EM Trauma 10 (ATLS 1) Flashcards
main components of prehospital phase in trauma
airway maintenance
control of external bleeding and shock
immobilization of the patient
immediate transport to the closest appropriate facility, preferably a verified trauma center
things to be done to every injured patient
Supplemental oxygen
“Every injured patient should receive supplemental oxygen.” (?)
Injuries identified in the secondary survey
simple pneumothorax
simple hemothorax
fractured ribs
flail chest
pulmonary contusion
elements of circulation that yield important information within seconds
level of consciousness
skin perfusion
pulse
remarks on fluid resuscitaiton
usual dose is 1L for adults or 20mL/kg for children
one study showed that crystalloid resuscitaiton of more than 1.5L independently increased the odds ratio of death
it is recommended to warm fluids to this temperature
39C
When fluid warmers are not available, a microwave can be used to warm crystalloid fluids, but NOT blood products
remarks on cervical trauma
most major cervical vascular injuries are the result of penetrating injury
wound that extend through the platysma should NOT be explored manually, probed with instruments, or treated by individuals in the ED who are not trained to manage such injuries
things to communicate in handover of trauma patients
MIST
Mechanism (and time) of injury
Injuries found and suspected
Symptoms and signs
Treatment initiated
the most important early assessment measure for airway and breathing
talking to the patient and stimulating a verbal response
a positive, appropriate verbal response with a clear voice indicates that the patient’s airway is patent, ventilation is intact, and brain perfusion is sufficient
triad of laryngeal fracture
hoarseness
subcutaneous emphysema
palpable fracture
describe stridor
crowing sounds
remarks on cervical cord injuries
injuries below C3 level result in maintenance of the diaphragmatic function but loss of the intercostal and abdominal muscle contribution to respiration
LEMON rule
Look externally (large incisors, tongue, small mouth, facial trauma)
Evaluate for 3-3-2 rule
incisor opening distance ≥3 FB
hyoid-mental distance ≥3 FB
thyroid notch to floor of mouth ≥2 FB
Mallampati 3-4
Obstruction (e.g. epiglottitis, retropharyngeal abscess, trauma)
Neck mobility (limited)
first priority of airway management
ensure continued oxygenation while restricting cervical spinal motion
remarks on OPA
do not use 180 degree method in children; instead use a tongue depressor
patients who tolerate OPA are highly likely to require intubation