Chapter 1-Initial assessment and management Flashcards
The “Initial Assessment” includes the following 10 elements:
- Preparation
- Triage
- Primary Survey (ABCDEs)
- Resuscitation
- Adjuncts to primary survey and resuscitation
- Does the patient need transferring?
- Secondary survey (head-to-toe evaluation & history)
- Adjuncts to secondary survey
- Continued post-resuscitation monitoring and reevaluation
- Definitive care
What are the 2 different phases of trauma preparation?
Prehospital and hospital
What are the 4 emphases of the Pre-hospital phase?
1/ Airway maintenance 2/ Control of external bleeding and shock 3/ Immobilization of the patient. 4/ Immediate transport to the closest appropriate facility.
What information should be taken from the ambulance crew?
1/ Time of injury 2/ Events related to the injury (mechanism of injury etc.) 3/ Patient history
What course addresses prehospital care of injured patients that is similar to the ATLS course?
Prehospital Trauma Life Support (PHTLS)
What 3 things should be made made immediately accessible in the prehospital phase?
1/ Airway equipment 2/ Warmed IV Crystalloids 3/ Monitoring devices
What does the Center for Disease Control and Prevention (CDC) recommend is worn as protection and the ACS COT say is the minimum precautionary equipment?
1/Mask 2/ Eye protection 3/ Water Impervious Gown. 4/ Gloves
What is the definition of triage?
“Sorting of patients based on their needs for treatment and the resources available to provide that treatment.”
What is the definition of Multiple Casualties?
“The number of patients and the severity of their injuries do not exceed the capability of the facility to render care.”
What is the definition of “Mass Casualties?”
“The number of patients and the severity of their injuries exceed the capability of the facility and staff”
How do you act if their are multiple casualties?
First treat those with with life threatening problems and multiple-system injuries.
How do you act if there are mass casualties?
First treat the patients with the greatest chance of survival and who require the least expenditure of time, equipment, supplies and personnel.
What does A stand for?
Airway maintenance and cervical spine protection
What does B stand for?
Breathing and ventilation
What does C stand for?
Circultation and haemorrhage control
What does D stand for?
Disability: Neurological status
What does E stand for?
Exposure/Environmental control:
1/ Completely undress the patient but prevent hypothermia.
2/ Warm with IV saline
3/ Warm environment.
Describe the quick 10 second way to assess a patient?
1/ Identify yourself,
2/ Ask the patient for his or her name
3/ Ask what happened.
(An appropriate response suggests no airway compromise, breathing is not severely compromised and is alert.)
Describe the 5 specialist populations and why?
1/ Children - anatomic and physiological differences (e.g. quantity of blood, fluids, medications, rapidity of heat loss and injury pattern difference)
2/ Pregnant females - anatomic and physiological difference. Ascertain pregnancy soon in females.
3/ Older adults - poor physiological reserve and multiple co-morbidities.
4/ Obese - difficult intubation, diagnostic difficulties and poor pulmonary reserve.
5/ Athletes - normally low BP and HR.
What is included in airway management?
1/ Clearing foreign bodies & suctioning
2/ Inspection of facial, mandibular or tracheal fractures that can cause airway obstruction.
3/ Administering oxygen
4/ Securying the airway.
When can you most likely need definitve airway management?
GCS < 8 or nonpurposeful motor response.
If there is history of a traumatic event or altered level of conciousness what should be assumed & done?
Assume there is loss of stability of the cervical spine.
Protect the patient’s spinal cord with immobilization devices.
If you take off the collar what must be done?
Inline mobilization techniques should be used in order to manually stabilise the C-spine.
When assessing breathing in the primary survey what do you look for?
1/ Assess JVP
2/ Position of the trachea
3/ Chest wall excursion
4/ Auscultation
5/ Percussion.
What breathing injuries should be assessed during the primary survey?
1/ Tension pneumothorax
2/ Flail chest with pulmonary contusion
3/ Massive haemothorax
4/ Open pneumothorax
What is the main goal of inital ventilatory management?
To prevent secondary brain injury by maintaining adequate oxygenation and perfusion.
What are the 3 main circulatory issues to consider in C on your primary survey?
Is there:
- Blood volume
- Poor cardiac output
- Bleeding - Internal or external?
What are the 3 clinical elements that assist with assessing blood volume & cardiac output?
1/ Level of conciousness - cerebral perfusion can indicate low circulating volume.
2/ Skin colour
3/ Pulse - assess bilaterally. A rapid thready pulse indicates hypovolaemia. If absent central pulses then immediately resuscitate with fluid.
If someone is bleeding what do you do in the primary survey?
1/ Identify the bleed - physical, radiology or FAST
2/ Apply direct manual pressure
3/ Tourniquets for massive bleeding in limbs.
4/ Management - either chest decompression, pelvic binders, splint application, clamps or surgical intervention.
What are the 5 most common sites of internal haemorrhage?
1/ Chest
2/ Abdomen
3/ Retroperitoneum
4/ Pelvis
5/ Long Bones.
Describe the rapid neurological examination in the primary survey?
1/ Quick GCS
2/ Pupillary size and reaction
3/ Lateralizing signs
4/ Spinal cord injury level.
What can cause a reduce level of conciousness?
1/ Decreased cerebral oxygenation.
2/ Direct cerebral injury.
3/ Hypoglycaemia
4/ Drugs - alcohol, narcotics and other drugs.
What does the acronym AMPLE stand for and when should it be used?
- A- Allergies
- M- Medications currently used
- P- Past illnesses/Pregnancy
- L- Last meal
- E- Events/Environment related to the injury.
It should be used just prior to the secondary examination & can be obtained from patient, family or paramedics.
