Assessment of trauma patients (Sources: OH's, SOPs, Revision notes) Flashcards
What are the common causes of depressed conscious level in trauma patients?
Brain injury Hypoxia Shock Alcohol or other drugs Precipitating neurological or cardiovascular events
What are the common causes of breathing difficulties in a trauma patient?
Lung or chest wall injury
Airway obstruction
Laryngeal injury
Pulmonary aspiration
Describe the Injury Severity Scale
Gives a score between 0 and 75
Based on the AIS grades for the 3 worst body regions
16 or more indicates major trauma
Add the top 3 scores, each squared first
If a 6 is reached in an AIS then a 75 is automatically achieved
Death with an ISS < 24 should be rare
Very high mortality rates occur with an ISS > 50
What is the Abbreviated Injury Scale?
Measure of injury severity
AIS divide the body up into 6 regions
- the head and neck, face, thorax, abdomen, pelvis and extremities, and external
Specific injuries in each body region are coded on a scale of 1 (minor), 2 (moderate), 3 (serious, not life-threatening), 4 (severe, life-threatening), 5 (critical, survival uncertain), and 6 (unsurvivable)
What are the causes of traumatic cardiac arrest?
Hypoxic - airway obstruction, high spinal cord injury
Obstructive - tension pneumothorax, cardiac tamponade
Hypovolaemic - internal or external haemorrhage
Neurogenic - catastrophic head injury
A medical arrest precipitating a traumatic event. E.G a cardiac arrythmia causing an MVA
How should you manage a traumatic cardiac arrest?
Managing a traumatic cardiac arrest is different from managing a medical arrest with a standard ALS approach.
Cause of cardiac arrest needs to be considered and all possible reversible causes should be addressed.
Chest compressions should be stopped as needed to allow these interventions to be done.
1. Airway - ensure a patent airway, clear any obstruction, BVM with 15L oxygen, intubate
2. Breathing - bilateral finger thorcacostomies (may need to do needle decompressions during intubation depending on skill mix)
C - Control haemorrhage, IV/IO access, pelvic binder, femoral splints, direct pressure on bleeding points, thoracotomy if indicated (penetrating epigastric/chest injury and cardiac arrest < 10 mins), fluid bolus or blood if available
Discuss the role of CPR in trauma patients?
Controversial
CPR is no value if there’s an empty heart or tamponade and may do harm if there’s chest injuries. Should be ceased to allow other interventions to be done as needed
CPR should recommence once the other actions are complete
If the trauma has occurred due to a medical event then routine ALS, following the standard protocol should occur in these patients
What ISS is consistent with major trauma?
> 15
What is the purpose of a primary survey in trauma patients?
Identify and address immediately life-threatening injuries
Describe the secondary survey?
A systematic head-to toe examination of the whole body to identify injuries missed in the primary survey Should involve examining the back, buttocks and extremities History should include Allergies Medications Past medical history Last ate and drank Events surrounding the injury
What is a tertiary survey?
Repetition of the primary and secondary surveys over the following days in conjunction with imaging
Minimizes risk of a missed injury
What is damage controlled resuscitation?
A concept of acute trauma care consisting of
- permissive (therapeutic) hypotension
- haemostatic resuscitation
- damage-control surgery
What is permissive hypotension?
The targeting of a lower thann normal BP to avoid clot disruption in trauma patients
Shown to reduce mortaility in urban, young males with penetrating trauma
It’s wider applicability is unclear
What leads to the coagulopathy of trauma?
Multifactorial
- loss of clotting factors
- dilution of clotting factors
- activation of fibrinolysis by tissue injury
- shock-related acidosis
- hypothermia
Describe damage control surgery
Where trauma is associated with significant matabolic derrangement surgery is limited to life-saving procedures prior to transfer to ICU to restore physiology, after which the patient can return to theatre in the following days.
