Critically injured patient

Question 1

What are the 3 top body regions and injuries most important in the AIS score?

Answer 1

thorax
extremity
external contusion injury

Question 2

What rapidly kills the critically injured patient?

Answer 2

ATOM FC
A = airway obstruction, aortic injury
T = tension pneumothorax, traumatic brain injury
O = open pneumothorax
M = massive haemothorax
F = flail chest
C = cardiac tamponade, catastrophic haemorrhage, cervical disruption

Question 3

What is the lethal triad?

Answer 3

acidosis
hypothermia
coagulopathy

Question 4

What are the principles of initial stabilisation?

Answer 4

catastrophic haemorrhage - tourniquet 
airway - open, maintain it, adequate oxygenation, control ventilation -- recovery position and lit chin
breathing 
circulation 
disability 
exposure

Question 5

What is an OPA/EPA ?

Answer 5

oropharyngeal airway management

Question 6

What is SAD in terms of airway management?

Answer 6

supraglottic airway device

Question 7

What are the key signs of a tension pneumothorax?

Answer 7

anxious and agitated
respiratory distress
cardiovascular compromise
chest signs

Question 8

How do you treat a tension pneumothorax?

Answer 8

high flow oxygen (15L/min)
immediate decompression
intercostal drain placement

Question 9

What are the signs of an open pneumothorax?

Answer 9

sucking chest wound
anxious and agitated
respiratory distress
tachycardia
chest signs

Question 10

What is the treatment of a open pneumothorax?

Answer 10

high flow oxygen 15L/min
cover the hole = flutter valve dressing
intercostal drain placement

Question 11

What are the signs of a massive haemothorax?

Answer 11

anxious and agitated 
respiratory distress
cardiovascular compromise
chest signs
ongoing bleeding through chest drain

Question 12

What is the treatment for massive haemothorax?

Answer 12

high flow oxygen (15L/min)
volume resuscitation
intercostal drain placement
surgery

Question 13

What are flail chest signs?

Answer 13

pain
respiratory distress
bony crepitus
paradoxical chest movement

Question 14

What is the treatment for flail chest?

Answer 14

high flow oxygen (15L/min)
analgesia
respiratory support
surgery

Question 15

What is very hard to differentiate from tension pneumothorax?

Answer 15

cardiac tamponade

• anxious and agitated
• cardio compromise
• beck’s triad: distended jugular veins, decreased arterial pressure and distant heart sounds

Question 16

What should be given to minimise blood loss?

Answer 16

tranexamic acid <1 hour of injury significantly reduces risk of death from bleeding

Question 17

What are the reasons or limiting fluid resuscitation?

Answer 17

over zealous fluid admin can be harmful
hypotensive/volamic resuscitation reduces blood loss
safe if not prolonged (<1 hour)
endpoints still pragmatic