Abdominal Trauma Flashcards

1
Q

What are the principles of surgical treatment for a patient that presents in A&E?

A

Catastrophic haemorrhage? - pneumatic tourniquet
A - airway w/ c-spine control
B - breathing - chest decompression in tension pneumothorax
C - circulation
D - damage control resus + disability
E - everything else

use lactate as an indicator of the quality of resus
arterial-end tidal CO2 difference –> arteriole dead space
2 wide bore cannulae for aggressive IV fluid resuscitation
Foley’s urinary catheter
Crossmatch patient’s blood type for transfusion

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2
Q

You have a patient with a catastrophic haemorrhage and you place them on IV fluid resuscitation. Their vital signs ____. What does this mean?

a. normalise
b. transiently normalise
c. do not respond to IV fluids

A

a. most patients have experienced intravascular volume loss that stopped due to coagulation and tamponade
b. ongoing intra-abdominal bleeding
c. major intra-abdominal injury or severe solid organ injury –> immediate surgical attention required

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3
Q

How do you assess a patient who experienced blunt trauma but is haemodynamically stable?

A

Focussed Assessment with Sonography for Trauma (FAST) - eFAST = extended
or
CT to assess fluid and organ injury

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4
Q

How do you assess a patient who experienced blunt trauma but is haemodynamically unstable?

A

find the site that’s bleeding
IV fluids, blood transfusion, catheter
XR to check chest, abdomen, and pelvis for haemothorax or pelvic fracture

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5
Q

How do you assess a patient who experienced penetrating trauma?

A

local wound exploration to evaluate for perforation of abdominal wall fascia

if peritonitis + haemodynamically unstable –> immediate laparotomy
needs thorough exploration
prophylactic abx

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6
Q

What are the primary and secondary surveys?

A

Primary:
ABCD

Secondary
DE + Radiographs + CT
AMPLE

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7
Q

Describe the triage sieve

A

Priority 1 = immediate life-saving intervention required
P2 = significant intervention required within 2-4hrs
P3 = needs treatment but can safely be delayed
P4 = dead

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8
Q

What is the surgical sieve?

A
Vascular
Infective/inflammatory
Trauma
Autoimmune
Metabolic
Iatrogenic
Neoplastic

Congenital

Degenerative
Endocrine/environmental
Functional

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9
Q

Which analgesia would you give for ____ pain?

a. mild (1-3/10)
b. moderate (4-6/10)
c. severe (7-10/10)

A

a. NSAIDs +/- pentazocline +/ cold/hot compresses
b. cold/hot compresses +/- tramadol +/- pethidine
c. Morphine +/- fentanyl

give IV in small doses frequently until pain relief is achieved
reassess every 5 mins
any signs of adverse effects –> halt next dose of treatment

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10
Q

Describe the mechanism that results in blunt trauma

A

rapid deceleration = shear forces cause organs and vascular pedicles to tear

crushing = intra-abdominal contents are crushed against the anterior abdominal wall and vertebral column

external compression = leads to a sudden rise in intra-abdominal pressure –> ruptures hollow viscous organs

blunt trauma results in large tissue injury + major inflammation + organ failure

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11
Q

How do explosions cause trauma?

A

blastwave = increased air pressure
suction = decreased air pressure
these forces damage your organs

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12
Q

What is abdominal compartment syndrome?

A

= intra-abdominal pressure >20mmHg
if perfusion is impaired –> organ dysfunction
can occur due to excessive fluid resus or massive blood transfusion
will present as;
increased airway pressure
decreased UO
tense abdomen

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13
Q

How do you correct abdominal compartment syndrome?

A
decrease intra-abdominal pressure by:
evacuation of its contents
fluid balance
correct body position 
adequate analgesia
neuromuscular blockade in some cases
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14
Q

What is AMPLE and ATLS?

A
AMPLE = 
Allergy
Medications
Past pertinent history
Last meal
Events leading up to the injury

ATLS = Advanced trauma life support

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15
Q

At what GCS can patients no longer support their airways?

A

<8

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16
Q

If you cannot feel the ____ pulse, what is the estimated SBP of the patient?

a. radial
b. femoral
c. carotid

A

a. <90
b. <70
c. <50

17
Q

What is a flail chest?

A

2 + fracture in 2+ ribs

-ve pressure of breathing pulls floating rib fractures inwards –> paradoxical breathing

18
Q

What is Beck’s triad?

A

signs of Tamponade:
hypotension
raised JVP
muffled heart sounds

19
Q

What does ATMIST stand for?

A
Age
Time
Mechanism
Injury
S&amp;S
Treatment

used for efficient handover

20
Q

What is DCR?

A

Damage Control Resuscitation

aims to maintain circulating volume
control bleeding
correct lethal triad - acidosis, low temp, coagulopathy

does this by;
early blood transfusion
stop haemorrhage
restore blood volume + haematological stability

21
Q

When would you allow permissive hypotension in a trauma setting?

A

prior to damage control surgery
IV fluids may exacerbate the problem

you wouldn’t allow if GCS <8 as brian needs perfusion

22
Q

What is ROTEM?

A

rotational thromboelastometry

measures clot strength
= reaction time (formation) –> K time (fixed strength) –> alpha angle (fibrin cross-linking) –> max amplitude (overall stability) –> LY30 (amplitude @ 30 mins)

23
Q

What is tranexamic acid?

A

anti-fibrinolytic

24
Q

What is REBOA?

A

Resuscitative Endovascular Balloon Occlusion of the Aorta

used for severe haemorrhage from chest/abdo/pelvis

25
Q

What is the first thing you give to someone in anaphylactic shock?

A

IM adrenaline

26
Q

What do you do if someone is suspected of having a tension pneumothorax?

A

tube thoracostomy 5th ICS MAL

27
Q

What do you do when someone is suspected of having pericardial tamponade?

A

US-guided needle/catheter placement or emergency thoracotomy