Acute 2 Flashcards
FFP?
- All factor in low concentration
- Good in general bleeds or alcoholics
- Universal FFP donor is AB+ (opposite of normal)
Cryoprecipitate?
- Lots of factor 8 and fibrinogen
- Good for DIC
- Used in haemophilia A emergency
Prothrombin complex?
- Antiwarfarin
- Contains factors 10, 9, 7 and 2
- Give with vit K
- Also good in factor 10a inhibitors (DOACs)
What needs to be given with VWF concentrate?
Desmopressin
Platelets?
- Give to patients with thrombocytopaenia (<30) and significant bleed
- Threshold <100 when bleeding at severe sites like CNS
What is the process of warfarin reversal?
1) Stop warfarin
2) Give vit K
3) Give FFP
4) Give prothrombin complex
What is the process of warfarin reversal?
1) Stop warfarin
2) Give vit K
3) Give FFP
4) Give hum prothrombin complex
What is part of the primary survey in trauma?
- A-E as normal
- FAST scan
- CT polytrauma within 30mins
What are the signs of a BSF?
- Panda eyes
- Battle’s sign
- CSF rhinorrhoea (suggests cribriform fracture) or otorrhoea
- Retinal haemorrhage
- Haemotympanum
- Facial nerve palsy
What is in an AMPLE history?
- Allergiess
- Medications
- PMH and pregnancy
- Last meal
- Events of trauma
What is the most commonly injured organ in blunt injury?
Spleen
What is the most commonly injured organ in GSW?
Small intestine
What is the most commonly injured organ in children?
Kidneys
What can be done in raised ICP in acute setting?
- Give mannitol (osmotic diuretic)
- Controlled hyperventialtion
What are some acute life threatening MSK disorders?
- Long bone fracture
- Arterial haemorrhage
- Traumatic amputation
- Crush injury (rhabdomyolysis)
What are some cute limb threatening injuries?
- Complex open fracture
- Degloving
- Severe vascular injury
What are the lethal 6?
- Airway obstruction
- Cardiac tamponade
- Tension pneumothorax
- Open pneumothorax
- Massive haemothorax
- Flail chest
What are the hidden 6?
- Aortic injury
- Tracheobronchial injury
- Oesophageal injury
- Pulmonary contusion
- Cardiac contusion
- Diaphragmatic hernia
If airway can’t be secured what should you do?
Cricothyroidotomy
What is Beck’s triad of cardiac tamponade?
- Raised JVP
- Hypotension
- Muffled heart sounds
- (also pulsus paradoxus)
What is the investigation for cardiac tamponade?
- FAST scan usually
- Echo is gold standard
What are some signs of cardiac tamponade?
- Electrical alternans on ECG
- Absent Y descent in JVP
Management of tamponade in peri-arrests?
Thoracotomy or pericardiocentesis
Management of tension pneumothorax?
1) 2 wide bore cannulae in 2nd IC space mid-clavicular line
2) Insert chest drain in triangle of safety (4-6 IC space, lateral edge of lat dorsi and pec major)
Management of open pneumothorax?
1) High flow oxygen and dressing with one side open
2) Chest drain
How does massive haemothorax present compared to tension pneumothorax?
Presents the same except:
- Hypovolaemic
- Collapsed neck veins (distended in tension)
- Dull percussion (hyperreasonant in tension)
- White on CXR (black in tension)
When does a haemothorax become massive?
When a third of blood volume is lost (approx 1500ml)
Management of massive haemothorax?
- Restore circulating volume before inserting drain (will cause CV collapse)
- Insert chest drain (can dislodge a clot)
- Thoracotomy if V large (>1500ml comes from chest drain) or a clot
What are the complications of flail chest?
- Pulmonary contusion (mainly)
- Can cause pneumo- or haemothorax
Management of flail chest?
- Good pain management
- Pain worsens respirations which worsens the problem
How does aortic injury occur?
Shearing forces from blunt deceleration (e.g. RTA/fall)
How does aortic injury present?
Similar to dissection
What are the 2 main imaging modalities for aortic injury?
- Contrast enhanced CT is best
- X-ray
What will an X-ray show in aortic injury?
- Widened mediastinum
- Loss of aortic knuckle
- Filling of AP window
- Elevated right main bronchus and depressed left one
- Tracheal deviation
What is the management of aortic injury?
- Surgical graft repair
- Permissive hypotension
What are the signs of a tracheobronchial injury?
- Hoarse voice
- Haemoptysis
- Surgical emphysema in neck, chest wall and mediastinum
How is tracheobronchial injury diagnosed?
Bronchoscopy
Management of tracheobronchial injury?
- Airway protection
- Surgical repair
When should you consider cardiac contusion?
In sternal fracture (heart compression)
What are the signs of cardiac contusion?
Tissue behaves like infarcted tissue:
- ST elevation
- Raised troponin
- Same complications ass MI
What will a chest X-ray show in pulmonary contusion?
Serial CXR shows increased patchy consolidation
Management of pulmonary contusion?
Supportive
What does chest X-ray show in diaphragmatic tear?
Loops of bowel in chest or gastric bubble in thorax
Management of diaphragmatic tear?
Surgical repair and gastric tube
Signs of ARDS?
- Rapid onset severe hypoxia
- Think with unexplained tachycardia and hypoxemia post trauma
Causes of ARDS?
- 48 hours post trauma especially chest (pulm contusion 50% get this)
- Sepsis (main cause)
- Other - pneumonia, aspiration, pancreatitis, fat embolism, inhalation, transfusion and covid
Management of ARDS?
- ICU -> ventilation -> PEEP
- Proning
- Negative fluid balance - diuretics and fluid restriction
- Reduce pulm pressure -> Nitrous oxide and prostacyclins
