Approach to Trauma

Question 1

Airway

Answer 1

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*

Question 2

“Definitive airways”

Answer 2

(Intubation)

RSI for agitated patients with c-spine immobilization

ETI for comatose patients (GCS <8)

Question 3

Definitive airway appropriate for comatose patients

Answer 3

ETI - Endotracheal Intubation

Question 4

Definitive airway appropriate for agitated patients with c-spine immobilization

Answer 4

RSI - Rapid Sequence Intubation

Question 5

Findings with inspection, palpation, auscultation - Breathing

Answer 5

Deviated trachea

Crepitus

Flail Chest

Sucking chest wound” ?

Absence of breath sounds

Question 6

Flail Chest

Answer 6

Inspiration causes injured portion of chest wall to “suck in”, expiration causes it to “bulge out”

poor ventilation, depending on size of injury

Question 7

Pneumothorax

Answer 7

Identification, intervention

Question 8

What should be assumed in any hypotensive trauma patient

Answer 8

Hemorrhagic shock

Question 9

Rapid assessment of hemodynamic status

Answer 9

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)

Question 10

Circulation interventions

Answer 10

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)

Question 11

Circulation interventions

Answer 11

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)

Question 12

Abbreviated neurological exam to assess Disability (Brain and Spine)

Answer 12

Level of consciousness

Pupil size and reactivity

Motor function

GCS

• to determine severity of injury
• guide urgency of heat CT and ICP monitoring

Question 13

Disability intervention for spinal cord injury

Answer 13

High dose steroid within 8 hrs

Question 14

Disability intervention for elevated ICP

Answer 14

Elevate head of bed

Mannitol

Hyperventilation

Emergent decompression

Question 15

Exposure Interventions

Answer 15

Complete disrobing

Logroll to inspect back

Rectal temp

Warm blankets / warming devices, prevent hypothermia

Question 16

Secondary survey - 3 steps

Answer 16

Focused heat to toe exam
(similar to general exam)

Identify non-life threats

• wounds
• ortho trauma

Question 17

After primary and secondary survey - what’s next?

Answer 17

• Obvious violation of chest of abdomen = OR
• Otherwise, CT
  > Thoracic trauma (aorta, vena cava)
  > Abdominal trauma (aorta, vena cava)
  > Head trauma (epidural hematoma)

Question 18

Early screening tool for abdominal trauma

Answer 18

FAST exam (Focused Abdominal Scanning in Trauma)

via ultrasound

GOAL: EVALUATE FOR FREE FLUID

Question 19

Most commonly injured organ in blunt trauma

Answer 19

Spleen

Question 20

Injury which involves stomach, bowel, mesentary known as

Answer 20

Hollow Viscous Injury

Question 21

Symptoms of a hollow viscous injury are a result of

Answer 21

Blood loss, and peritoneal contamination

Question 22

Small bowel and colon injuries most often result from

Answer 22

Penetrating trauma

Question 23

Deceleration injuries can result in what kind of abdominal injuries

Answer 23

Bucket-handle tears of mesentery

Question 24

What should you suspect until proven otherwise when a patient presents with free fluid (in abdomen) without solid organ injury

Answer 24

hollow viscous injury

Question 25

4 views of the FAST exam

Answer 25

1. Cardiac
2. RUQ
3. LUQ
4. Subrapubic

goal: evaluate for free fluid

Question 26

General flow of trauma management in ED

Answer 26

1. Primary survey &raquo_space; immediate life saving interventions
2. Secondary Survey&raquo_space; OR, penetrating ab or chest
3. FAST&raquo_space; OR, blood on FAST
4. CT head to pelvis&raquo_space; OR w findings
5. Home or observation or nonemergent OR