ABCs of Trauma

Question 1

Trauma handover

Answer 1

M - mechanism of injury
I - injuries sustained
S - signs at the scene
T - treatment initiated

Question 2

Primary survey purpose

Answer 2

Purpose: Identify life threatening injuries within the first 15mins

• CATASTROPHIC HAEMORRHAGE CONTROL PRIORITISED*
• Airway + c-spine control
• Breathing + adequate ventilation
• Circulation + haemorrhage
• Disability
• Expose but keep warm

Question 3

Life-threatening trauma injuries: AIRWAY

• identify
• causes
• signs and symptoms
• assessment
• management

Answer 3

face and neck trauma

• Causes of airway compromise: foreign body, tongue, haemorrhage, swelling, LOC
• Signs and symptoms: dyspnoea, tachypnoea, noisy breathing, bleeding, change in voice, agitation
• Assessment: GCS <8 intubate, patency, speak to pt
• Management: oxygen, suctioning, adjuncts, head tilt/chin lift

Question 4

Secondary survey

Answer 4

G: gadgets

• Vitals
• Pathology
• ECG
• BSL
• FAST
• Xray
• CT

H: history

• Allergies
• Medications
• Past medical history
• Last meal
• Event surrounding history

I: investigations

J: jot it down
- assessment, management, forensic evidence

K: koffee and debrief

Question 5

Aims of trauma

Answer 5

15mins: Primary survey + FAST
within 45 mins: Secondary survey + plan

haemodynamically unstable out of resus within 30mins

Question 6

Types of shock

Answer 6

Cardiogenic
Hypovolaemic
Anaphylactic
Neurogenic
Septic

Question 7

Orthopaedic injury nursing care

Answer 7

• Analgesic
• Splint
• Prevent further injury
• Neurovascular observation

Question 8

Life-threatening trauma injuries: tension ptx

• symptoms
• management

Answer 8

air in chest cavity

• Symptoms: chest pain, tachypnea, respiratory distress, unable to speak in full sentences
• Management: needle decompression, thoracotomy, chest drain

Question 9

Life-threatening trauma injuries: massive htx

- symptoms

Answer 9

massive htx - blood in chest cavity

- Symptoms: shock (pale, sweaty, BP drop), tachypnea, respiratory distress, decreased rise/fall chest symmetry,

Question 10

Life-threatening trauma injuries: flail chest

• symptoms
• management

Answer 10

flail chest - 2 rib fracture expanded lung

• symptoms: pain, tachypnoea, decrease in symmetry, decreased sats
• management: pain relief, oxygenation

Question 11

Life-threatening injuries: open ptx

• symptoms
• management

Answer 11

open ptx - air between chest wall and lung

• symptoms: wound, pain, shock, tachypnea, respiratory distress, decrease rise/fall symmetry
• management: cover wound, antibiotics, analgesia, oxygenation, chest drain, washout + debridement

Question 12

Life-threatening trauma injuries: C

• assessment
• management

Answer 12

CIRCULATION + HAEMORRHAGE:
internal + external bleeding
- assessment: skin colour, altered mentation, vitals (temp, HR, BP, cap refill)
- management: stop bleeding, full bloods, warm everything

Question 13

Life-threatening trauma injuries: Disability

• identify
• assessment
• management

Answer 13

DISABILITY:
head injury, D+A, hypoxia, hypovolaemia
- assessment: GCS, AVPU, pupils
- management: head CT scan, prevent secondary injury (oxygenation, BP)

Question 14

Life-threatening trauma injuries: E

- management

Answer 14

• Disrobe entire patient

- Prevent hypothermia: warm fluids, blankets, limit exposure time, environmental control

Question 15

Life-threatening trauma injuries: LIST ALL

Answer 15

• face + neck trauma
• airway compromise
• tension ptx
• massive htx
• open ptx
• flail chest
• haemorrhage (I+E)
• head injury
• D+A
• hypoxia
• hypovolaemia
• hypothermia