Emergency 2 Flashcards
Describe the importance of establishing and securing the airway in emergency surgery
It is always the first step in management, with altered mental status being a common indication for intubation in trauma patients.
What is the first step in managing a cervical neck injury in emergency surgery?
The first step is to apply a cervical collar.
Define the hemodynamic changes indicating hypovolemia in emergency surgery
Pulse change is the first indicator, followed by a drop in blood pressure after at least 20-25 blood loss.
How is pericardial tamponade diagnosed and treated in emergency surgery?
Diagnosis includes distended neck veins, high central venous pressure, and treatment involves immediate pericardiocentesis.
What are the characteristics of tension pneumothorax in emergency surgery?
It presents with distended neck veins, high central venous pressure, respiratory distress, absent breath sounds, and tracheal deviation.
Do you know the management steps for flail chest in emergency surgery?
Treatment includes pain control, supplemental oxygen, strapping the chest, and positive pressure mechanical ventilation.
How is traumatic aortic rupture managed in emergency surgery?
It requires surgery and is usually caused by severe trauma to the chest wall, often at the descending aorta.
Describe the diagnosis and treatment of epidural hematoma in emergency surgery
It occurs after side head trauma, involves rupture of the middle meningeal artery, and presents with specific symptoms requiring urgent surgical intervention.
What are the indications for surgery in head trauma cases in emergency surgery?
Comminuted or depressed skull fractures require surgical intervention, while closed fractures with no symptoms may not need treatment.
Describe the honeymoon period in head trauma patients.
It is the period when the patient immediately awakes and appears normal after the injury.
What are the typical signs of Cushing’s reflex in head trauma patients with increased intracranial pressure?
Hypertension, bradycardia, and respiratory depression.
Define subdural hematoma.
It is bleeding from the venous system, often caused by head trauma, leading to fluctuating consciousness, gradual headaches, memory loss, and personality changes. Long period of loss of consciousness
How is a subdural hematoma diagnosed?
Through a CT scan showing a concave crescent-shaped hematoma.
What is the treatment approach for subdural hematoma if lateralizing signs and midline displacement are present?
Emergency craniotomy.
Describe diffuse axonal injury.
It results from acceleration-deceleration injuries to the head, leading to deep unconsciousness and a terrible prognosis.
What is the recommended management for elevated intracranial pressure?
Head elevation, hyperventilation, avoiding fluid overload, and using medications like mannitol and furosemide.
What is the first step in managing penetrating abdominal trauma?
Controlling the site of bleeding by applying direct pressure.
What should be done if an object is embedded in a patient with penetrating trauma?
Never remove it in the ER; only remove it in the operating room under general anesthesia.
Describe the priority in managing abdominal trauma after controlling bleeding.
Fluid resuscitation with normal saline and setting up large gauge IV lines.
What is the recommended type of fluid for blood transfusion in abdominal trauma?
Even where there is significant disruption of solid organs with haemodynamic insatiability conservative management is usually possible with adequate resuscitiation.
Conservative management implies close and continuous observation, and is not the easy option. It should only be undertaken only in an institution where rapid access to surgical intervention is available at all times.
ABCDE
Fluid resuscitation with 20 ml / kg normal saline or Hartmans.
Second bolus of fluid as above, if required (see chapter 1.18).
If further boluses of fluid are required, use blood.
Immediate further SURGICAL review.
Pass orogastric tube.
All patients with free intraperitoneal air require a laparotomy.
All penetrating wounds should be explored in theatre under general anaesthetic (see chapter 1.9).
Intra-peritoneal bleeding is not an indication for laparotomy, so Diagnostic Peritoneal Lavage (DPL) has no significant role in children.
Children with a history of significant trauma or high impact trauma should be admitted for observation even in the absence of examination findings. Racgp
When should a knife at the chest be removed in a trauma scenario?
Only in the operation room after specific steps like intubation, chest tube insertion, and under general anesthesia.
Describe the procedure for intraosseous cannulation in children.
Intraosseous cannulation in children is typically performed in the proximal tibia.
What is the recommended initial bolus fluid for children in trauma situations?
.
Choice of Fluid
The preferred fluid type for IV maintenance is sodium chloride 0.9% with glucose 5%
Alternative maintenance fluid options include:
Plasma-Lyte 148 with glucose 5% (contains 5 mmol/L of potassium) - generally stocked in tertiary paediatric centres and intensive care
Hartmann’s with glucose 5%
Glucose 5% should be given in maintenance fluids for children with no other source of glucose. Racgp
List the most commonly affected organs in blunt abdominal trauma after a car accident involving a restrained driver.
The spleen, liver, and kidney are the most commonly affected organs in blunt abdominal trauma.
What are the clinical presentations of internal bleeding in blunt abdominal trauma?
Clinical presentations of internal bleeding in blunt abdominal trauma include hypotension, tachycardia, abdominal wall ecchymosis, abdominal rigidity, and tenderness.
What does the FAST exam stand for in trauma assessment?
The FAST exam stands for Focused Assessment with Sonography for Trauma.
When is the FAST exam typically performed in trauma patients?
The FAST exam is performed in unstable trauma patients.
