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Anaesthetics, ED and Plastics > ED - Trauma Management + ATLS > Flashcards

ED - Trauma Management + ATLS Flashcards

1
Q

When does ATLS start and what is important

A

Time of injury
Platinum 10 minutes
Golden hour

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2
Q

What is important to know pre-hospital

A

Mechanism of injury
If RTA - where sitting / where they thrown?
Time of injury
Suspected serious injuries - LOC / head injury / neck pain
Vital signs
Any interventions

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3
Q

What is put out

A 
Trauma call to all teams
Anaesthetist 
ED
ITU 
Surgical 
Radiology
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4
Q

What is important in the history

A 
AMPLE
Allergies
Medication
PMH / pregnancy
Last meal
Events / environment relating to injury
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5
Q

What is the primary assessment

A

CABCDE

Restart if any changes

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6
Q

C

A

Catastrophic haemorrhage control

  • Tourniquet
  • Pressure
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7
Q

A

A

Airway with C-spine control
Always stabilise C-spine and never put into recovery if suspect injury
Always assume C-spine injury in major trauma till proven otherwise
- Triple mobilisation with collar, block and tape
- May not need collar if able to cooperate and keep head still
- Beware of patient with AS when immobilisation C-spine due to subluxation and risk of fracture and nerve damage

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8
Q

What do you look for in A

A

Noises
- Speech suggest patent
- Stridor = worrying so DEAL
Visual
- Any swelling / deformity / blood / vomit
- Can suction away any visible foreign body

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9
Q

How do you manage airway

A 
Chin lift jaw thrust
Oropharyngeal airway - guedel
Nasopharyngeal airway
Endotracheal intubation 
Needle / surgical cricothyroidectomy 
Intubation
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10
Q

What do you avoid in trauma and why

A

Nasopharyngeal

Incase of basal skull fracture

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11
Q

When do you intubate

A

If reduced GCS <8
Requires anaesthetic
Continuous capnograpy after

Tension pneumothorax will get worse after ventilation

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12
Q

What requires urgent aesthetic assessment

A

Impending obstruction

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13
Q

What do you do for C-spine

A

Consider early on

Immobilise

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14
Q

When do you assume C-spine injury

A

Dangerous mechanism
Reduced GCS
Injury above clavicle
Any neurology

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15
Q

B

A

Breathing

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16
Q

What do you look for in B

A

Look and felt chest including posterior aspect

  • Want to see if any stab areas / open wound
  • Any bruising
  • Look for distended or flat neck veins
  • Distended = tamponade / SVC obstruction
  • Flat = hypo

Work and effort of breathing
- Use of accessory / abdominal

Chest expansion 
Tracheal position - should be central 
JVP fdifficult to do in trauma 
Palpate and percuss
Ausculate
O2 sats
Get CXR
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17
Q

What is important to look for

A

Any flair segment or signs of pneumothorax

  • Tracheal deviation = late sign in tension
  • Decreased movement / unequal expansion / no air entry / hypo and low sats and look unwell = suggestive
  • Will go into cardiac arrest

Underlying fracture

  • Subcut emphysema - crepitus on palpation (due to pneumothorax or gas producing infection)
  • Pneumothorax
  • Flail chest

Bruising or open wounds

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18
Q

What are 6 main causes of breathing problems in trauma

A

ATOMFC
Airway obstruction
Tension pneumothorax
Open pneumothorax / Sucking Chest injury
Massive haemothroax
Flail chest
- 2+ rib broken next to each other in 2 places causing portion of rib cage to be separated from the chest wall
- Get parodical movement of flail / bruising when chest moves
Cardiac tamponade

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19
Q

How do you manage B

A 
15l O2 non-breath for all trauma 
Decompress pneumothorax
- Wide bore cannula into 2nd IC space midclavicular will decompress
- Need chest drain if in hospital 
Decompress haemothorrax with chest drain if in hospital 
High flow O2 - 15l non-rebreath
O2 monitoring
ABG 
CXR
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20
Q

C

A

Circulation + haemorrhage control

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21
Q

What is shock in a trauma patient

A

Hypovolaemic until proven otherwise

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22
Q

How do you assess and what imaging

A 
HR
Pulse
Pulse pressure 
CRT
BP
Urine output
Confusion 
Colour and temp
Hb and lactate on VBG will give good idea
USS / CT
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23
Q

What are common sites of blood loss

A 
Floor and 4 more 
Haemothorax
- Will detect on chest exam / CXR
Abdomen 
- Peritonism / rigid + shock 
Pelvis 
Long bones - femur 
- Look swollen / brusised / tender
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24
Q

Options for haemorrhage control

A

Direct pressure
Pelvic binder if pelvic fracture
Thomas splint for femur fracture

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25
Q

How do you value replace

A 
IV access - 2 large bore
Get bloods - can see Hb drop 
X-match 
Catheter to see UO 
O2
Fluid resus 
Massive transfusion protocol
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26
Q

If can’t get vein what are options

A

IO access for max 48 hours
Tibial tuberosity
Proximal humerus
Distal femur

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27
Q

What type of fluid do you give

A

Want to replace blood lost with blood and clotting
4 units O neg blood in ED
Whilst waiting for blood can give crystalloid resus but will eventually dilute and won’t clot
Need to replace clotting to prevent DIC
Give tranexamic acid

28
Q

How do you monitor replacement and response

A 
Vital signs 
Want high enough BP to perfuse organs
UO hourly
Lactate
Repeat gas
29
Q

What is lethal triad of haemorrhage

A

Coagulopathy
Acidosis
Hypothermia

30
Q

Wha scan to look of bleeding

A

FAST

- Focussed assessment with sonography in trauma

31
Q

D

A

Disability

32
Q

What do you assess

A 
Neuro - C-spine / head injury
- AVPU
- GCS
- PEARL
- Tone / reflex
- Log roll
DONT FORGET GLUCOSE
33
Q

E

A 
Environment / exposure 
- Prevent hypothermia
- Warm blanket
- Log roll for injuries to back
Temperature 
Abdo exam
PR exam
34
Q

What is secondary survey

A

Identify all injuries once patient stable

35
Q

What can you do

A

FAST scan will show blood in abdo or cardiac tamponade
- Don’t do if delays CT
CT = definite imaging in trauma (NOT if unstable)
Blood gas
Urine dip
ECG

36
Q

What is further management

A

Theatre
Interventional radiology
ITU for ICP monitoring

37
Q

What should you always check in long bone fracture

A

Hb

38
Q

What causes tension pneumothorax

A

External injury e.g. stab

Internal injury to lung e.g. from rib fracture

39
Q

How does if form

A

Air can pass into pleural space but can’t move out
Pressure builds up
Everything is pushed away

40
Q

What are signs

A 
Hyper-expanded chest
Absent movement due to pressure 
Reduce or absent breath sound
Hyper-resonant
Trachea and apex deviated
Distended neck vein
Shock and hypoxia
41
Q

How do you Rx in emergency

A

Needle thoracocentesis
Place grey cannula into 2IC space midclavicular line
Advanced and aspirate till your hear air

or
Finger thoracotomy
Cut a slice and put finger in and remove and should hear air

42
Q

What is role of this

A

Equlibrate pressure so become simple pneumothorax

43
Q

What is definite Rx

A

Chest drain

44
Q

What is safe triangle

A 
Lateral border of pec major
Base of axilla 
5th IC space
Lat edge of lat dorsi
Go along top of the rib NOT underneath
45
Q

What is an open pneumothorax

A

Chest wound which allows air movement in on respiration

46
Q

How does it present

A

Like tension pneumothorax

47
Q

How do you treat

A

3 sided dressing

Stops air getting in but allows air out when breath

48
Q

How do you definitely treat

A

Drain

49
Q

How does a massive haemothorax present

A 
Reduced breath sounds
Dull to percuss  
Flat neck veins due to shock or distended if SVC is obstructed 
Shock and hypoxia 
Normal movement
Trachea central
50
Q

How do you Rx

A

Chest drain to see how much blood lost
Volume resus
Thoracotomy or sternotomy if continue to bleed

51
Q

If patient is shocked in trauma what do you think

A

Could it be tamponade

52
Q

How does it present R

A

Raised JVP
Muffled heard sounds
Kausmaull
- Rise of JVP on inspiration (should decrease)
Distended neck vein as fluid builds up in pericardium and heard can’t fill and expand

53
Q

How do you Rx

A

Volume resus - any but ideally blood
Thoracotomy
Pericardiocentesis

54
Q

What are other risks of trauma

A

PE

Fat embolism

55
Q

If haemodynamically compromised

A

No CT etc

Straight to theatre

56
Q

What is the triad of significant bleed

A

Coagulopathy as use up coag factors
Hypothermia as not moving warm blood which further impacts coagulation
Acidosis due to initial trauma + lactic acidosis as not perfusing

57
Q

If major bleed

A

Recognise early
Get access and bloods send
Senior help

58
Q

What bloods

A

FBC, U+E, LFT
VBG
Lipase
Clotting / INR

59
Q

Major haemorrhage

A

If >4 units RBC within 1 hour or replacing >50% blood volume in 3 hours

60
Q

ATLS class of haemorrhage shock

A

4 classes

Look to see if any drugs that could be masking signs e.g. BB

61
Q

If minimal bleed with no harm-dynamic compromise what do you do

A

Conservative

62
Q

If BP low but overload what do you d

A

Bolus vs adrenaline to vasoconstrict

63
Q

HYpovolaemic and cariogenic shock

A

Decreased CO and BP

Increased HR and SVR

64
Q

Rx

A

Fluid

65
Q

Septic shock

A

Normal CO
Decreased BP
Increased HR
Decreased SVR as vasodilate

66
Q

Rx

A

Fluid

May need adrenaline to vasoconstrictor

67
Q

Neurogenic shock

A

Decreased sympa or increased para

Vasoconstrictor used to return vascular tone

Anaesthetics, ED and Plastics (14 decks)

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