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EMED Unit 3 > Evaluation of the Trauma Patient > Flashcards

Evaluation of the Trauma Patient Flashcards

1
Q

Immediate death from trauma is usually due to…

A

Fatal disruption of great vessels, heart, lungs, or major body cavity

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2
Q

Death 1-4 hours following traumatic injury is usually due to…

A

CV or pulmonary collapse

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3
Q

Death days to weeks after traumatic injury is usually due to …

A

Sepsis and multiple organ failure

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4
Q

What is the cause of half of all trauma deaths?

A

CNS injury

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5
Q

Most common cause of preventable mortality in trauma?

A

HEMORRHAGE

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6
Q

______ is the cause of 1/3 or all trauma deaths

A

Exsanguination

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7
Q

What are indicators of increased mortality in trauma?

A

Lower GCS score

Older age

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8
Q

Standard of care and standardized protocol for trauma patient evaluation

A

Advanced Trauma Life Support (ATLS)

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9
Q

What does S stand for in SALT mass casualty triage algorithm

A

Sort

“Walk to me if you can” - they get seen third

“Raise your hand if you need help” - they get seen second

Those who don’t respond/lie still - they get seen first

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10
Q

What are the four colors for triage

A

Green = minor injuries (seen last)

Yellow = delayed (serious but not life threatening injuries)

Red = immediate (life threatening injuries - seen first)

Black = morgue

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11
Q

Name the trauma center level:

Highest level of care
Leaders in research, clinical care, and education

A

Level 1

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12
Q

Name the trauma center level:

Provides definitive care in wide range of complex traumatic patients

A

Level 2

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13
Q

Name the trauma center level:

Provides initial stabilization and treatment
May care for uncomplicated trauma patients

A

Level 3

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14
Q

Name the trauma center level:

Provides initial stabilization and transfers all trauma patients for definitive care

A

Level 4/5

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15
Q

Objectives of the primary survey in evaluating trauma patients

A

Stabilize trauma patient

Identify life treating injuries and initiate adequate supportive therapy

Efficiently and rapidly organize definite therapy or transfer to facility for definitive therapy

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16
Q

What are components of the primary survey?

A

“ABCDE”

Airway - assess and protect
Breathing - maintain adequate oxygenation
Circulation - control hemorrhage, maintain perfusion
Disability - neuro eval
Exposure - undress patient then redress and warm them
FAST exam

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17
Q

What is the best way to quickly assess airway in a conscious patient?

A

Ask simple question - “What’s your name? What happened?”

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18
Q

What all are you looking for when assessing a patient’s airway?

A

Observe for signs of respiratory difficulty

Inspect oropharyngeal cavity for obstacles to ET tube

Inspect and palpate anterior next for signs of injury

If patient unconscious - protect airway immediately, c-spine protection

Hypoxia can lead to death within minutes

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19
Q

What can you do to maintain airway patency?

A

Suction of secretions
Chin lift/jaw thrust
Nasopharyngeal airway
LMA

—> Definitive airway

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20
Q

What are some different ways to give airway support once patency established?

A

Oxygen

NRBM (100% O2)

Bag valve mask

DEFINITIVE AIRWAY

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21
Q

What are the two definitive airways?

A

Endotracheal intubation

Surgical crichothyroidotomy

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22
Q

Who gets a c-spine immobilized?

A

All blunt trauma patients

Can be a cervical collar (remove anterior portion for intubation) or manual in-line stabilization (head in neutral position, grasped at mastoid process)

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23
Q

Which should you do first, ET intubation or cric?

A

Duh, attempt ET intubation first

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24
Q

How is a cricothyroidotomy performed?

A

Incision through cricothyroid membrane, insert small tube

Later convert to orotracheal tube or tracheostomy

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25
Evaluation of breathing/ventilation should include...
Inspection of chest wall (asymmetry or paradoxical movement) Auscultate - breast sound as Alice’s and axillae Palpate - for crepitus and deformity Immediate threats to life - tension pneumo, massive hemothorax, cardiac tamponade Unstable patients - chest xray
26
When to presumptively treat for pneumothorax
Hypotension, dyspnea, ipsilateral decreased breath sounds Treat with needle decompression
27
Where do you perform needle decompression for pneumothorax?
ADULTS: 5th ICS anterior to mid axillary line*** KIDS: 2nd ICS at midclavicular line
28
What should immediately follow needle decompression for pneumothorax?
Tube thoracostomy
29
How should sucking chest wounds be treated?
Emergently with occlusive dressing
30
How do you assess circulation?
Palpate central pulses (carotid, femoral) Observe for obvious exsanguinating external injury Determination of exact BP unnecessary Permissive hypotension - SBP 80-100 IV catheters placed at time of circulation (16 gauge or larger) Blood type and cross match
31
How do we control hemorrhage?
Arterial hemorrhage —> manual pressure, proximal compression (tourniquet), elevation Venous hemorrhage —> direct pressure TXA Transexamic acid Blood transfusion Emergency thoracotomy for patients without central pulses
32
Who gets an emergency thoracotomy?
Patients without central pulses
33
What is the step down method for treating shock?
1. 1L crystalloid NS or LR 2. 1-2 units O-Net PRBCs 3. Start MTP
34
What is MTP?
Massive Transfusion Protocol 1:1:1 ratio of PRBCs: Fresh Frozen Plasma: Platelets
35
Rapid infusers can deliver products at over _____/min
1000mL
36
What makes up the Disability portion of the primary survey?
Determine level of consciousness/mental status GLASCOW COMA SCALE - best if performed prior to intubation Evaluate pupils (size, symmetry, reactivity) Motor/sensory exam Imaging
37
Maximum score on GCS
15
38
Maximum GCS score for an intubated patient
10T
39
At what GCS score do you intubate a patient?
8 - coma
40
What does the Exposure portion of the primary survey entail?
Visualize entire body - must completely undress patient Common missed regions = scalp, axillary folds, perineum, abdominal folds
41
What body temp is considered hypothermia?
<35C
42
How do you treat hypothermia?
Warm blankets Warm IV fluids and blood External warming devices Warm room
43
What is the lethal triad of trauma?
Hypothermia - remove wet clothing and warm patient Coagulopathy - permissive hypotension and blood products Acidosis - stop bleeding, treat shock
44
What is “AMPLLE” history for the secondary survey?
``` Allergies Medicines Past medical history Last meal Last menstrual period Events that lead to the trauma ``` We wanna know if they’re on blood thinners or if they’re preggo
45
What medications in particular are you worried about when taking your AMPLLE history?
Antiplatelets or anticoagulants
46
What are you looking for on secondary survey: Skin
Lacerations Abrasions Ecchymosis Hematoma
47
What are you looking for on secondary survey: Head and face
Inspect and palpate entire bony structure
48
What are you looking for on secondary survey: Neck
All blunt trauma —> assume injury Distended neck veins? Evaluate c-spine
49
What are you looking for on secondary survey: Chest
Inspect and palpate entire chest wall | Careful auscultation
50
What are you looking for on secondary survey: Abdomen
Inspect and palpate entire abdomen | Can be unreliable
51
What are you looking for on secondary survey: Rectum and GU
Inspect rectum and perineum Sign of pelvic injury
52
What are you looking for on secondary survey: Musculoskeletal
Inspect entire length of all 4 extremities - tenderness, deformity,
53
What are you looking for on secondary survey: Neuro
Serial exams Status can change over time
54
What is the NEXUS c-spine rule?
``` Radiography is unnecessary if patient satisfies all of the following: • No midline cervical tenderness • No focal neuro deficits • Normal alertness • No intoxication • No painful distracting injury ```
55
PECARN for kids younger than 2
AMS or GCS<15 or palpable skull fx —> CT Recommended LOC >5s, non-rental hematoma, not acting normal, or severe mechanism —> observe, maybe CT None of the above —> NO CT
56
PECARN for kids >2
AMS or GCS<15 or signs of basilar skull fx —> CT recommended History of LOC, vomiting, severe HA, or severe mechanism —> observe, maybe CT None of the above? No CT
57
How do you reverse antiplatelets?
Platelets
58
How do you reverse Coumadin?
FFP Vitamin K Prothrombin complex concentrate Factor VIIa
59
How do you reverse Heparin?
Protamine sulfate
60
How do you reverse LMWH?
Protamine sulfate
61
How do you reverse direct thrombin inhibitors (ie Pradaxa)
Idarucizumab (Praxbind)
62
What is a chance fracture?
Displacement of lumbar vertebrae due to seat belt
63
What is Cullen’s sign?
Periumbilical bruising - due to internal hemorrhage
64
What is Gray Turner’s sign?
Flank ecchymosis - due to internal bleeding
65
Most frequently injured organ in penetrating trauma
Liver Also 2nd most frequently injured organ in blunt abdominal trauma
66
Most frequently injured organ in blunt trauma in adults
Spleen Most important to save in kids
67
If you gotta take out somebody’s spleen because it exploded post MVA, what should you consider?
Vaccination: • Pneumovax • H. flu • +/- meningococcus
68
What does FAST stand for?
Focused Assessment with Sonography for Trauma
69
What are the only indications for rectal exam?
Spinal cord injury (assess for sacral sparing) Pelvic fracture (to assess for open fracture) Penetrating abdominal trauma (to assess for gross blood)
70
Hemodynamically unstable open pelvic fractures can lead to blood loss of up to ______
1-3L of blood
71
How do you stabilize pelvic fractures?
Bind pelvis if suspect fracture Check for blood at the meatus (urethral injury)
72
Blood at the urethral meatus?
Urethral injury - beware with Foley
73
When is an NG tube contraindicated?
Mid face fracture
74
Hard signs of vascular injury from penetrating trauma
``` Active or pulsatile bleeding Expanding hematoma Pulseless limb Shock Compartment syndrome (6 Ps) Bruit thrills (rare) ```
75
Soft signs of vascular injury in penetrating trauma
Small non expanding hematoma Venous oozing History of pulsatile bleeding Unexplained neuro deficit
76
What Ankle-Brachial Index is considered Abnormal?
<0.9
77
What is brachial/brachial index?
Comparing injured to uninjured brachial BP BBI >0.9 = normal
78
What do you do with patients who have hard signs of vascular injury?
Straight to OR
79
What do you do for patients with soft signs of vascular injury?
ABI If >0.9 —> no arterial injury If <0.9 —> CT Angiogram of extremity
80
If no signs of vascular injury —> ....
Xray
81
How do you assess neuro/vascular status for arm fractures?
“Rock paper scissors” and “OK” sign
82
What are the six P’s for compartment syndrome?
``` Pain Paresthesias Pallor Poikilotherma Paralysis Pulselessness (Late) ```
83
What are the components of a PAN SCAN?
``` Non-contrast CT of: • Head • Maxillary (face) • C spine • Thoracic spine • Lumbar spine ``` CT w/ contrast of: • Chest • Abdomen • Pelvis Other studies based on scenario (CTA of neck if potential vascular injury, CTA of extremity if potential vascular injury)
84
What labs do you run as adjunct to secondary survey?
``` CBC CMP hCG PT/INR PTT Type/Cross Lipase Alcohol level U/A Urine drug screen Lactate/base deficit ```
85
What is the parkland formula for burn patient resuscitation?
4mL LR x weight in KG x TBSA affected Give 1/2 over first 8 hours, remainder over following 16 hours
86
What position should pregnant women be placed in for chest compressions?
Left lateral decubitus position (back at 30˚)
87
In cases of perimortem c-section, prognosis for intact survival of an infant is best if...
Delivered within 5 min of maternal arrest Goal - to remove fetus and continue resuscitation of both mother and fetus
88
How is a perimortem cesarean section performed?
During procedure, maternal CPR maintained Vertical midline abdominal incision from 4-5cm below xyphoid process to pubic symphysis Incise through the fascia and muscles into the peritoneum
89
What things to consider in geriatric trauma patients?
Meds - 60% increased risk of mortality if they’re on WARFARIN Which came first - the MI or MVC? Hidden trauma
90
What is the maximum opiate Rx you should write in the ER?
3 days

EMED Unit 3 (5 decks)

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