survey.
EKG monitoring is required in all trauma patients
Foley catheter should be placed to monitor urine output (look for blood too - could indicate pelvic fracture)
When is the secondary survey done?
Once the patient starts to show signs of normalization
It includes a head to toe evaluation of the patient, including vitals
“Fingers or tubes in every orifice”
Define definitive care and describe how it relates to the care of trauma patients
getting the patient to a facility that is capable of taking care of them (short and long term)
appropriate transport team should be chosen if the patient needs to be transported
