ADVANCED TRAUMA LIFE SUPPORT Flashcards
initial assessment and management of trauma patient
epidemiology
________ is the major cause of long term morbidity and mortality in developing nations
road traffic accidents
most trauma deaths occur immediately or in the _________ hour
1st hour
trauma systems development (LEVEL)
highest level of care, leaders in research, clinical care and education
level 1
trauma systems development (LEVEL)
provides definitive care in wide range of complex traumatic patients
Level 2
trauma systems development (LEVEL)
provides initial stabilization and treatment. may care for uncomplicated trauma patients
Level 3
trauma systems development (LEVEL)
provides initial stabilization and transfers all trauma patients for definitive care
Level 4
MECHANISM OF ENERGY
types of blunt trauma
_______ forces ( there are 3)
C-S-O
compression forces
shear forces
overpressure partial tear
BASICS OF TRAUMA ASSESSMENT
designed to identify injuries that are immediately life threatening and treat them as they are identified
Primary survey
TOPIC: AIRWAY INTERVENTIONS
Definitive airway of choice
video laryngoscopes
explanation:
visualize glottic opening using a monitor/screen
prevents movement of head and neck, specially in trauma patients
TOPIC: BREATHING AND VENTILATION
LIFE THREATENING INJURIES
most life threatening
air trapping in the pleural space between the lung and chest wall
sufficient pressure builds up and pressure to compress lungs and shift the mediastinum contralaterally
tension pneumothorax
TOPIC: BREATHING AND VENTILATION
LIFE THREATENING INJURIES
Tension Pneumothorax
_________ is definitive management
5th intercostal space, anterior axillary line
tube thoracostomy
TOPIC: BREATHING AND VENTILATION
LIFE THREATENING INJURIES
described as blood collecting in the pleural space and is common after penetrating and blunt chest trauma
Hemothorax
TOPIC: BREATHING AND VENTILATION
LIFE THREATENING INJURIES
described as blunt trauma involving area 1 inch from the Carina
Tracheobronchial Injury
TOPIC: BREATHING AND VENTILATION
LIFE THREATENING INJURIES
described as direct injury to the chest resulting in an unstable segment of the chest wall that moves separately from remainder of thoracic cage
Flail Chest
TOPIC: BREATHING AND VENTILATION
LIFE THREATENING INJURIES
described as Sucking chest wound
large defect of chest wall
Open Pneumothorax
TOPIC: BREATHING AND VENTILATION
LIFE THREATENING INJURIES
Open Pneumothorax
lifesaving procedure
midclavicular line
needle thoracostomy
TOPIC: CIRCULATION
impaired tissue perfusion
tissue oxygenation is inadequate to meet metabolic demand
blood transfusion together with early surgical intervention is key for prevention
Shock
TOPIC: CIRCULATION
Clinical signs of shock
Arterial Hypotension <____
Radial Pulse - SBP > ____
Femoral pulse - SBP >____
Carotid pulse - SBP >____
120, 90, 80, 60 RESPECTIVELY
TOPIC: CIRCULATION
TYPE OF SHOCK
Assume ________ shock in all trauma patients UNTIL proven otherwise
results from external or internal bleeding
Hemorrhagic
TOPIC: CIRCULATION
TYPE OF SHOCK
cardiac tamponade
tension pneumothorax
Obstructive
TOPIC: CIRCULATION
TYPE OF SHOCK
secondary to spinal cord injury
Neurogenic
TOPIC: CIRCULATION
SITUATIONS UNDER CIRCULATION
used in combination with damage control surgery
control hemorrhage rapidly and prevent coagulopathy by minimizing crystalloid use and transfusing early using relatively high ratios of plasma and platelets to RBCs
damage control resuscitation
TOPIC: CIRCULATION
SITUATIONS UNDER CIRCULATION
an approach that targets early fluid resuscitation onto to a SBP or greater than 70 mmHg
beneficial to patients with hemorrhagic shock due to torso injuries from gunshot or stab wounds
delayed fluid resuscitation/ controlled hypotension
TOPIC: CIRCULATION
SITUATIONS UNDER CIRCULATION
for trauma patients that is unlikely to be controlled quickly or adequately -> IMMEDIATE transfusion of blood products in 1:1:1 ratio of PRBCs, fresh frozen plasma FFP, and platelets
severe ongoing hemmorhage
TOPIC: CIRCULATION
SITUATIONS UNDER CIRCULATION
pericardium or sac around heart fills with blood due to penetrating or blunt injury to chest
MENTION BECK’S TRIAD
D, H, M
Cardiac tamponade
BECK’S TRIAD
distended jugular veins
hypotension
muffled heart sounds
TOPIC: CIRCULATION
SITUATIONS UNDER CIRCULATION
Invasive procedure must be done ultrasound-guided
puncture skin 1-2 cm inferior to xiphoid process
45/45/45 degree angle
pericardiocentesis
TOPIC: CIRCULATION
SITUATIONS UNDER CIRCULATION
CARE FOR TRAUMA PATIENT WITH CARDIAC ARREST
CPR
B
P
V
CPR
Bilateral Tube Thoracostomy
Pericardiocentesis
Volume resuscitation
TOPIC: DISABILITY
Baseline neurologic exam
described with dilated pupil - suggests transtentorial herniation on ipsilateral side
pupillary exam
TOPIC: SECONDARY SURVEY
signs
injury extends from clavicle to the pelvic area
rule out: neck, blunt chest wall, blunt abdominal and pelvic injuries
FAST ultrasound
Seatbelt sign
TOPIC: FAST EXAM
4 views of abdomen to look for fluid
R
S
L
B
RUQ/Morrison’s pouch
Sub-xiphoid
LUQ
Bladder
TOPIC: FAST EXAM
4 views of abdomen to look for fluid
Trauma ultrasound- fluid = black
most dependent portion of the abdomen during trauma
(+) blood will be between in kidney and liver
RUQ/Morrison’s pouch
TOPIC: FAST EXAM
4 views of abdomen to look for fluid
E FAST Ultrasound
done in cardiopulmonary resuscitation in non-trauma patients
Sub-xiphoid
TOPIC: FAST EXAM
4 views of abdomen to look for fluid
View between the spleen and kidney
another dependent place where fluid collects
Diaphragm can also be seen
Left Upper Quadrant
TOPIC: FAST EXAM
4 views of abdomen to look for fluid
evaluates for fluid in the pouch of douglas (posterior to bladder)
dependent potential space
Bladder view
