CBD 4: Trauma Flashcards
Head injury.
a) Primary injury
b) Secondary injury
a) Coup
b) Contre-coup
Primary survey
Catastrophic bleeding control
Airway and c-spine control
Breathing
Circulation
https://patient.info/doctor/trauma-assessment#nav-0
Secondary survey
Head-toe injuries (non-life-threatening)
Imaging in trauma
Whole-body CT - gold standard (head, c-spine, chest, abdomen, pelvis, +/- limbs)
FAST (focused assessment with sonography for trauma)
Blood replacement
a) Quickest
b) If less urgent
a) O negative blood
b) Crossmatch
Haemothorax
a) Massive - define
a) Blood loss > 1.5 L or one-third of the blood volume, requiring a thoracotomy
Pneumothorax
a) Simple
b) Tension
c) Signs of a tension pneumothorax
a) No mediastinal deviation or compensation; usually resolve spontaneously
b) Accumulation of air in the pleural space under pressure under the creation of a one-way valve, compressing the lungs and decreasing venous return to the heart (hence reducing stroke volume; note: initially you can compensate with a tachycardia)
c) Tracheal deviation to contralateral side, apex beat displacement, ipsilateral reduced air entry, reduced chest expansion and hyper-resonance to percussion
Management of a tension pneumothorax
a) Initial
b) Then
a) Mid-clavicular line, 2nd ICS, above the rib (because below the rib is the neurovascular bundle)
b) Insertion of a chest drain - location?
Life-threatening chest injuries
- ATOM FC
- Aortic disruption/airway disruption
- Tension pneumothorax
- Open pneumothorax (wound penetrating thoracic cavity)
- Massive haemothorax
- Flail segment (2+ consecutive ribs on same side fractured in 2+ places, so not moving with ventilation)
- Cardiac tamponade
What is meant by permissive (balanced) resuscitation?
Should you fluid resuscitate?
- Should give low-volume resuscitation to maintain his BP below the usual level but enough to perfuse vital organs
- This prevents disruption of clotting in patients with active bleeding
Whole body CT
a) Indications
b) If indicated, should be performed within what period of time after arrival to resus?
a) - Abnormal observations
- Unable to properly assess clinical outcome (e.g. due to reduced GCS)
- Suspected spinal injury with sensory level
b) 30 mins
Femoral shaft fracture
a) Local anaesthetic
b) Splint
a) Femoral nerve block (lateral to femoral artery - NAVY VAN)
b) Thomas splint
John Thomas sign
Positive: penis pointing towards the hip fracture
Negative: penis pointing away from the hip fracture
Flail chest.
a) Define
b) Features
a) Fractures of 2 or more contiguous ribs in 2 or more locations, causing the creation of a ‘free segment’ in the thoracic cage.
b) Paradoxical chest wall movements, impaired ventilation, hypoxia
Head injury - who to CT
https://cks.nice.org.uk/head-injury#!scenario
