A&E: Trauma Flashcards
What is meant by trauma?
Transfer of kinetic energy
Explain why finding out information about the mass and the velocity is important when taking a trauma history
Kinetic energy= ½ x M x V2
Hence, mass and particularly velocity are important when assessing how much energy may be have been transferred to patient. Young patients can compensate well so even if they look okay think about how much trauma they have experienced as they may be compensating but will crash later
Describe the 3 peaks of death for trauma patients
*Golden hour is the first hour after trauma; resuscitating quickly and effectively in golden hour reduces risk of death- particularly reduces 3rd trauma peak
What is meant by the primary, secondary and tertiary survey for trauma patients?
- Primary survey: identify and treat life-threatening injuries
- Secondary survey: head to toe examination, brief focused history, exclusion of major injuries
- Tertiary survey: a patient evaluation that identifies and catalogues all injuries after the initial resuscitation and operative intervention (often done just prior to discharge, legal purposes)
Describe what is involved in the primary survey for trauma patients
ATLS
- Airway & C-spine stabilisation
- Breathing
- Circulation & haemorrhage control
- Disability
- Exposure (with temperature control) *Must fully undress patient but avoid hypothermia
Describe what is involved in the secondary survey for trauma patients
- Head-to-toe examination (to look for any other injuries)
- AMPLE history:
- Allergies (LIFL also says ADT status)?
- Medications
- Past history
- Last meal
- Events and environment of the injury
- Continue to assess/monitor vital signs
-
Adjuncts/investigations
- Bloods: FBC, U&Es, LFTs, coagulation, G&S, crossmatch
- Imaging: CXR, long bone x-rays, pelvic x-rays, CT trauma series
- Monitoring: ECG/cardiac monitor, ICP, arterial BP
Describe what is involved in the tertiary survey for trauma patients
Repetition of secondary survey that aims to pick up missed injuries; may be done on several occasions including after initial injuries resolved and after any surgery
What airway manoeuvre should you not do in trauma patients and why?
Head tilt (until you know/proven to be no C-spine injury)
What are the common places for people to bleed from and develop hypovolaemic shock?
*HINT: on the floor & four more
- Abdomen
- Pelvis
- Thorax
- Long bones
State some example pathologies that will interfere with ventilation
- Tension pneumothorax (compresses IVC and SVC hence reduced venous return to heart resulting in reduced cardiac output)
- Pneumothorax
- Cardiac tamponade
- Haemothorax
- Sucking wound
- Flail chest
What is a flail chest?
Describe how/why it can be a problem
What is the management if impairing ventilation?
- Flail chest is defined as three or more adjacent ribs that are fractured in at least two places
- Paradoxical motion of ribs occurs. E.g. during inspiration rest of chest wall moves outwards but due to decrease in thoracic pressure the affected area moves inwards and vice versa for expiration.
- Positive pressure ventilation (endotracheal tube) *NOTE: oxygen, splinting, pain management & physiotherapy may be used for milder cases
Although we follow A-E, why must you have circulation under control before draining a haemothorax?
Pleural cavity can hold up to 5L of fluid therefore you could drain entire circulating volume into chest if you inserted chest drain and drained entire contents and thus allowed more to drain into pleural cavity.
*NOTE: bleeding in haemothorax is most commonly from intercostal vessels
What is a sucking wound? Describe why it is a problem and how you deal with it
- Injury causing hole in chest wall allowing free passage of air between environment and thoracic cavity
- When breath in, air can move down pressure gradient into thoracic cavity and if has valve like mechanism will then not allow air to move out during expiration (same mechanism as tension pneumothorax)
- Seal it/dress it (this may create tension pneumothorax also so be prepared to deal with this. Generally say tape at 3 sides to stop air coming in but allowing for air to come out if necessary)
What should be examined for in the neck of a trauma patient?
- Tracheal deviation
- Wounds
- External markings
- Laryngeal disruption
- Venous distension
- Emphysema (surgical)
These findings suggest life threatening injuries to neck or thorax (e.g. tension pneumothorax, cardiac tamponade)
Recommended resource for trauma assessment
