ATLS Flashcards
C Spine restriction
- how would you do this
- when would you do this
Prehospital care
Assume C spine injury - Are there any neck concerns?
-Assess by asking patient if they have neeck pain, can rotate neck 45deg to either side
Restriction of C Spine
- ask someone to use 2 hands to hold head in place
- cervical collar + 2 blocks + 2 straps
- if suspecting thoracolumbar spinal injury => spinal board
Airway assessment
- what would you ask for
- what would you assess
- what would you do
Patency test
Can patient speak?
Is the Hudson mask with resevoir bag fogging up?
Not patent Basic airway maneuvres -jaw thrust, chin lift -O2 -bag valve to bridge intubation/CRP -suction fluid, forceps out FB
If jaw thrust tolerated => ANAESTHETIST! Airway adjuncts Conscious => nasopharyngeal airway -avoid in basal skull/facial fracture Unconscious => oropharyngeal airway to bridge intubation -avoid in conscious with gag reflex If tolerated => ANAESTHETIST! If OP not helping and still LOC => LMA (not definitive airway) -avoid in conscious with gag reflex Anesthetist struggling => cricothyrotomy
Ask for monitoring and assessments
- ECG, BP, RR, HR, BM, temp, SaO2
- FBC, U&E, LFT, CRP, clotting profile, ABG, Group and Match, glucose
Indications for endotracheal intubation
Inability or anticipated inability to maintain airway
-obstruction
-GCS U9
Failure or anticipated failure of ventilation or oxygenation
-acute severe asthma, COPD
High risk of deterioration
-trauma, anaphylaxis, shock
Breathing assessment
- what would you do
- what are immediately life threatening chest injuries
SaO2 => NRB 15L regardless of CO2 status
RR => bag mask if tiring
Chest - inspect for cyanosis, tracheal devation, accessory muscle use, asymmetry, expansion, percussion, auscultation
Calves
Tension pneumothorax
Open pneumothorax
Massive hemothorax
Cardiac tamponade
Management of open and tension pneumothorax -relationship between the 2 -suspicions -management
Open can progress to tension
-open => air enters PC via chest wall
Open pneumothorax
-Hyperresonance + reduced breath sounds
Mx - 3 way occlusive dressing + chest drain
Tension pneumothorax
- SOB
- Narrow BP => falls
- High HR
- Tracheal deviation is a late sign
Mx - needle decomp 5ICS antMAL + chest drain
Management of massive hemothorax
- suspicions
- management
DECREASED BREATH SOUNDS + DULL PERCUSSION
Chest drain
Management of cardiac tamponade
- suspicions
- management
High HR, low BP
Muffled heart sounds
JVP
Pericardiacocentesis
Circulation assessment
-what would you do
-what are you assessing for
-
BP, HR (radial and carotid) , CRT
Heart auscultation
2 large IV bore cannula => IO line (proximal tibia/humerus)
Ongoing hemorrhage
- Direct pressure
- neurovascular examination - DOCUMENT FINDINGS
- torniquet/BP cuff 30+ systolic
- if severe => 2222 major hemorrhage protocol, tranexemic acid
Hypotension
-250ml saline bolus
Bleeding => O-ve, group matched
Reversal of anticoagulation
-warfarin => VitK, prothrombin complex if acute
Classes of shock and management
Total blood volume - 5L 1 - 15% lost 2 - 15-30% lost => FLUID 3 - 30-40% lost => BLOOD 4 - 40%+ lost => BLOOD
Femur - 1-2L
Pelvis - 2L+
Compartments
- floor
- chest, abdo, pelvic, femur
Types of shock and ways to identify them
Hypovolemic - high HR, RR, cold, weak pulse
- hemorrhage
- D&V
- DKA
- Burns
Cardiogenic - pump failure => JVP, weak pulse, high HR, low BP, SOB
- MI
- muscle/rhythm/valve issue
Obstructive - sim to cardiogenic
- TP
- PE
- CT
Distributive
- septic, anaphylactic - fever
- neurogenic - warm peripheries, low BP, HR
