Chapter 3 - Initial assessment Flashcards
Steps for initial assessment
- preparation and triage
- Primary survey + corresponding interventions
- re-evaluation (including TRANSFER / HIGHER LEVEL CARE)
- Secondary survey + corresponding interventions
- Re-evaluation and post reusustiation care
- Definantive care of the transfer to an appropriate traume ceter
Considerations of a patient when first entering a trauma bay
- Universal precautions
- PPE
- Hazardous exposure
Across the room observation
evaluation can allow for rapid determination of a patients overall physiologic stability
Uncontrolled hemorrhage
- IF noted during across-the-room observations would go (<C> ABC)</C>
- leading cause in combat casulty death
MARCH Mnemonic (Battlefeilds)
Haemorrhage
<M>assive hemorrhage - control with the use of tourniquets - REPLACE Blood loss @ ratios of 1:1:1 (Platelets, red blood cells and plasma)
<a>irway - establish and maintain
<R>espiration - decompress suspected tension pneumothorax and support vent. oxygen required
<C>irculation - IO / IV
<H>ead injury / hypothermia - PREVENT and treat
</H></C></R></a></M>
Airway +
Alertness, Airway and CSpine
C spine
C-spine
- considered in all multi-trauma patients
- Need CT or radiography
- Older adult with blunt trauma
HOW?
1. Manual stabilisation - two hands holding the patient’s head and neck in alignment
2. Spinal motion restriction: semi rigid cervical collar
**minimum of 2 people for inline stabilisation to remove helemt
Alertness assessment
Alert - maintain an airway and talk to you
Verbal - responds to verbal stimuli; may need an adjunct to protect the tongue from obstructing the airway
Pain - may not be able to maintain airway ; may need adjunct or may need a definitive airway
Unresponsive - airway needed. pulse vs no pulse
Assessment of the airway
Open mouth
- assessment of obstructions or potential
- jaw thrust if any issues
*if Cpsine > 2 people to complete, one for manual stabilisation and second to do the jaw thrust
INSPECT: anything loses, foreign
LISTEN: any airway sounds (indicate partial obstruction)
PALPATINE: possible bone deformity / subcutaneous emphysema
DEFINITIVE AIRWAY :
1. C02 after 5-6 breaths assess for exhaled co2
2. Observe rise and fall
3. Auscultate for the absence of gruelling and presence of bilateral breathe sounds
What situations need a definitive airway ?
- GCS >8
- serve maxilllofacial fractures
- Apena
- facial burns
- largenal , neck or tracheal hematomia
- high risk aspertation
- high risk of detertaion of neurological satus
Can’t intubate?
Do 10-15L / minute NRB
Breathing / Ventilation - INSPECT
INSPECT Spontaneous, symmetrical, A+E (looking), skin colour. looking for any continuous, abrasions or deformities that may be a sign of underlying injury.
*open pneumo - sucking chest wound
- JVD + deviation of the tracea are late signs of a tension pneumo.
Breathing / Vent: Auscultate
resp. assessment
Breathing/vent - palpate
- the integrity of boney structures
- subcutaneous emphysema (sign of a pnenumo)
- soft tissue injury
What would happen if a patient couldn’t oxygenate their body?
Hypoxemia , resulting in anerobic metabilism and acidosis.
ETCO2 - what is good and what is bad?
IDEAL 35-45 mmHg
>50 mmHg = depressed ventiltaion
Ideal ventilation
10-12 breaths per minute, (one every 5 to 6 seconds).
What is the number one priority when “looking across the room”
<C> replaces A in ABC if massive hemorrhage
</C>
What would muffled heart sounds indicate?
pericardial tamponade
Number 1 sign of pericardial tamponade
muffled heart sounds
Causes (possible) of PEA
- a penetrating wound to the heart
- pericardial tamponade
- rupture of great vessels
- intra abdominal hemorrhage
What would a rapid and thready pulse indicate? in a hemorrhage
hypovolemia
What would an irregular pulse indicate in a hemorrhage?
potential cardiac dysfunction
Volume resuscitation
Traditionally, it isotonic crystalloid.
However, raising BP in this manner can dislodge clots the body has formed and promote further bleeding. it can also lead to dilutional coagulopathy.
NOW = red blood, platelets and plasma.
- this helps to optimise delivery of oxygen, acidosis is corrected and coagulopathy is prevented.
