3 - Primary / Secondary Flashcards
Who determines the disposition of the trauma patient?
Trauma surgeon
Who is normally the first to report injuries?
HEENT
Who documents everything in the trauma bay?
Scribe
Who administers the meds ordered by the provider?
Circulating nurse
What imaging modalities are available at bedside in the trauma bay?
Ultrasound
Plain films
Steps of patient arrival in trauma bay
EMS brings patient in
All clothing removed (if not already done by EMS)
Primary survey immediately performed
Secondary survey starts by HEENT and clavicles-down
Trauma surgeon asks for EMS report
Imaging (CXR, ABD xray, obvious Fx and FAST exam)
Primary survey includes:
XABCDE
Addresses life, limb, eyesight
Secondary survey includes
Hx
Head to toe
Add’l imaging that wasn’t already accomplished during primary survey
Consult specialists based on injuries
Tertiary survey includes
Basically anything that wasn’t done in primary or secondary
This is after the imaging stuff has been evaluated by radiologists and the various consultants have seen the patient
Potential dispositions from the trauma bay:
Rush to OR
Send for advanced imaging (CT / angio)
Admit
“Downgrade” (hold in ED until imaging read, make disposition later; close lacs, reduce Fx, splint and discharge)
Common examples of blunt trauma
Fall (either from standing or from height)
Motor vehicle crashes
Alleged assault
Closed head/neck injuries
Extremity fx’s
Chest trauma
ABD/GU trauma
Common sequelae of falls from standing height?
Head bleed (especially if on anticoagulants)(think old folks falling from standing height that say they feel fine, meanwhile they’ve got a slow bleed developing)
Prophlyatic treatment to consider following patient presenting with lac?
Tetanus
Fall from height is considered anything higher than:
3 to 6 feet (so even just missing a few steps would be considered “from height” as opposed to “from standing height”)
Minimum care for fall from height should include:
Head CT
Imaging of any bone pain
Close lacs
Update tetanus
Rapid deceleration injury is usually associated with MVC’s, but can also be caused by:
Fall from extreme height
Sequelae of chest trauma:
Pneumothorax Hemothorax Pericardial effusion / tamponade Diaphragmatic hernia Aortic transection Rib Fx
Sequelae of ABD trauma
Liver / spleen injuries
Kidney injuries
Hollow viscous organ injury
Bladder injury
Name some examples of injuries that can be treated without surgery:
Stable intracranial bleeds Simple / tension PTX Hemothorax Rib Fx’s Lacs Small fx’s
How is a PTX normally treated?
Thoracostomy
What imaging best shows a hemothorax and also tells you where to place your chest tube?
Upright plain films
How is pericardial effusion emergently treated?
Pericardiocentesis (pull off that fluid)
Diaphragmatic hernia is normally on which side of the chest?
Left
Txt for diagrammatic hernia ?
Decompress the stomach
Then surgery to close the rent
Which traumatic injury results in over 80% of patients dying on scene?
Aortic transection
Management of rib fractures
Adequate pain control very important (either narcs or epidural)
Commonly concurrent PTX
Can lead to atelectasis / pneumonia
Txt for flail segment (multiple fractured ribs)?
Rib plates (metal ribs, basically? Slide 20)
You can treat liver or spleen lacs non-operatively if:
The hematoma is contained and patient remains hemodynamically stable
Low threshold to take to the OR
Kidneys are less commonly injured during trauma because of:
Their location (retroperitoneal)
Hollow viscous organs of the abdomen include?
Stomach, intestines, gall bladder, uterus, bladder
CT sign of hollow viscous organ injury?
Fat stranding
If seen, highly likely that there is a violation of the lumen and subsequent inflammation
During a pelvic fx, we need to be highly suspicious of:
Urethral or bladder injury
Three hard signs of a urethral injury:
High riding prostate
Blood at urethral meatus
Gross blood during rectal
*do a RUG prior to cath
Widened mediastinum, ABD free air/fluid, or extravasated contrast are all indications that the patient probably going to need:
Surgery
Why does almost all penetrating ABD injury go to the OR?
Succus leak -> peritonitis -> sepsis -> shock -> death
*most penetrating CHEST trauma managed non-operatively
Emergent procedures (in the trauma bay)
Thoracotomy (open em up)
*rush to OR for uncontrollable bleeding
Examples of urgent procedures include:
Stuff done in the OR, normally
Thoracostomy after needle decomp
Suprapubic catheter if urethral injury
Exploratory lap
Admission dispositions include
ICU (many types)
Tele
Med
Features of ICU includes:
Q1H VS
Ventilator management
ECMO
Constant tele monitoring
CIWA protocol (EtOH withdrawal)
1:1 or 1:2 nursing
Multidisciplinary approach
Features of tele floors
Constant ECG monitoring
1: 3-4 nursing
Q4H VS
Features of medical floors
Low acuity patients
1: 6-8 nursing
Q4H VS
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