Abdominal Trauma Flashcards
What are the principles of surgical treatment for a patient that presents in A&E?
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
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. 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
How do you assess a patient who experienced blunt trauma but is haemodynamically stable?
Focussed Assessment with Sonography for Trauma (FAST) - eFAST = extended
or
CT to assess fluid and organ injury
How do you assess a patient who experienced blunt trauma but is haemodynamically unstable?
find the site that’s bleeding
IV fluids, blood transfusion, catheter
XR to check chest, abdomen, and pelvis for haemothorax or pelvic fracture
How do you assess a patient who experienced penetrating trauma?
local wound exploration to evaluate for perforation of abdominal wall fascia
if peritonitis + haemodynamically unstable –> immediate laparotomy
needs thorough exploration
prophylactic abx
What are the primary and secondary surveys?
Primary:
ABCD
Secondary
DE + Radiographs + CT
AMPLE
Describe the triage sieve
Priority 1 = immediate life-saving intervention required
P2 = significant intervention required within 2-4hrs
P3 = needs treatment but can safely be delayed
P4 = dead
What is the surgical sieve?
Vascular Infective/inflammatory Trauma Autoimmune Metabolic Iatrogenic Neoplastic
Congenital
Degenerative
Endocrine/environmental
Functional
Which analgesia would you give for ____ pain?
a. mild (1-3/10)
b. moderate (4-6/10)
c. severe (7-10/10)
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
Describe the mechanism that results in blunt trauma
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
How do explosions cause trauma?
blastwave = increased air pressure
suction = decreased air pressure
these forces damage your organs
What is abdominal compartment syndrome?
= 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
How do you correct abdominal compartment syndrome?
decrease intra-abdominal pressure by: evacuation of its contents fluid balance correct body position adequate analgesia neuromuscular blockade in some cases
What is AMPLE and ATLS?
AMPLE = Allergy Medications Past pertinent history Last meal Events leading up to the injury
ATLS = Advanced trauma life support
At what GCS can patients no longer support their airways?
<8
If you cannot feel the ____ pulse, what is the estimated SBP of the patient?
a. radial
b. femoral
c. carotid
a. <90
b. <70
c. <50
What is a flail chest?
2 + fracture in 2+ ribs
-ve pressure of breathing pulls floating rib fractures inwards –> paradoxical breathing
What is Beck’s triad?
signs of Tamponade:
hypotension
raised JVP
muffled heart sounds
What does ATMIST stand for?
Age Time Mechanism Injury S&S Treatment
used for efficient handover
What is DCR?
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
When would you allow permissive hypotension in a trauma setting?
prior to damage control surgery
IV fluids may exacerbate the problem
you wouldn’t allow if GCS <8 as brian needs perfusion
What is ROTEM?
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)
What is tranexamic acid?
anti-fibrinolytic
What is REBOA?
Resuscitative Endovascular Balloon Occlusion of the Aorta
used for severe haemorrhage from chest/abdo/pelvis
What is the first thing you give to someone in anaphylactic shock?
IM adrenaline
What do you do if someone is suspected of having a tension pneumothorax?
tube thoracostomy 5th ICS MAL
What do you do when someone is suspected of having pericardial tamponade?
US-guided needle/catheter placement or emergency thoracotomy
