Emergency medicine trauma Flashcards
38 year old male Motorcycle vs car Bullseye windscreen LOC initially then GCS 15/15 HR 100 BP 145/78 GCS 9/15
Diagnosis and why?
Extradural haematoma
Lucid interval occurred
What is the primary survey?
Structured approach to the injured patient
Catastrophic Haemorrhage?
Airway with c spine control Breathing Circulation Disability Exposure
‘C-ABC’
What does dilation of left eye in the context of TBI mean?
Lots of blood- pushes base of brain through foramen magnum (herniation)
How do we try and reduce the hernia?
Mannitol- sucks water out of the brain
How does ED manage a TBI/ haematoma?
Optimise oxygenation
A, B, C
Keep CO2 normal
A,B
Maintain cerebral perfusion
(CPP= MAP-ICP)
Make sure nothing more life threatening takes priority
Primary survey
Neurosurgical input & theatre
How do we assess the primary survey?
Systematic approach
C- ABC
Treat life threatening problems as you find them
Trauma team – lead by a senior doctor
Simultaneous action
But we teach it in order so you remember the priorities
What can a trauma surgeon do?
Open both chest and abdo
Why is history important?
Mechanism of injury is the strongest predictor of injury
Applies to all trauma- minor and major
Create a mental picture of events in your head
How to you check airways?
Are they breathing? Is it normal or noisy? Noisy = obstructed Obstructed = do something! Do they need a ‘definitive airway’ (cuffed tube that protects the airway)
How do you check breathing?
How do you assess breathing in a trauma patient? Look Palpate Percuss Auscultate
How do you check circulation?
Assessment Pulse, BP, capillary refill time General appearance Source of haemorrhage ‘ on the floor & 4 more’ Chest/Abdo/Pelvis/Long bones Treatments
How do you do haemorrhage control?
Turn off the tap Fluids/ bloods/ FFP Warfarin Coagulopathy to correct TXA (tranexamic acid)
Damage control surgery
How do you assess disability?
GCS- Glasgow Coma Score
level of consciousness
Pupils
Blood sugar
Limb movements
What is the quickest thing you can do to relieve tension in a tension pneumothorax?
Thoracostomy
What are the potential injuries from a fire?
Direct Burns Inhalation Injury Smoke Inhalation Carbon Monoxide Poisoning Cyanide Poisoning Trauma
