a&e Flashcards
Talk through the ABCDE and things you might do in each
A
Secure airway: guedel, NP airway, ET tube, LMA
B
RR. Oxygen, nebulised salbutamol/ipratropium bromide
Sats
C
BP, HR, CRT, UO. Fluid resuscitation, vasopressors, catheterisation
D
GCS, AVPU, capillary glucose. CT, IV dex
E
Rash, burns etc
What is the canadian c spine score for?
Who can it be used on?
CT scanning post neck injury
If the patient is alert (GCS 15) and stable following trauma
4 types of burns
thermal
chemical
electrical
radiation
[EMOTIONAL]
where is a quick place to check for inhalation injury in unconscious pt
nostrils
Rule of 9 for burns - wallace’s
Arm 9% Head 9% Leg 18% Torso (front) 18% Torso (back) 18%
Which chart can you use to assess burns in children
lund and browder
Accounts for age and growth
which level of burn
Pain, red, glistening, NO blisters, brisk capillary refill.
Recovery?
Epidermal/superficial partial thickness
Heal in one week no scarring
Which level of burn
Pale pink/mottled, swelling, SMALL blisters ± weeping, brisk capillary refill.
How long for recovery ?
superficial dermal
Heal 3 weeks minimal scarring
Which level of burn
Cherry red, blistering, dry, blotchy, no blanching, no capillary refill, reduced sensation.
How long recovery? mx?
deep dermal 3-8 weeks healing with scarring ± surgical treatment
Which level of burn
White/black, dry, no blisters, np capillary refill, no sensation.
Mx
3rd degree
Requires surgical repair/graft
Which level of burn
Includes subcut fat, muscle + bone.
Mx?
4th degree
Reconstruction ± amputation
burns Ix
Bloods
FBC, crossmatch, carboxyhaemogobin, serum glucose, U+E, ABG
CXR
Cardiac monitoring
Dysrhythmia for hypoxia and electrolyte disturbances
*Circulation
BP may be difficult and unreliable
Monitor urine hourly therefore urinary catheter
When should you re examine a minor burn after you’ve dressed it?
48 hours
burns are dynamic and can change
If infection of burn occurs - mx?
- daily wound inspection + dressing change + 7 days flucloxacillin
What prophylaxis should you consider in burns?
tetanus
3 key worries in major burns
Direct thermal injury -> airway oedema/obstruction
Carbon monoxide poisoning
Inhalation of smoke -> pneumonia + oedema
What things might indicate inhalation injury ?
mechanism of burn - fire
hoarseness
singed nostril hairs
face/neck burns
What to do if burns pt has a stridor
ET intubation and ventilation
transfer to burns centre
CO poisoning makes what result unreliable
PaO2
How can you try and reduce oedema in airway of burns
elevate head and chest to 25 degrees
What urine output do you want with burns
0.5-1ml/kg urine adults
1-2ml/kg children
How much fluid to give in major burns
Parkland formula
4ml / kg / %total body area of Hartmann’s/Ringer’s lactate
= 4 x weight x %
Half in first 8 hours, half in following 16 hours
Children also receive maintenance calculated as expected 4/2/1
Burns complications
Fluid loss, infection, scarring (minimised by graft in under 3 weeks)
What is flail chest
life threatening injury that occurs when a segment of the rib cage (3 or more ribs) breaks due to trauma and becomes detached from the rest of the chest wall (i.e. unable to contribute to rib expansion)
What does flail chest indicate?
pulmonary contusion. May puncture lung and cause pneumothorax
Seen O/E of flail chest
paradoxical movement (indrawing on inspiration)
Mx of flail chest
ventilation PPV (positive pressure ventilation) (n.b. Intubation and ventilation will exacerbate a pneumothorax or tension pneumothorax) +
pain control (intercostal blocks) +
pulmonary toilet (clear mucus and fluid from lungs)
reversible causes of cardiac arrest
Hypoxia Hypovolaemia Hypo/hyperkalaemia Hypothermia H+ ions - acidosis
Thrombosis (coronary or pulmonary)
Tamponade (cardiac)
Toxins
Tension pneumothorax
Where does the blood go in major haemorrhage
Blood on the floor and 4 more… chest, pelvis, abdomen/retroperitoneum, thigh
What can you do if bleeding of chest / abdo / pelvis
REBOA - resuscitative balloon occlusion of the aorta
What is the lethal triad of major haemorrhage
Hypothermia, acidosis, acute coagulopathy of trauma*
How do you stop bleeding
Splint, pressure, haemostatic agents (tranexamic acid IV), REBOA
Major haemorrhage - what do you transfuse
RBC - 4 units
FFP - 2 units
Platelets - 1 unit
Pt sick and on steroids whatcha do?
double dose of steroids
[boosts cortisol]
Amox + chest rash
ebv
Overdose - tinnitus
aspirin
Overdose - yellow vision
digoxin
What does the lund and browder chart do?
assesses burns in children. accounts for age and growth
