ATLS principles Flashcards
ABCDE means
airways and cervical spine protection breathing and ventilation circulation with haemorrhage control disability (glucose) exposure and environmental control
what to do for A 5 steps
assess airway stabilise neck open airway with jaw thrust clear obstructions (suction) give 100% oxygen
what to do for B 5 steps
Inspection palpate: central trachea, expansion percussion dull for blood, resonant for air auscultation obs-spo2, pulse, bp
signs of obstructed airways
hoarseness
stridor
snoring
no noise
breathing management for ATLS
high flow o2 trauma mask-50L
what is a insufficient respiratory rate
<10 breaths per minute
specific breathing injuries to be aware of for breathing 2
c2 fracture- common in hyperflexion injuries- can cause a pneumothorax
pneumothorax
3 types of pneumothorax
tension
open
closed
what is a tension pneumothorax
internal one way valve so air flowing in builds up in pleural space
signs of a tension pneumothroax 6
mediastinum shift engorged neck veins reduced lung expansion deviation trachea increased percussion decreased breath sounds
management of a tension pneumothorax and location
needle decompression in 2nd intercostal space mid clavicular
definitive chest drain
what is a open pneumothorax
sucking chest wound
external one way valve with air coming in
air pressure same as outside-tear doesnt act as a valve
management open pneumothorax
three sided occlusive dressing
what is a closed pneumothorax
air has got in and then closed
so pressure is < then the atmosphric pressure
what is flail chest
when 2 or more ribs are fractured in 2 or more places- ie complete separated
cant contribute to lung expansion
signs of flail chest
indrawing on inspiration
moving out on expiration
circulation assessment steps 3
circulatory compromise signs: pale, hr, bp, pulses
obvious sources
IV access establish x2
fluid resus components 3 and how much
fluid bolus (10-20ml/kg)-1l crystalloid
Blood products
Tranexamic acid 1gIV
3 blood products and their ratio
red blood cells
fresh frozen plasma
platelets
1;1;1
responses to fluids 3
responsive
transient: goes up/down
non-responsive
what is permissive hypotension and what bp aiming for
restrictive fluid therapy so that don’t quite reach normal BP
only to achieve radial pulse/ bp of 80-90 systolic
pelvic fracture management
pelvic binder as can lose all of circulating volume
normal blood volume l
5l
what is the definition of a massive haemothorax and the signs
> 1500ml of blood in pleural cavity
dull on percussion
respiratory compromise
large volume loss
management of a massive haemothorax
chest drain and surgery
what is cardiac tamponade
fluid in the pericardium sac
what is Beck’s triad of cardiac tamponade
hypotension: decrease SV
jugular venous distension: increase heart pressure
muffled heart sounds
management of cardiac tamponade
pericardiocentesis under ultrasound guidance
what is shock
end organ dysfunction
low blood pressure
inadequate o2 available
what organs are prone to shock 4
brain
renal
cardiac
GI
lethal triad of shock measurements
- acidosis pH <7.25, base excess <5 and lactate >2.5
- hypothermia <35
- coagulopathy platelets <120 inr >1.5
2 types of shock
haemorrhagic and non-haemorrhagic
types of haemorrhagic shock 5
intrathoracic intraperitoneal retroperitoneal thigh compartment floor
types of non-haemorrhagic shock 5
cardiogenic tension pneumothorax neurogenic- spinal cord injury and BP septic: vasodilatory anaphylaxis
class I shock measurements and management
blood loss <15% pulse <100 BP N urine <30 crystalloid replace
class II shock
blood loss 15-30% pulse 100-120 BP N urine 20-30 crystalloid replace
class III shock
blood loss 30-40% pulse 120-140 BP low urine 5-15 crystalloid and blood
class IV shock
>40 blood loss pulse >140 bp low negative urine crystalloid and blood
normal circulating volume
70mlx kg
3 GCS components
eye opening
verbal response
motor response
what is the AVPU scale
alert, verbal, pain or unresponsive
disability components
GCS or AVPU
pupils constriction
blood glucose
2 steps after abc
secondary survey- full on exam with leg roll
tertiary survey
