Approach to Trauma Patient Flashcards
What is the number 1 cause of death in age group 1-44
what is the mortality most commonly associated iwth
Trauma
head injury, chest injury, major vascular injury
What is Trimodal death distribution
Immediate (seconds to min)
Early (minutes to hours)
Late (days to weeks)
What is “golden hour”
early (minutes to hours) death distribution
Focus: control bleeding, supportive care, sugical management
What is the primary survey
ATLS approach (ABCs)
Airway assessment/protection
Breathing and ventilation
Circulation assessement
Disability assessment (neuro)
Exposure and environment (keep warm while getting them naked)
What is the most common cause of preventable death
Hemorrhage
What are the NEXUS C-spine rules
Focal deficit?
midline tenderness?
AMS?
Intoxicated?
Distractiong injury?
What areas should you look for significant blood loss
chest
abdomen
pelvis
long bone
floor
What is a trauma Neuro assessment
Eye opening
best verbal response
best verbal response
best motor response
Head injury
pupils
sensation
posturing
seizures
What is SAMPLE
S: signs and symptoms
A: Allergies
M: Medications
P: Past medical history
L: Last oral intake
E: events surrounding trauma
What is included on a secondary assessment
typically head to toe assessment
will often include CXR and pelvic XR
E-fast exam
what is the massive transfusion protocol
> 10 units of pRBCs in 24 hrs following trauma
What are risks of transfusion
infection
allergic rxn
immunologic rxn
volume overload
hyperkalemia
iron overload
when should a CT be obtained with head trauma
ASAP
what are keys with bleeding head traumas
reverse anticoagulation
call neurosurgery
BP management (target SBP <180)
if blown pupil/unresponsive - burr hole
What are signs of elevated ICP
Decorticate posturing
Decerebrate posturing
What are the H-bombs
hypotension
hypoxia
hypo/hypercarbia
hyepr/hypothermia
hypoglycemia
What is neurogenic shock
distributive shock wiht hypotension, bradycardia, warm/flushed skin, good pulses.
seen with injury above T6
What is a complete spinal injury
traumatic disruption of the entire cord
- insensatie, areflexic and immobile distal to site of injury
What is incomplete spinal cord injury
only a section of the cord has been injured
- includes the cord syndrome
- may not only be associated with trauma but also malignancy or other compressive pathology
What can you not miss with chest trauma
airway obstruction
tension pneumothorax
cardiac tamponade
vascular injury
what is the significance of a simple pneumothorax
progression to tension pneumothroax
will need decompression
what is the significance of aortic dissection
exsanguination
disruption of blood flow
need surgical repair
what is the significance of diaphragm rupture
herniated abdominal contents into chest->
decrease lung volumes
what is the significance of myocardial contusion
decreased CO
risk of arrhythmia
what is the significance of pulmonary contusions
increased ventilatory pressures
decreased VQ
What is the workup for thoracic trauma
ABC, IV/O2/Monitor
E-fast
CXR
ECG
CT scan (consider CTA)
if pt worsens with PPV, reeassess (think pneumo)
what is the gold standard imaging for abdomen and pelvic traumas
CT scan (if stable) with contrast
what is the most common abodmen and pelvic trauma
blunt injury
what is the E-fast exam
Right and left anterior chest: penumothorax
RUQ/LUQ: peritoneal FF, pleaural FF
Subxiophoid/PSL: pericardial effusion
Suprapubic: peritoneal FF
What injuries are at HIGH RISK for life-threatening hemorrhage
Pelvic fractures
What is included in the initial assessment of open pelvic fractures
perindeal exam
vaginal exam in females
DRE
bleeding at the urethreal meatus
When should thoractomy be considered with a penetrating trauma
penetrating wound with arrest
