Causes & Effects of Accidents Flashcards
Statistics of Traffic Accidents:
According to WHO, what are the most common causes of death?
- 20,000 severely injured per year
- 4500 deaths per year
- Most common cause of death in under 40s
WHO
1) Dementia
2) Heart Disease
3) Accidents
Give 5 examples of road safety measures:
1) Seatbelts
2) Speed bumps
3) Speed limits
4) Speed cameras
5) Drink and drug driving regulations
Define MAJOR TRAUMA / POLYTRAUMA / MULTIPLE TRAUMA.
Give examples.
Severe injury to more than one organ system.
1) Pelvic fracture -> damaged pelvic floor (vascular structure) -> severe bleeding
2) Femoral shaft fracture -> fat embolism
- External fixation -> preferred
- Intramedullary nail -> marrow in bone distributed to lung -> small vessels in lung blocked -> problems with oxygenation
3) Tension pneumothorax AKA collapsed lung
- Air goes in but cant come out
- Heart shoved to the side of uncollapsed lung -> restricted venous return and blood out
- Patient is breathless (rapid and shallow breaths)
- Treatment: cannula in chest and chest drain
How is major trauma scored?
ISS - Injury Severity Score
1) Head and Neck
2) Face
3) Chest
4) Abdomen
5) Extremities (pelvis, skin, hands, feet, arm, leg)
6) External
- Top 3 scores are squared and added up -> higher than 15 = 10% mortality rate, thus considered as major trauma
How is major trauma managed?
How long do you have to live if airway is blocked?
ATLS - Advanced Trauma Life Support system by USA
Airway with cervical spine control
Breathing (with ventilation)
Control of haemorrhage -> stop bleeding
Disability brain protection -> maintain O2 supply to brain
Exposure -> careful w hypothermia in children and elderly
- 3 mins
What does pre-hospital care comprised of?
1) 100% oxygen to all injured patients -> prevents secondary damage to CVS and brain
- via breathing bag
2) Basic Life Support
3) Advanced Life Support (if BLS isn’t adequate)
- Endotracheal intubation / Nasotracheal intubation -> tube in trachea
- OR cricothyroidotomy -> incision in cricothyroid membrane -> tube
- OR tracheostomy -> needle in gap in 2nd tracheal ring (Seldinger technique safer than mini-tracheostomy) -> followed by cannula
4) Replace lost blood with whole blood
- crystalloid IV (Hartmans/saline solution) may worsen major trauma
What does the trimodal death distribution show? and where does it happen?
It shows when death is occurs following an accident - three peaks
1) 1st peak - seconds to minutes - at accident site
2) 2nd peak - minutes to hours - in hospital
3) 3rd peak - days to weeks - in ICU
What happens in the 1st peak of the trimodal death distribution?
1) laceration of brain
2) laceration of brainstem
3) laceration of spine
4) ruptured heart
5) ruptured major blood vessels
What happens in the 2nd peak of the trimodal death distribution? and possible management?
What happens during the golden hour?
1) Brain haemorrhages (extradural and subdural) -> remove blood ASAP
2) Tension pneumothorax (cannula and chest drain), open pneumothorax (dressing), hemathorax (drain blood, and transfusion)
3) pelvic fracture -> pelvic binders and pelvic plaster
4) Long bone fractures -> fixatures
5) abdominal injuries (ruptured liver and spleen)
GOLDEN HOUR (~20% preventable deaths) -> save life and prevent complications
1) Rapid assessment
2) Resus by ATLS
What is the physiological response to major trauma?
How is the inflammatory level, and thus the recovery state, marked?
1) Systemic inflammatory response -> releases cytokines -> makes blood vessels leaky -> can’t operate -> wait 4-5 days
2) Counter-regulatory anti-inflammatory response to balance
- IL6
What does the 2-hit theory of trauma show?
1) 1st hit - initial accident
- ARDS (acute respiratory distress syndrome)
- MODS (multiple organ dysfunction syndrome)
2) 2nd hit - surgical procedure
- ARDS
- MODS
- Recovery
SURGICAL PROCEDURE
- If fit (and no trauma triad) -> fixatures
- If unfit -> Damage Control Orthopaedics (DCO) to prolong life
What is the Trauma Triad composed of?
1) Acidosis
2) Hypothermia
3) Coagulopathy
Management of Damage Control Orthopaedics.
1) Control bleeding
- Chest -> CT scans & thoracotomy -> chest drain
- Abdomen -> CT scans, FAST scans & laparotomy
- Extremities -> long bone fractures and open wounds
- Pelvis -> pelvic binder -> angiography and embolisation -> pelvic plaster
2) Arterial repair, decompress tension pneumothorax, fasciotomy (for compartment syndrome)
3) External fixature for provisional fractures
Why can PELVIS FRACTURES be fatal?
How are they managed?
pelvis fractures -> damaged pelvic floor ->severe bleeding ->death
- bladder and bowel
- reproductive organ and prostate
- major arteries and veins
MANAGEMENT
1) Pelvic binder along greater trochanter
- bind legs
- pillow under knee to flex hips
2) Angiogram (to detect arterial bleed) -> embolisation
3) Pelvis packing
- apply double pelvic external fixators -> definitive fixation/treatment
- laparotomy
- pelvic packing
Define COMPARTMENT SYNDROME, and give an example.
How is it managed?
How is it measured?
A rise in pressure within a closed space resulting in ischaemia of components
EXAMPLE Tibia -> 4 compartments - Anterior - Deep posterior - Lateral - Superficial
Tibial fracture -> severe bleeding -> rise in pressure within compartment -> compresses and shuts down…
1) lymphatic - no clinical signs
2) small vessels to muscle - severe unremitting ischaemic pain & pain when passively stretching/ moving foot or toes
3) Nerve -> paraesthesia, numbness, paralysis
4) Major arteries -> by this time, limb is dead
MANAGEMENT
Urgent fasciotomy
MEASURED
1) intermittently - pressure meter
2) continuously - cannula inserted in compartment
