Basics of Trauma Flashcards
What is the Initial Assessment
A
B
C
D
E
steps?
Initial Assessment
- for any trauma call or any call really for that matter that enters the ER this is the way in which you approach the situation
- you MUST complete, intervene if nessecary and stabilze one layer before moving to the next
- always call out your postive and negative findings to the room as you go
A: Airway
- probable need to intubate
B: Breathing
- breathsounds?
C: Circulation
- bleeding? fluids?
D: Disability
- GCS sclae
E: Exposure
- trauam naked to assess the body
Airway
Breathing
AIRWAY
- assess patency of the airway (within the C-collar precautions)
- is the patient talking? = probably in tact airway
- any obstruction (FB, fracture, etc.) ?
- GCS < 8 = intubate
in C spine collar = dont tilt head back to intubate
secure?
- secure placement with ET tube, confirm by auscultating, looking at ETCO2 measures on the device (end tidal Co2) to see if the ventilation is working
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BREATHING
- a secure airway does not mean they are accurately ventilating
- think about the lungs here: the biggest concern is a PTX or hemothorax
Assess
- expose neck and chest
- examine for tracheal deviation
- listen for breath sounds BILATERALLY
Address
- tension pneumothorax: absent breath sounds unilaterally, dyspnea & hypotension with trachial deviation = emergent needle decompression &/or chest tube (needle decomp. in the 4th-5th midaxiallry line)
- massive hemothorax: absent breath sounds, hypotension = chest tube placement with auto transfusion (give the blood back to them)
Circulation
CIRCULATION
- think about the blood volume, hemorrhage and cardiac output, where is the bleed and how to correct it
- once the tension pneumo is excluded or corrected & the hypotension remains = think about a bleed
Address
- Level of Consciousness = amont of cerebral perfusion
assess distal pulses in all extremities
- lack a pulse? problem probably in that limb (a SBP of 90-100 will have pulses, anything lower you probabl wont feel)
see the bleed?
- try to stop it via tournequet or quick suture close (especially the scalp)
give blood products:
- 1- 1.5 L of LR bolus THEN swap to blood products
if pt. remains hypotensive despite control of external bleeding = think about internal bleeds
Internal Bleeding
- FAST Exam: to see interal bleeding from US
- pelvic xray: to see for internal bleeds
unstable and postive FAST? = to the OR
open book pelvic fracture = pelvic binder
D: Disability (Neurologic Evaulation)
Disability: do the GCS assessment
GCS: never 0!
minor = 13-15
moderate = 9-12
severe = 3-8
less than 8 = intubate
GCS
- Eye Opening Response
- Verbal Response
- Motor Response
if the GCS Score is low… consider why
- head trauma?
- hypovolemia/shock
- hypoglycemic
- durs/alcohol?
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Pupils
- equal? reactive? Size? pinpoint or dialted?
Motor/Sensation
- evaluate for SCI
- sensation? can they move all exteremities
- purposeful = crosses midline
- docorticate ( towards core-chest)
- decerebrate (away from chest)
E: Exposure
EXPOSURE
- trauam naked: remove clothing
Need to assess entire body = role pt. on their side to examine back (while keeping them in spinal precautions on the board)
- evaule back via roll
- lift arms to evaluate axilla
- spread legs to see perineum
- palpate spine
cover with blankets!!
also take this time toe valute environemtn expousre (frosbite and burns
Trauma Codes
Traumatic Cardiac Arrest
Thoracotomy (Open Chest)
Traumatic Cardaic Arrest
- B/L chest tubes
- central line
- CPR
- H/Ts for most common cuases of teh cardiac arrest
Thoracotomy
- clam-shell opening to identify vascualture and cariadac injury
- allow for cardiac massage
cardaic arrest?
CPR
B/L chest tubes
thoracotomy
Secondary Survey
Secondary Survery
- done after the ABCDE’s to get a better idea and more through impression of the pt.
- go in a head to toe fashion to indetify other injuries that need attention
- also helps idenitfy possible mechanism of injuries
Skull
- basialr skull fx? depression? fractures? lacerations?
Face
- palpate face for facical fx. and stabbility
Eyes
- globe rupture?
- increase IOP?
Ears
- hemotympanum? sigsn of internal head injury
- lacerations
Nose
- blood?
- septal deviation?
- singed nasal hairs? smoke
Mouth
- teeth? missing?
- intraoral lacterations
Neck
- open wounds
- seatbelt sing: bursing of upper neck
Secondary Survery (from the neck) pt. 2
Chest
- rib tenderness or deformity
- penitrating wounds
Abdomen
- soft and nontender?
- penitration?
Pevlis
- stable?
- rectal tone? can be done if youre nevous about SCI
- blood in orifices?
Flank (back)
- assess for ecchymosis (can be done on initial role)
Back (during long roll)
- midline tenderness or stepoffs
Arms and Legs
- pulses? recheck
- deformities
- open fractures
- tissue injuries
- sensation/strength
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Intervention
- reduce any fractures if NV compromised
- ABI cna be done to determine vascular injuries
- immobilze unstable fractures
- pressure dress teh wounds
e-FAST Exam
indications
locations
Indications
- blunt trauma
- unstable penitrating trauma
- good for kids/pregnant
US basics
- fluid = dark
- fat = bright
- bone = brightest
negative fast doesnt rule out intra-abdominal injury
Stable? can do all locations than intervene
unstable if find a postive finding at a location; intervene
Locations
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Cardiac
- get 4 chamber window
- subxyphoid or parasternal views
- look for pericardial effusion
RUQ
- fluid between liver and kidney
LUQ
- fluid between spleen and kidney
Pelvis
- fluid in plevis
- identify bladder
Lung
- midclavicualr line 2/3 intercostal
- look for lung sliding = the waves on a beach
- if barecode (no slidng) = PTX
TBI: in trauma assessment
things to remember
Monroe-Kellie Doctrine
Severity
severity: classified by the GCS scale
remeber: severity does not always correlate with size of hemorrhage
- older people: more atrophy: more room for the brain to get thrown around and swell before we know its happening
Monroe-Kellie Doctrine
- total volume of intracrainal contents has to saty constnat – so somehting has to give/decrease in order to keep same amount there
Subdural Hematoma
Subdural - below the dura
- collection between dura and arachnoid
- bleeding from bridging vessels = CRESCENT shape
- underlying brain damange more severe than EDH because injury to parynchma high
CT
Epidural Hematoma
Epidural = above the dura
- between dura and skull
- MMA is most common artery to bleed but can be venous, venous sinus too
- football shape on imaging
- pt. will have classic LOC, leucid interval then steep decline
- often temporal lobe
CT
Subarachnoid Hemorrhage
- between arachnoid and pia mater
- bleeding can be traumatic (see on the edges) or atramatic (anyuresym rupture, middle MC)
CT
Intraparenchymal hemorrhage
think about this as a bruise
- a contusion of the brain tissue: frontal or temportal MC
- blossom over time: like can continue to bruise = follow up imaging!!!
CT head continuously to monitor
Diffuse Axonal Injury
- high velocity impact, acceleration/decelleration injury
- see multiple punctate hemorrages on the boarder of the grey and white matter
- DAI = stretched axons; not torn
Symptoms
- severe = unconsciousness
- less severe = on imaging you can see mild areas which are less severe punctates
Dx. MRI
