43 trauma resus Flashcards
3 main times of trauma deaths
- immediate -seconds to minutes
- early - salvagabel -golden hour
- late - days to weeks, often in hospital due to complications
5 parts of ATLS care
- primary survey
- resuscitaion
- secondary survey
- investigations
- definitive care
5 parts of primary survey
Airway and Cspine Breathing Circulation Disability (neuro eval) Exposure
potential causes of airway obstrucion
- teeth
- emesis
- blood
- fracture
- soft tissue swelling
what to do for mandible fracture
sux for intubation
what to avoid is C-spine fracture
head tilt
main trauma intubation method
RSI
- only do if confident that airway can be secured
2 main reasons for surgical airway
- failed RSI
2. severe facial trauma
how to protect C-spine in intubation
one person whose sole job is to hold the head
what is rule out in breathing
tension pneumo
indications of tension pneumo
- absent breath sounds
- trachea deviation
- bulging neck veins
Tx of tension pneumo
needle decompression followed by chest tube insertion
7 parameters to assess circultion
- LOC
- pulse
- HR
- BP
- skin color
- urine output
- base deficit
real DDx for hypotensive trauma PT
- HEMORAGE
- obstructive
- neurogenic - high spinal
- cardiogenic
- other
main system to think about hypotension by
by region
head causes of hypo
compression of brainstem - accomanied by brady
neck causes of hypo
- penetration - blood loss
chest reasons for hypo - 5
- tension pneumo
- hemothorax - CXR and low breath sounds
- aortic arch - rare for for patiets to survive to ER
- ruptured diaphragm - rare
- penetration of heart or large vessel
abdo causes of hypo (4)
FAST is essential
- spleen 50% - LUQ free fluid
- liver 40% - RUG and FAST in morrison’s pouch
- retroperitoneum 15% - renal laceration
- other - IVC, pancreas, bladder
2 main divisions of pelvic bleed
veins and arteries (worse)
3 main steps for pelvic bleeds
- tightly wrapped
- palvic angio with embolization
- OR f or pelvic packing
most effective Tx of external bleeds
direct pressure
Tx of shock
- 2 large bore IVs - 2L NS
- after 2L start PRBCs
- transexemic acid - fibrinolytic
blood types to give
O+ in male and O- in female
what is mneumonic for Disability
AVPU Alert Verbal stim response Painful stim response Unresponsive - also look at pupils and general muscle functions
what is needed in enviroment
keep patient warm amd dry
3 initial investigations
- CXR
- AP pelvis
- FAST exam
