Approach to Trauma Flashcards
Airway
Patency:
- Ask patient’s name
- Foreign bodies?
- Stridor, hoarseness, gurgling, pooled secretions or blood?
Assume C-spine injury
Supplemental O2 Suction Chin lift / jaw thrust Oral/nasal airways *Definitive airways*
“Definitive airways”
(Intubation)
RSI for agitated patients with c-spine immobilization
ETI for comatose patients (GCS <8)
Definitive airway appropriate for comatose patients
ETI - Endotracheal Intubation
Definitive airway appropriate for agitated patients with c-spine immobilization
RSI - Rapid Sequence Intubation
Findings with inspection, palpation, auscultation - Breathing
Deviated trachea
Crepitus
Flail Chest
Sucking chest wound” ?
Absence of breath sounds
Flail Chest
Inspiration causes injured portion of chest wall to “suck in”, expiration causes it to “bulge out”
poor ventilation, depending on size of injury
Pneumothorax
Identification, intervention
What should be assumed in any hypotensive trauma patient
Hemorrhagic shock
Rapid assessment of hemodynamic status
Level of consciousness
Skin color
Pulses in FOUR extremities
Mental status, cap refill at extremities both good, quick indications of perfusion
(Blood pressure and pulse pressure - once stabilized)
Circulation interventions
Cardiac Monitor
Apply pressure to external hemorrhage (tourniquet)
Establish IV access - 2 large bore or central lines
Cardiac tamponad decompression, if indicated
Volume resuscitation (IV fluids, blood)
Circulation interventions
Cardiac Monitor
Apply pressure to external hemorrhage (tourniquet)
Establish IV access - 2 large bore or central lines
Cardiac tamponad decompression, if indicated
Volume resuscitation (IV fluids, blood)
Abbreviated neurological exam to assess Disability (Brain and Spine)
Level of consciousness
Pupil size and reactivity
Motor function
GCS
- to determine severity of injury
- guide urgency of heat CT and ICP monitoring
Disability intervention for spinal cord injury
High dose steroid within 8 hrs
Disability intervention for elevated ICP
Elevate head of bed
Mannitol
Hyperventilation
Emergent decompression
Exposure Interventions
Complete disrobing
Logroll to inspect back
Rectal temp
Warm blankets / warming devices, prevent hypothermia
Secondary survey - 3 steps
Focused heat to toe exam
(similar to general exam)
Identify non-life threats
- wounds
- ortho trauma
After primary and secondary survey - what’s next?
- Obvious violation of chest of abdomen = OR
- Otherwise, CT
> Thoracic trauma (aorta, vena cava)
> Abdominal trauma (aorta, vena cava)
> Head trauma (epidural hematoma)
Early screening tool for abdominal trauma
FAST exam (Focused Abdominal Scanning in Trauma)
via ultrasound
GOAL: EVALUATE FOR FREE FLUID
Most commonly injured organ in blunt trauma
Spleen
Injury which involves stomach, bowel, mesentary known as
Hollow Viscous Injury
Symptoms of a hollow viscous injury are a result of
Blood loss, and peritoneal contamination
Small bowel and colon injuries most often result from
Penetrating trauma
Deceleration injuries can result in what kind of abdominal injuries
Bucket-handle tears of mesentery
What should you suspect until proven otherwise when a patient presents with free fluid (in abdomen) without solid organ injury
hollow viscous injury
4 views of the FAST exam
- Cardiac
- RUQ
- LUQ
- Subrapubic
goal: evaluate for free fluid
General flow of trauma management in ED
- Primary survey »_space; immediate life saving interventions
- Secondary Survey»_space; OR, penetrating ab or chest
- FAST»_space; OR, blood on FAST
- CT head to pelvis»_space; OR w findings
- Home or observation or nonemergent OR
