C - Circulation Flashcards
What signs would you notice in Class I of haemorrhage
Tachycardia
What signs would you notice in Class II of haemorrhage
Tachycardia
Decrease in pulse pressure
Agitation
20-30 ml urinary output / hour
BE -2 -> -6
What signs would you notice in Class III of haemorrhage
Tachycardia >120
Dropped BP
Dropped GCS
Increased RR
Base deficit 6 -> 10
What signs would you notice in Class IV of haemorrhage
Tachycardia +++
Dropped BP and GCS
Very low pulse pressures
NO urinary output
BE >-10
Why does Obesity confound haemorrhage recognition
There can be extensive blood loss into tissues which would be more than in a normal BMI
What step differs in fluid resus in penetrative trauma than non-penetrative?
Delaying fluid resus or limiting it can DECREASE coagulopathy
Fluids dilute coag factors
NB: this is only a temporary measure until definitive surgical intervention
Why might an NG tube be part of management of C
can assess for GI injuries if blood in NGT
Gastric dilation causes a vagal response causing hypotension and dysarrythmia meaning inadequate response to IVF
What factors may influence the body’s response to bleeding and change the clinical presentation
old age
obesity
bblockers / NSAIDS / diuretics / insulin use
ICD
Why does insulin alter the body’s response to bleeding
- insulin enhances platelet. aggregation (Indirectly: high BMs cause platelt disfunction)
- insulin dependance means in bleed hypoglycaemia may occur
- due to glucose/potassium channels that are used in fluid balance hypoglycaemia causes disregulated fluid balance affecting bp
In terms of thoracic trauma what may happen in C
Haemothorax
Cardiac tamponade
Thoracic trauma arrest
What structures are typically injured in hemothorax
systemic of hilarious vessels
What is the management of a massive haemothorax
Decompress with chest tube and give blood immediately
Thoracotomy may be needed (immediate return on 1.5L or more of bloodier continued bleeding needing transfusion)
When is a Thoracotomy indicated in chest trauma
massive hemothorax: after chest drain if theres with large blood loss >1.5L / continued need for transfusions
OR
Penetrating injury to mediastinal box
mediatrinal box : clavicles -> medial nipple/scapula line -> costal margins/ T9
What is the usual cause of cardiac tamponade in trauma
penetrating trauma
What type of shock does cardiac tamponade cause
obstructive, decreased Flow to heart causing reduced CO
What is kussmals sign
Increase in JVP on inspiration
How do you treat cardiac tamponade
Emergancy thoracotomy / sternotomu + IVF
definitive surgical Mx then needed
Define traumatic circulatory arest
Trauma patients who are unconscious with no pulse (PEA or systole)
what is the management of traumatic circulatory arrest
closed loop CPR and Mx of A-C
ALS management
bilateral thoracostomy
definitive surgical mx or resus thoracotomy +/- pericardioscentesis
What are signs of pelvic #
scotal / perineal bruising
Blood at urethra
Limb length discrepancy
Rotational deformities
unexplained hypotension may be only sign
Should you test mechanical stability in pelvic #, why?
no
dislodges clots which can increase bleeding
which type of impact typically causes pelvic #
falls from great height
motor vehicle typically lateral / TBone
Surgical or conservative Mx?
Pelvic # haemodynamically stable
conservative
Surgical or conservative Mx?
Pelvic # haemodynamically unstable
surgical
what is the surgical management usually needed for pelvic #
angiography to stop bleed
or operative
What is the affect of thermal burns on C how does it differ from normal trauma
leakage from capillary into extravascular aspact vs traditional haeorraghe
What is the equation for adult resusitation in thermal burns
how quickly should this be given
2ml x kg x % TBSA
1/2 in first 8 hrs
1/2 in subsequent 8 hrs
What is the equation for paeds resisitation in termal burns, how does this differ is the child weighs 25 kg?
3ml x kg x %TBSA
if under 30 kg add maintenence fluids with 5% dex.
How doea hypovolaemia present differently in burns than in other causes
it thermal injuries tachycardia isnt reliable sign of fluid status
