49 - Adult - Trauma Thinking Points

Question 1

In the adult trauma patient, explain the common signs of shock

Answer 1

• absence of radial/femoral pulse
• pale, cool, clammy skin
• exsanguinating hemorrhage
• Adult SBP under 90 mmHg
• tachycardia/tachypnea
• ALOC/confusion/restlessness/combativeness
• delayed capillary refill

Question 2

What patient population(s) may not show normal signs of shock in trauma? I.e. “What populations have vital signs that are not reliable as indicators of shock?”

Answer 2

• The elderly (why?)

- Those on certain medications

Question 3

What conditions may be precursors to shock?

Answer 3

• significant MOI
• Tender/distended abdomen
• Pelvic instability
• Bilateral femur fracture

Question 4

In the adult trauma patient, what are “Load and Go” criteria?

Answer 4

• head injury with unconsciousness
• GCS < 10
• unequal pupils
• Traumatic arrest
• airway obstruction not relieved by suction/positioning

Question 5

In the adult trauma patient, what are the signs of “Cushing’s Triad” (or increasing ICP)

Answer 5

• increased SBP
• bradycardia
• irregular respirations

*All of these are due to herniation of the brain through foramen magnum, causing pressure on the brainstem, where respiration/heart rate is controlled.