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TNCC > Chapter 3 - Initial assessment > Flashcards

Chapter 3 - Initial assessment Flashcards

1
Q

Steps for initial assessment

A
  1. preparation and triage
  2. Primary survey + corresponding interventions
  3. re-evaluation (including TRANSFER / HIGHER LEVEL CARE)
  4. Secondary survey + corresponding interventions
  5. Re-evaluation and post reusustiation care
  6. Definantive care of the transfer to an appropriate traume ceter
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2
Q

Considerations of a patient when first entering a trauma bay

A
  • Universal precautions
  • PPE
  • Hazardous exposure
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3
Q

Across the room observation

A

evaluation can allow for rapid determination of a patients overall physiologic stability

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4
Q

Uncontrolled hemorrhage

A
  • IF noted during across-the-room observations would go (<C> ABC)</C>
  • leading cause in combat casulty death
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5
Q

MARCH Mnemonic (Battlefeilds)

Haemorrhage

A

<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>

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6
Q

Airway +

A

Alertness, Airway and CSpine

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7
Q

C spine

A

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

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8
Q

Alertness assessment

A

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

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9
Q

Assessment of the airway

A

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

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10
Q

What situations need a definitive airway ?

A
  • GCS >8
  • serve maxilllofacial fractures
  • Apena
  • facial burns
  • largenal , neck or tracheal hematomia
  • high risk aspertation
  • high risk of detertaion of neurological satus
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11
Q

Can’t intubate?

A

Do 10-15L / minute NRB

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12
Q

Breathing / Ventilation - INSPECT

A

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.
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13
Q

Breathing / Vent: Auscultate

A

resp. assessment

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14
Q

Breathing/vent - palpate

A
  • the integrity of boney structures
  • subcutaneous emphysema (sign of a pnenumo)
  • soft tissue injury
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15
Q

What would happen if a patient couldn’t oxygenate their body?

A

Hypoxemia , resulting in anerobic metabilism and acidosis.

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16
Q

ETCO2 - what is good and what is bad?

A

IDEAL 35-45 mmHg
>50 mmHg = depressed ventiltaion

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17
Q

Ideal ventilation

A

10-12 breaths per minute, (one every 5 to 6 seconds).

18
Q

What is the number one priority when “looking across the room”

A

<C> replaces A in ABC if massive hemorrhage
</C>

19
Q

What would muffled heart sounds indicate?

A

pericardial tamponade

20
Q

Number 1 sign of pericardial tamponade

A

muffled heart sounds

21
Q

Causes (possible) of PEA

A
  • a penetrating wound to the heart
  • pericardial tamponade
  • rupture of great vessels
  • intra abdominal hemorrhage
22
Q

What would a rapid and thready pulse indicate? in a hemorrhage

A

hypovolemia

23
Q

What would an irregular pulse indicate in a hemorrhage?

A

potential cardiac dysfunction

24
Q

Volume resuscitation

A

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.
25
Q

Disability

A

CT
ABC
BGL
Toxicology

26
Q

Exposure

A

cut the clothes

  • hypothermia, hypotension and acidosis are a potentially lethal combination in the injured patient.
  • need to prevent heat loss
27
Q

F - full set of vital signs and family presence

A

monitor effectiveness of resussitation

28
Q

Primary assessment (A-G)

A

Airway, alertness and Cspine

Breathing & Ventillation

Circulation control or hemorrhage

Disability (Neurological status)

Exposure and environmental control

Full set of vital signs and family presence

Get the monitoring devices and give comfort <LMNOP></LMNOP>

29
Q

G - Get monitoring devices and give comfort

A

LMNOP

L - lab studies ;
*lactic acid is a KEY indicator of tissue perfusion. High levels = hypoperfusion. >2 to 4 mmol/L are associated with poor outcomes

*An Abnormal base deficit may indicate poor perfusion and tissue hypoxia, which generates hydrogen ions and metabolic acidosis… Base deficit >6 = poor outcomes

M - monitor cardiac rate and rthym

N - Nasogestic + Orogstic considtation. Can help to optomise infataion of the lungs

P - pain assessment and management

30
Q

Re-evaluation considerations

A
  • portable radiography
  • consider need for patient transfer - definitive / specalised
31
Q

Secondary survey steps (H-J)

A

Head to toe
Inspect posterior surface
Just keep reevaluating

32
Q

History - MIST

A

Mechanism of injury
injuries
signs and symptoms
treatment

33
Q

History - SAMPLE

A

symptoms
allergies
medications
past medical hx
last oral intake. output. period
event and environmental factors

34
Q

Others factors with history

A

Age
Burns
Preg.
Disabilities

35
Q

Head to toe

A

Use of eFAST (resus)

36
Q

Head to toe - “LACE” for each section

A

LACE

Lacertaions
Abratuions / avulsios
cotutaions
Edema, Ecchmosis

37
Q

Head to toe

A
  1. general appearance
  2. eyes; diplopia can mean entrapment of cranial nerves 3, 4 and 6. REMOVE contacts
  3. Ears; Do NOT pack ear (in case of CSF leak). check for glucose *approx 2/3 of the BGL. test for B2 -transferrin.
  4. neck and spine
  5. chest
  6. abdomen. flanks
  7. pelvis/perineum
  8. extremities
38
Q

URINE OUTPUT? WHY

A

reflects end-organ perfusion and is considered a sensitive indicator of the patient’s volume status

IDC

39
Q

Secondary survey - rectal tone

A

Rectal tone can indicate spinal cord injury. A DRE is performed by a physician

  • the presence of rectal tone or the absence
  • the presence of a high-riding prostate
40
Q

Secondary survey - Just keep reevaluating

A

Major componenets (VIPP)
-Vital signs
-Injuries sustained and interventions performed
- Primary survey
- Level of pain

41
Q

Secondary survey - what to consider for other tests/treatments

A

CT
Wound care
Splints
Traction
TETANUS
ABs

TNCC (18 decks)

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