Emergency 1 Flashcards
Definition of Trauma
Acute physiological and structural change that occurs in a patient’s body when an external source of energy dissipates faster than the body’s ability to sustain and dissipate it.
Road Traffic Collisions
Frontal or head on Lateral or side impact rear impact Rotational Rollover
Paediatric pedestrian injuries
Bumper more likely to strike children in the pelvis or torso
Less likely to be thrown over the bonnet
More likely to be run over by the vehicle
Fall from heights
Severity: Height/Position/Area/Surface/Physical condition
Gunshot wounds
Amount of damage depends on... type of firearm velocity physical design distance type of tissue
Don’t assume that a bullet followed a straight path between the entrance and exit sites
Motorcycle crashes
Look for... motorcycle deformity Distance of skid in road Deformity of stationary objects Damage to helmet
Catastrophic Haemorrhage
Bleeding that is likely to cause death within a few minutes - head/truncal/juncitonal/limb
Catastrophic Haemorrhage Rx
Head/Neck/Torso:
Field Dressing
Direct Pressure
Haemostatic gauze
Pelvis:
Binder
Limb: Tourniquet Second tournique Haemostatic Gauze Field dressings
A 28-year-old male was injured in a motorcycle accident in which he was not wearing a helmet. On admission to the emergency room he was in severe respiratory distress and hypotensive (blood
pressure 80/40 mm. Hg), and appeared cyanotic. He was bleeding profusely from the nose and had an obviously open femur fracture with exposed bone. Breath sounds were decreased on the right side of the chest. The initial management priority should be:
- Control Haemorrhage with anterior and posterior nasal packing
- Tube Thoracotomy in the right Hemithorax
- ET Tube intubation
- Obtain IV Access and begin emergency blood transfusion
- Obtain a cross table cervical and chest film
ET Tube intubation
Catastrophic haemorrhage !Airway (with cervical spine consideration) Breathing Circulation Disability Exposure / Environment
A 60 year old female is brought in by family and collapses onto the floor of A&E. She has extensive bleeding from both legs where her varicose veins have ruptured. She does not appear to be breathing and you suspect she may have hit her head on the way down. What should be your first
priority
Take control of her airway using techniques and adjuncts
Assess and immobilise her spine
Manage her haemorrhage
Attach 100% Oxygen to assist her breathing
Gain immediate IV Access for drugs and transfusion
Manage her haemorrhage
It’s catastrophic
A seven-year-old boy is brought to the emergency department by his parents several minutes after he fell through a window. He is bleeding profusely from a 6-cm (2.4-inch) wound of his medial right thigh. Immediate management of the wound should consist of:
Application of a tourniquet
Direct pressure to the wound
Apply a haemostat dressing to the bleeding
Direct pressure on the femoral artery at the groin
IV Access for immediate blood transfusion
Direct pressure to the wound
Circulation Rx:
Direct pressure, field dressings Splinting Fluid therapy Tranexamic acid Minimal movement
A 42 year old homeless man is brought to AE via LAS with a fever, cough and increasing delirium. His HR is 121bpm, RR 22 and he is hypotensive at 81/48mmHg. As part of his Sepsis Six bundle, his CXR shows bilateral pulmonary infiltrates. Blood cultures were taken and he is on oxygen and antibiotics. What other marker should be obtained as part of his Sepsis Six management?
Lactate Glucose Potassium Haemoglobin Neutrophil Count
Lactate (+ catheter and fluids)
3 IN and 3 OUT, within 1 hour IN: High flow oxygen Give empirical IV antibiotics IV fluid resus – 500ml/15min challenge OUT: Take blood cultures Check lactate (ABG/VBG) Urine output – catheter
Sepsis six
3 IN and 3 OUT, within 1 hour IN: High flow oxygen Give empirical IV antibiotics IV fluid resus – 500ml/15min challenge OUT: Take blood cultures Check lactate (ABG/VBG) Urine output – catheter
Which of these patients must be transported to hospital immediately?
A patient with sunburn covering their entire back and shoulders which you estimate to 4%
A patient with a burn circling their whole arm
A partial thickness burn covering less than 1% of their body
A scald to their wrist
A cigarette burn to the stomach
A patient with a burn circling their whole arm
The palm of your hand is approximately what % of your body
1% 3% 5% 7% 10%
1%
