6 - Basics of Emergency Medicine Flashcards
When writing up acute prescriptions in ED, what is one class of you drug you should always consider?
PAIN RELIEF - check their pain score and reevaluate to check anagelsia effectiveness
A primary survey is done before any history is taken. What does the primary survery consist of? (done before top to toe secondary survery)
DRABC (recognise anything life threatening)
D - Check if danger
R- Is patient responsive?
A - Is airway patent
B - Check for 10 seconds if breathing
C - Any severe bleeding
Put into recovery position if breathing but unresponsive!
Whay questions should you ask after the primary survey?
- Symptoms
- Signs
- AMPLE
What is the secondary survey?
Head to toe examination
- Head and face
- Neck
- Chest
- Abdomen
- Limbs
- Back
- Buttocks and perineum
- Genitalia
What are you looking for when looking at the head and face in a secondary survey?
- Any lacerations or bruising
- Mastoid or periorbital bruising
- Palpate for any depressions im skull
- Look in the eyes for foreign body, irregular iris
- Assess ears for CSF leak, bleeding or blood behind tympanic membrane
- Nose for bleeding, nasal septal haematoma or CSF leak
- Check if any missing or loose teeth
- Test eye movements, pupillary reflexes, vision and hearing.
- Palpate bony margins of the orbit, maxilla, nose and jaw
- Inspect jaw for any pain or trismus
What are you looking at when examining the neck in the secondary survey?
- Open cervical collar and support head with manual in-line stabilisation throughout the exam
- Gently palpate the cervical vertebrae
- Check soft tissues for bruising/pain
- Is trachea deviated?
- Any subcutaneous emphysema
- Any Laryngeal tenderness or crepitus (may be laryngeal fracture)
- Neck vein distension?
- Any difficulty swallowing
Re-apply collar
What are you looking at when examining the chest in the secondary survey?
- Palpated for rib tenderness and subcutaneous emphysema
- **Auscultate lung fields **and percuss (any lack of breath sounds, wheezing or crepitations)
- Check heart sounds: apex beat and presence and quality of heart sounds
What are you looking at when examining the abdomen in the secondary survey?
- Palpate for areas of tenderness especially over the liver, spleen, kidneys and bladder
- Look for any bruising, lacerations or penetrating injuries
- Check pelvis and apply binder if suspect fracture
- Auscultate bowel sounds
- Inspect the perineum and external genitalia for bruising or haemorrhage
What are you looking at when examining the limbs in the secondary survey?
- Inspect limbs and joints, palpate for bony and soft-tissue tenderness and check joint movements, stability and muscular power
- Look for any deformities, penetrating injuries or open fractures.
- Examine sensory and motor function
- Assess distal colour, warmth, movement, sensation and capillary refill
What are you looking at when examining the back in the secondary survey?
- Log roll the patient
- Inspect the entire length of the back noting any deformity, bruising and lacerations
- Palpate the spine for any tenderness or steps between the vertebrae
- A PR only if a spinal injury suspected for loss of tone or sensation
What scoring system can be used in major trauma?
Injury Severity Score (ISS)
What is the first imaging of a patient done in a trauma situation and what is it looking for?
- FAST Scan: Focused assessment with sonography for trauma. Looks for pericardial and intrabdominal fluid
- May be bedside X-rays of pelvis or chest
What is the next type of imaging done in a trauma patient after a FAST scan?
CTs:
Non-contrast:if hyperacute traumatic brain injuries
CT angiography: vascular injuries
Contrast-enhanced: traumatic abdominal organ injuries and the only radiographic modality for which dedicated organ injury scores
Where is CT scanned in trauma patients?
- Head and Neck WITHOUT contrast
- CAP with contrast
How are resuscitation decisions made in ED?
- Talk to patient and family
- Senior doctor will assess
- Look at co-morbidities and likelihood of successful resuscitation and quality of life if to be resuscitated
