Chapter 1 - Initial Assessment and Management Flashcards
What are multiple casualties
Number of patients and their injuries do not exceed the capabilities of the facility
What are mass casualties
Number of patients and the severity of their injuries does exceed the capability of the facility
What happens during the primary survey
life-threatening conditions are identified and treated in prioritised sequence - ABCDE
How to you assess the airway
- clearing the airway
- suctioning
- administering oxygen
- securing the airway
When airway management is required, how do we protect the c-spine
The cervical collar is opened and team member manually restricts movement of c-spine
What immediate steps should be taken when a tension pneumothorax is suspected
chest decompression - as tension pneumothroax acutely and dramatically compromises ventilation and circulation.
what should every injured patient receive
supplemental oxygen
Are there any risks associated with intubating someone who has a simple pneumothorax
simple pneumothroax can covert to tension pneumothorax when intubated and positive pressure ventilation started if we have not already decompressed the pneumothroax with a chest tube
Main cause of preventable deaths after injury
haemorrhage
3 elements of clinical observation that help assess haemodynamic status
- level of conciousness. critical impairment of cerebral perfusion
- skin perfusion
- pulse
how do we manage rapid external blood loss
direct manual pressure on the wound. Tourniquets useful in massive exanguination
major areas of internal haemorrhage
- chest
- abdomen
- retroperitoneum
- pelvis
- long bones
How would you prepare for a patients arrival
Prepare equipment necessary to support ABC evaluation.
Oxygen and suction available and checked.
Warm IV fluids.
Aware of institutions capabilities and what to do if needs exceeds
What information is helpful to know before patients arrival into ED
Vital signs including GCS
What interventions have been performed
Time of arrival
What is the emphasis during the prehospital phase
Airway maintenance, control of external bleeding and shock, immobilisation of the patient and immediate transfer
What are critical aspects of the hospital preparation
Resuscitation are for trauma patients
Airway equipment
Warmed IV crystalloids
Protocol to summon additional assistance, prompt radiology and labs
Transfer agreements with major trauma centres
What are important communications from the prehospital team
Time of injury
Events related to the injury
Patient history and vital signs
Mechanism of injury
What are standard precaution devices
Face mask
Eye protection
Water impervious gown
Gloves
What adjuncts are used during the primary survey
ECG - continuous Pulse oximetry CO2 Ventilation rate assessment ABG Urine output NG Lactate, X-ray, FAST scan,
What condition is associated with the following dysrhythmias
Tachycardia, AF, premature ventricular contractions, ST changes
Blunt cardiac injury
What condition is associated with the following dysrhythmias
PEa
Cardiac tamponade
Tension pneumothorax
Profound hypovolaemia
What condition is associated with the following dysrhythmias
Bradycardia, aberrant conduction, premature beats
Hypoxia
Hypothermia
What is the goal of the primary surgery
To identify and treat life threatening injuries in a prioritised sequence based on the effects of the injuryies of the patient physiology, because st first it may not be pooible to identify specific anatomical injuries
How can you manage equipment failure
Test regularly and keep spare equipment and batteries
How can you manage unsuccessful intubation
Identify patients with difficult anatomy
Identify your most skilled airway manager
Ensure adequate equipment is available to rescue the failed airways attempt
Be prepared to perform a surgical airway
How do you manage progressive airway loss
Recognise the dynamic status of the airway
Recognise the injuries that can result in progressive airway loss
Frequently reassess the patient for signs of deterioration of the airway
Which patient populations warrant special considerations
Children, pregnant women, older adults, obese patients and athletes
When do we begin the secondary survey
The secondary survey starts once the primary survey is finished, resuscitative efforts are underway and vital signs improvements are seen
What is the secondary survey
A head to toe assessment of the patient
Full history and physical examination including reassessment of all vital signs
What pneumonic can we use to take a history.
AMPLE Allergies Medications Past illnesses / pregnancy Last meal Events / environment related to the injury
What are the two broad categories of injuries
Blunt trauma
Penetrating trauma
What is the sequence of the physical examination during the secondary survey
Head Max fax structures C spine and neck Chest Abdomen and pelvis Perineum, vagina, rectum Musculoskeletal system Neurological examination
What is particularly important to examine during head assessment in secondary survey
The eyes - oedema can develop later
Visual acuity, pupil size, haemorrhage of conjunctiva or fundi, penetrating injury, contact lenses, lens dislocation, ocular entrapment
What should examination of the face include
Palpating of all bony structures, assessment of occlusion, intraoral examination and soft tissue assessment
What is the acronym for handover
MIST Mechanism and time of injury Injuries found and suspected Symptoms and signs Treatment initiated
What does pulse oximetry measure
The saturation of oxygen.
It can be confounded by carboxyhaemoglobin and so should be used with caution in patients with inhalation injuries
How can we make the pulse oximetry readings more accurate
Place it above the BP cuff
Confirm with ABG findings
What X-rays are used during primary survey
ONLY chest and pelvis X-rays
What specialised diagnostic tests can be performed during the secondary survey to identify specific injuries
X-ray of spine and extremities CT scans Contrast URL graphs and angiography TOE, trans oesophageal ultrasound Bronchoscopy OGD
how can we help reduce facial odedema
minimise it by elevation of the head to trendelenburg position
where do we auscletat on the chest and what for
high at apex for pneumothorax and at the bases for haemothorax
how do we prevent large blood loss in pelvic fractures
place a pelvic binder and do not repeatedly or vigorously manipulate the pelvis
