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%
How long after a burn has happened can you still run it under cold water and effectively deliver first aid and reduce scarring
10 Mins 1 Hour 2 Hours 3 Hours 5 Hours
3 Hours
Classification of burns
Superficial
Epidermal Layer Burn
No Underlying Damage
Pinky Red and Painful to touch
Partial Thickness
Edidermis and Dermis Burnt
Painful, Red and Blistered
Fleshy Fat Visible
Full Thickness 3rd Degree
Epidermis, Dermis and Hypodermis burnt
Very Dry
Sometimes little or no pain?
Full Thickness 4th Degree
Burn down through to the bone and/or organs
Very dangerous and severe
Burns First aid
- Start cooling the burn immediately under running water
- Remove Jewellery if not stuck to skin
- Dial 999/112 for an ambulance IF BURN GREATER THAN 1 % OF BODY
- Apply a non-fluffy dressing such as a cloth or cling-film
- Monitor Vitals
Clothing on Fire
Don’t Panic
STOP them moving
Wrap them in a coat, blanket (Not Nylon) or heavy-duty fabric
Roll them along the floor until flames go out
Burns to Airways
Call 999/112 Improve Air Supply however possible Loosen Clothing Increase Airflow Offer casualty Ice or Sips of Water Monitor Condition and Vitals
Electrical Burns
Ensure source is removed
Flood Entry and Exit points with water
Treat in the same way as Major Burn
Consider Widescale Damage
Chemical Burns
Make you and the casualty safe
Flood burn with water for 20 Mins!
Treat as normal
Chemical Burns to the Eye
Rinse eye for at least 10 minutes with water
Ensure eyelid is open
Apply Eye-Pad
Arrange for Hospital Transport
NB – Pepper Sprays
An 18 year old medical student is rushed to A&E after consuming a biscuit with nuts. O/E his lips are swollen and his chest has an audible polyphonic wheeze. What is the most appropriate treatment:
0.05mg IV Adrenaline 100mg IV Hydrocortisone 0.5mg IM Adrenaline 10mg IV Chlorphenamine 1.5mg IM Adrenaline
0.5mg IM Adrenaline
Anaphylaxis management
ABCD management
O2 - intubate in airway obstructed
Lower head + raise legs
Call help!
0.5mg IM ADRENALINE - Per 5 min as necessary – guided by BP and resp function
IV steroids and antihistamine:
chlorphenamine 100mg IV hydrocortisone 200mg IV
IV fluids
SABAs if wheeze
ITU if poor response
(Measure mast cell tryptase 1-6h after suspected anaphylaxis.
Most abundant mediator stored in mast cells: released alongside histamine
Refer to an allergy clinic)
