Anaesthetics and A&E Flashcards
Initial management of acute patient
ABCDE
Airway
- Secure airway (Guedel, NP airway, LMA (i-gel), ET tube
Breathing
- Check RR
- O2, neb salbutamol/Ipratropium bromide
Circulation
- BP, HR, Cap refill, urine output
- Fluid resus, vasopressors, cathertirisation
Disability
- Do GCS, AVPU, cap glucose,
- CT, IV glucose if needed
Exposure
- Rashes, burns etc
What scoring system used to determine CT post neck injury
Canadian C spine score
Canadian C-spine indicators for Radiography
Age over 65 Dangerous mechanism Parasthesia Immediate pain, C-spine tenderness Unable to rotate 45 degrees L and R
AVPU
- What does this assess
Patient response:
Awake
to Voice
to Pain
Unresponsive
Burns:
- Who are high risk
- Initial assessment
Under 5 and over 75 yrs
ABCDE (prevent hypothermia) ± need for fluid resus
Burns rule of 9s
Head 9% Each arm 9% Torso front 18% Torsa back 18% Each leg 9%
Hand as % body surface area
1%
5 Burn thickness
1) Epidermal (superficial partial thickness)
2) Superficial dermal
3) Deep dermal
4) Full-Thickness (third degree)
5) Fourth degree
Superficial epidermal/dermal features
Pain, red, no/small blistering, brisk cap refill,
Healing 1-3 week, minimal scarring
Full thickness burn features
White/black, dry, no blistering, no cap refill, no sensation/pain
Tx: requires surgical excision and graft.
What is fourth degree burn?
Includes sub cut fat/muscle/bone.
May need Reconstruction/amputation
What is the problem with burns assessment
They are DYNAMIC. Need reassessment in 24-72hrs
Ix in burns
Bloods: Serum glucose, Crossmatch, U&E
CXR: Dysrhythmia and electrolyte disturbance
Circulation: BP may be low, monitor urine
Burn management
Stop burning (remove stimulus, chemical/clothing etc) and cool site
Minor burns - Dress, analgesia, ABX (fluclox) if infected
Major: ABC
- A: look for inhalation injury, May need ET intubation (stridor due to airway oedema in inhalation inj)
- Breathing for inhalation, CO poisoning. COHb levels
- C: Fluid loss (vasodilation = inc cap permeability)). Fluid replace 15% Body SA burns adults and 10% in children
Parkland formula for fluids in burns
4ml/kg/% body area
Hartmann’s
50% first 8 hours
50% second 16 hours
Children then also get 4/2/1 maintenance per hour
Burns when to refer
Under 5 or Over 60yrs
Site: Face, hands, perineum (risk forneirs), flexure, circumferential
Inhalaiton injury
Over 5% child under 16
Over 10% in someone over 16
Flail Chest
- Mech
- what is seen
- Assoc with
3+ ribs broken in 2 + places due to trauma and detached from rest of the chest
Paradoxical breathing - in-drawing on inspiration
Pulmonary contusions - haemothorax
Punctured lung - pneumothorax
Flail chest management
Positive pressure ventilation (note intubation may worsen tension pneumothorax)
Pain control - intercostal blocks
Reversible causes of cardiac arrest (5H’s, 4T’s)
Hypoxia Hypovolaemia Hypo/Hyperkaaemia Hypothermia H+ (acidosis)
Thrombosis (coronary/pulmonary)
Tamponade
Toxins
Tension Pneumothorax
Major haemorrhage Lethal triad (similar to what kills you in shock)
Hypothermia
Acidosis
Coagulopathy of trauma
What kills you in shock?
Hypothermia
Acidosis
Coagulopathy (e.g. DIC)
Major haemorrhage management
Stop bleeding:
- splint, pressure, haemostat agent (tranexamic acid IV), REBOA (aortic occlusion balloon)
Replace fluids lost:
- Fluids + Blood + Blood products (FFP, cryoprecipitate)
Major haemorrhage protocol:
RBC 4 units
FFP 4 units
Platelets 1 unit
GCS
- Three categories
- How many points per
Eye opening response (4)
Verbal response (5)
Motor response (6)
Max score: 15
Min score: 3
GCS - Eye opening
Spontaneously
To verbal command
To pain
None
GCS - Verbal response
Oriented Confused conversation Inappropriate words Sounds None
GCS - Motor
Obeys command Moves toward pain Withdraws from pain Spastic flexion Extensor response No motor
BUFALO
Bloods Urine (vol and culture) Fluids Abx Lactate Oxygen
Status epileptics: Drug: - No IV access - IV access - If not effective
Buccal Midaz
Lorazepam
Phenytoin
