Approach to Trauma Flashcards
what is major trauma
- death after injury
- iss >12
- icu admission >24 hrs requiring mechanical ventilation
- urgent surgery for intracranial, intrathoracic, or intraabdominal injury
- surgery for fixation of pelvic/spinal fractures
most reported risk factor for vehicle related injuries
alcohol
leading cause of injury-related deaths
road traffic injuries
most common causes of death after trauma
traumatic brain injury
hemorrhage / exsanguination
trauma induced coagulopathy is associated with ___
- increased transfusion requirements
- risk of complications
- mortality
majority of post traumatic bleeding is __
noncoagulopathic
coagulopathic is unusual = failure to form hemostatic clot
t/f coagulopathic bleeding can be stopped with mechanical interventions
false, this is noncoag. coag involved bleeding of uninjured sites
pathway involving apc
hypoperfusion -> inc thrombomodulin activity -> inc apc -> inc coagulopathy and fibrinolysis
what is apc
- anticoagulant: inactivates factors 5a and 8a
- profibrinolytic: inhibits plasminogen activator inhibitor
- cytoprotective: activates anti-inflammatory and anti-apoptotic cell signaling pathways
what is thrombomodulin
- cofactor for protein c
- inhibits procoagulant functions of thrombin
mechanisms that lead to tic
- coagulation activation
- hyperfibrinogenolysis
- consumption coagulopathy
goal of prehospital care
initial immediate resuscitation
- airway maintenance
- control external bleeding and shock
- immobilization
- immediate transport
advanced trauma life support principles
- assess mechanism of injury
- always immobilize cervical spine
indications for definitive airway
AA8MAX OBSTRUCT90 OTHERS
- apnea
- protection from aspiration
- gcs <8
- severe maxillofacial fractures
- risk for obstruction (neck hematoma, laryngeal or tracheal injury)
- impending airway compromise (burns, inhalational injury)
- inability to maintain sp02 >90% by face mask
triangle of safety
- base of axilla
- lateral edge of latissimus dorsi
- 5th intercostal space
- lateral edge of pectoralis major
the neurovascular bundle is __ the rib
below, so incision should be above the rib
t/f chest drains are inserted in the prehospital setting
false, increases time on the scene and high risk
methods to stop bleed
- tourniquets
- pelvic binders
- hemostatic dressings
- resuscitative endovascular balloon occlusion of the aorta
- thoracotomy
t/f gcs score helps because motor score correlates to outcome
true
what is abcde (primary survey)
airway breathing circulatory disability exposure
deadly triad
acidosis, hypothermia, coagulopathy
ample history
allergies medications past medical history, pregnancy last meal environment, events leading to injury
what is “replace like for like”
- blood = blood and fresh frozen plasma (1:1:1)
- to achieve hemostasis or reduce risk of exsanguination within 24 hrs
- give calcium gluconate to prevent hypocalcemia secondary to transfusion
t/f imaging can be done if patient is not stable
false
what is fast
- focused assessment with sonography
- to detect pericardial effusion or free-flowing fluid in the abdomen
t/f giving txa early (<1 hr from injury) reduces risk of death due to bleeding
true, detrimental after 3 hrs
golden time to give txa
1-3 hrs
