EM Flashcards
Tx of seriously injured pts
rapid assessment
life-preserving therapy
Advanced trauma life support is done for every patient
Do ABCs
Time
is essential
less time to get to the trauma center, the better
Initial assessment
multiple things going on at the same time
Initial assessment components
P,T = preparation and triage P,R,A = primary survey, resuscitation, and adjuncts to primary survey S,A = secondary survey and resuscitation P = postresuscitation monitoring and re-evaluation D= Definitive care
When should one do primary and secondary surveys
repeated frequently to determine any deterioration in the pt’s status
any necessary tx is to be instituted in case of adverse change
What center is best to treat trauma
trauma center
Go there immediately
What are ABCDE?
PRIMARY SURVEY: airway maintenance with cervical spine protection breathing and ventilation circulation disability - neurologic status exposure/environment control
Pre-hospital phase
emphasis should be placed on airway maintenance, control of external bleeding and shock
immobilization of patient
advanced planning is essential - trauma team should be ready after EMS
MINIMIZE CLUSTER
Triage
defined as the sorting of the patients based on the need for tx and available resources to prove that tx
Level 1 trauma
has small resources
Implications of multiple casualties
the number of its and the severity of their injuries do not exceed the ability of the facility to rend care
pts in life-threatening problems or with multi-system injuries are tx first
Implications of mass casualties
the number of its and the severity of their injuries exceed the capability of the facility and staff
its with the greatest chance of survival with the least expenditure of time, equipment, supplies, and personnel are managed first
Exhaustive resources
means that a pt with 99% burn will not get the care because they will die the next day
Priorities of care
peds vs adults
the same care is given
Pregnant women
tx similar to non pregnant women - remember the changes in the maternal physiology mimic regular non traumatic ob patient
mothers are hypotensive and tachycardiac
Mother and baby
uterus is not a core organ, so blood is shunted away from the uterus in trauma victims who are pregnant
this is not good for the baby
***SAVE MONEY TO SAVE THE BABY
Focus on the baby
Airway
Focus on the airway
If pt can talk, their airway is intact
Look for foreign bodies
The airway should be assessed first
Rapid assessment for signs of airway obstruction
inspection for foreign bodies and facial, mandibular, or tracheal/laryngeal fx that can result in airway obstruction
Steps to ensure airway maintainence
no strap around the neck
protect the C spine
make sure airway is patent
C spine
prevent excessive movement of the c-spine
presume cervical spinal injury in any patient with multi system trauma, especially with an altered LOC or blunt injury above the clavicle
Tx of C spine injury
chin lift
jaw thrust manuevers
What is the name of the grading scale for coma?
Glascow Coma Scale (GCS)
8 or less GCS indication
usually requires a definitive airway
Assess breathing and ventilation
Pt’s chest should be exposed to assess the chest wall excursion
LOOK FOR CREPITANCE AND ASYMMETRY
Auscultation should be performed- listen to the lungs as peripherally as you can
Percussion => presence of air or blood in the chest; dull = blood
**Injuries that should be identified and treated in the Primary survey
Tension pneumothorax (Black lungs on XR)
Flail chest with pulmonary contusion (bruising of the lung as a result of trauma due to damage to the capillaries)
Massive hemothorax
open pneumothorax
Heart effusion
large heart because fluid in the pericardium
Assess circulation
LOC - level of consciousness
Skin color
pulse
Other things to worry about regarding circulation
Assess breast sounds - percuss
Determine where the bullets in a GSW are - belly, pelvis, or chest
Preserve evidence - don’t cut into the holes of GSW
If a pt arrives with vital signs, take it seriously
65 y/o with hypertension have low pressure
NOT normal
Must ensure Hx is taken
LOC
circulating blood volume is reduced, cerebral perfusion may be critically impaired, resulting in altered LOC
IF WE DONT CIRCULATE BLOOD TO THE BRAIN, BAD SIGN - CAN RESULT FROM IMPAIRED BLOOD VOLUME
Skin color
pink skin is reassuring that the pt is not hypovolemic
Ashen, gray skin and white skin - bad signs
Pulse
central pulses - femoral or carotid should be assessed bilaterally for quality, rate, and regularity
Femoral is more accessible
pushing 90 systolic BP is good
Full, slow, and regular peripheral pulses are good
How to manage rapid blood loss ?
direct pressure on the wound
DONT USE TOURNIQUETS - last method but it is used in army combat or for amputation
For the army, the ABCs are unique
C->A->B
Circulation comes first because they are usually bleeding out
Major sources of occult blood loss
Thoracic or abdominal cavity
soft tissue around long bone fx
BIG BONES BLEED ALOT
Blood loss from femoral fx
3-4 units
Blood loss from pelvis fx
4-5 units
CRITICAL
