A and E

Question 1

Outline ABCDE approach

Answer 1

A - secure airway - guedel, NP airway, ET tube, LMA

B - RR - Oxygen, nebulised salbutamol/ipratropium bromide

C - BP, HR, CRT, UO - Fluid resus, vasopressors, catheterisation

D - GCS, AVPU, cappilary glucose - CT, IV dex

E - rash, burns, trauma…etc.

Question 2

What is Canadian C-spine rule? What is it used for? When is it applicable?

Answer 2

Decision rule use to rule out C-spine injury

Used to decide if need CT scanning post neck injury

Applicable if pt is alert (GCS 15) + stable following trauma

Question 3

Define 4 types of burn Burn

Define Scald

Answer 3

Burn - injury by chemical, thermal, electrical or radiation energy

Scald - contact with hot liquid or steam

Question 4

Where to look/be careful of in burns

Answer 4

Nostrils - inhalation injury

Question 5

How to measure skin area of burns in adults?

Difference in children?

Answer 5

Rule of 9’s:
Head - 9%
Arm - 9%
Leg - 18%
Torso (front) - 18%
Torso (back) - 18%

Hand ~ 1%

CHILDREN: - Lund + Browder chart
1 year old:
- Head 18%
- Leg 14%
(For each +1yr = -1%head & +0.5%leg)

Question 6

Which layer of burn?

Pain, red, glistening, NO blisters, brisk capillary refill.

Heal in one week
No scarring

Answer 6

Superficial partial thickness

Question 7

Which layer of burn?

Pale pink/mottled, swelling, SMALL blisters +/- weeping, brisk capillary refill, reduced sensation

How long to heal?
Minimal scarring

Answer 7

Superficial dermal

Heal 3 weeks

Question 8

Which layer of burn?

Cherry red, blistering, dry, blotchy, no blanching, no cap refill, reduced sensation

How long to heal?
Scarring +/- surgical treatment

Answer 8

Deep dermal

3-8 weeks healing

Question 9

Which layer of burn?

White/black, dry, no blisters, no cap refill, no sensation

Treatment?

Answer 9

Full-thickness (3rd degree)

Damage through all layers of skin (epidermis, dermis, hypodermis)

Requires surgical repair/graft

Question 10

Which layer of burn?

Includes subcut fat, muscle + bone

Reconstruction/amputation needed

Answer 10

4th degree

Question 11

Investigations for burns?

Answer 11

Bloods - FBC, crossmatch, carboxyhaemoglobin, glucose, U+E, ABG

CXR

Cardiac monitoring - dysrhythmia for hypoxia + electrolyte distubances

*Circulation
- BP may be difficult + unreliable
- Monitor urine hourly –> CATHETER

Question 12

First aid + treatment of minor burn

Answer 12

1. stop burning + cool
   - Remove clothing
   - Brush chemical powders away
   - Run under cold tap - 20MINS!
   - remove constricting clothing + cover w/ clean+dry linens - for hypothermia
2. Dress + Analgesia
   - Clean w/ soap+water
   - Leave blisters <1cm intact (reduce infection) + aspirate large ones
   - Non-adhesive gauze dressing
   -Give analgesia + check tetanus prophylaxis

…If infection - daily wound inspection + dressing change + 7 days fluclox

Question 13

3 key worries with a major burn?

Answer 13

Direct thermal injury –> airway oedema/obstruction

Carbon monoxide poisoning

Inhalation of smoke –> pneumonia+oedema - CHECK NOSTRILS!

Question 14

Tx of Major burn??

Answer 14

ABCDE
A
- ET tube + ventilation
- ?Inhalation injury - hoarseness, singed nostril hairs, face/neck burns

B
- 100% O2 + COHb levels
- ABG (PaO2 not good with CO poisoning)
- elevate head - 25o = reduce oedema

N.B. Fluid loss:
Heat –> ^ cap perm, oedema + visible fluid loss + blisters

C
-IV fluid resus (within 24hr of injury) if: 15%adult/10%child burn s.a.
- children=also maintenance

E - Strong opioids + prevent hypothermia

Question 15

3 burns complications

Answer 15

Fluid loss, infection, scarring

Question 16

What is flail chest

Answer 16

Life theratening injury - segment of rib (3 or more) break + come detached from rest of the chest wall

–> so unable to contribute to rib expansion

Question 17

What can flail chest cause?

Answer 17

Pulmonary contusion - may puncture lung / cause pneumothorax

Question 18

What do you see on examination of flail chest?

Answer 18

Paradoxical movement - i.e. indrawing in inspiration

Question 19

Management of flail chest?

Answer 19

Ventilation PPV
Pain control - intercostal blocks
Pulmonary toilet/hygeine

n.b. - intubaton + ventilation = make pneumothorax worse

Question 20

9 reversible causes of cardiac arrest?

5Hs + 4Ts

Answer 20

Hypoxia
Hypovolaemia
Hypo/hyperkalaemia
Hypothermia
H+ ions - acidosis

Thrombosis (coronary/pulmonary)
Tamponade (cardiac)
Toxins
Tension pneumothorax

Question 21

Major haemorrhage - where could it be?

Answer 21

Blood on the floor + 4 more:

Chest
pelvis
abdomen
thigh

Question 22

What can you do if bleeding into chest/abdomen/pelvis?

Answer 22

REBOA - resuscitative balloon occlusion of the aorta

Question 23

Lethal triad of major haemorrhage?

Answer 23

Hypothermia
Acidosis
Acute coagulopathy of trauma –> i.e. HAEMORRAGE

Question 24

How to stop bleeding in major haemorhage?

Answer 24

Splint, pressure
tranexamic acid IV (haemostatic agent)
REBOA - resuscitative balloon occlusion of the aorta

Question 25

What do you transfuse in major haemorhage?

Answer 25

Fluid + blood + blood products (FFP, cryoprecipitate)

RBC - 4units
FFP- 4units
Platelets - 1unit

Question 26

In trauma what causes acute coagulopathy? what does it lead to?

Answer 26

shock + hypoperfusion

leads to haemorrhage