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ATLS > Initial assessment and management > Flashcards

Initial assessment and management Flashcards

1
Q

Components of the initial assessment

A

Preparation
Triage
Primary survey + Simultaneous resuscitation
Adjuncts
Consider transfer
Re-evaluation

Secondary survey

Re-evaluation
Definitive care

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2
Q

Priorities in the prehospital phase

A

Airway maintenance
Breathing support
Control of bleeding and shock
Immobilisation
Immediate transfer to closest appropriate facility

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3
Q

ATMIST handover

A

Age
Time of event
Mechanism of injury
Injuries head to toe
(Vital) Signs and symptoms
Treatments given / Time of arrival

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4
Q

Hospital phase

A

Resuscitation area
Airway equipment (organised, tested, accessible)
Warmed IV crystalloids (via Belmont)
Monitoring devices
Protocol for requesting additional assistance
Transfer agreements

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5
Q

PPE required for major trauma

A

Face mask
Eye protection / visor
Water resistant gown
Gloves

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6
Q

Primary survey

A

Airway and C spine immobilisation
Breathing
Circulation
Disability
Exposure / Environment

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7
Q

Goal of primary survey

A

Identify and treat life threatening injuries in a prioritised manner

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8
Q

10 second assessment

A

Introduce yourself
Ask their name
Ask them what happened

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9
Q

Airway management

A

Clearing the airway
Suction
Oxygen
Securing airway
Maintain C spine

If in doubt regarding patient airway - intubate

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10
Q

Requirements for adequate breathing

A

Adequate function of:
- Lungs
- Chest wall
- Diaphragm

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11
Q

Breathing management

A

JVP
Trachea position
Chest wall movement
RR
Air entry
O2 saturation

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12
Q

Considerations for circulation / perfusion assessment

A

Blood volume
Cardiac output
Bleeding

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13
Q

Signs of reduced perfusion

A

Reduced GCS
Skin colour / temp
Pulse rate and character

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14
Q

Disability assessment

A

GCS
Pupil size and reactivity
Lateralising signs
Spinal cord injury

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15
Q

Causes of reduced / reducing GCS

A

Cerebral injury
Reduced cerebral perfusion

If change in GCS - re-assess from ABCDE

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16
Q

Exposure assessment

A

Expose patient fully and keep warm with blankets
Temperature

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17
Q

Management of hypothermia

A

Warm blankets
Warm fluids
Control haemorrhage

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18
Q

Adjuncts to primary survey

A

ECG
Obs
ABG
Urine output
Imaging

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19
Q

Imaging adjuncts to primary survey

A

XR - chest or pelvis only
CT
FAST
eFAST
Diagnostic peritoneal lavage

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20
Q

When to consider need to transfer patient

A

Early
When pt needs exceed facility capabilities
Don’t delay transfer for diagnostic tests or secondary survey

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21
Q

When to complete secondary survey

A

After primary survey complete and patient resuscitation efforts are normalising the patient

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22
Q

Secondary survey

A

History
Head to toe examination
Complete neuro exam
Diagnostic tests including imaging
Re-evaluation

23
Q

AMPLE history

A

Allergies
Medications
PMH / Pregnancy test
Last meal
Events

24
Q

Categories of Mechanism of Injury

A

Blunt trauma
Penetrating trauma
Thermal injuries
Injuries from hazardous environments

25
Q

Suspected injury patterns from RTC frontal impact

A

C spine fracture
Flail chest
Myocardial contusion
Pneumothorax
Traumatic aortic disruption
Spleen / liver injury

26
Q

Suspected injury patterns from RTC side impact

A

Head injury
C spine fracture
Flail chest
Pneumothorax
Traumatic aortic disruption
Spleen / liver / kidney injury depending on side

27
Q

Suspected injury patterns from RTC rear impact

A

C spine injury
HI
Soft tissue neck injury

28
Q

Suspected injury patterns from RTC ejection from vehicle

A

Greater risk for all injury mechanisms
No specific injury patterns

29
Q

Suspected injury patterns from car vs pedestrian

A

HI
Traumatic aortic disruption
Abdo visceral injuries
Fractured lower extremities / pelvis

30
Q

Suspected injury patterns from fall from height

A

HI
Axial spine injury
Abdo visceral injuries
Fractured pelvis / acetabulum
B/L lower extremity fractures inc calcaneal fractures

31
Q

Suspected injury patterns from anterior chest stab wounds

A

Cardiac tamponade if within “box”
Haemo/pneumo -thorax

32
Q

Suspected injury patterns from left / right thoraco-abdominal stab wounds

A

Diaphragm injury
Spleen / liver injury
Haemopneumothorax

33
Q

Suspected injury patterns from truncal gunshot wounds (GSW)

A

High likelihood of injury
Trajectory / retained projectiles help predict injury

34
Q

Suspected injury patterns from extremity gunshot wounds (GSW)

A

Neurovascular injury
Fractures
Compartment syndrome

35
Q

Suspected injury patterns from thermal burns

A

Circumferential eschar on extremity or chest

36
Q

Eschar definition
(Pronounced es-car)

A

Dead tissue that sheds or falls off the skin

37
Q

Suspected injury patterns from electrical burns

A

Arrhythmias
Myonecrosis / compartment syndrome

38
Q

Suspected injury patterns from inhalation burns

A

CO poisoning
Upper airway swelling
Pulmonary oedema

39
Q

Secondary survey examination

A

Head / scalp
Eye / ear
Maxillofacial structures
Neck
Chest
Abdo / Pelvis
Perineum +/- Rectum / Vagina
MSK system / extremities
Log roll + spinal examination
Neurological system
Specialised tests

40
Q

Contraindication to NG tube insertion

A

Fracture of cribriform plate

41
Q

Examination of maxillofacial structures

A

Facial bones
Dental occlusion
Intra-oral examination

Look for potential airway obstruction and CIs to NG tube placement

42
Q

Examination of neck

A

Inspect
Palpate (inc carotid arteries)
Auscultate

In head or maxillofacial trauma assume unstable C spine injury until all studies completed

43
Q

Findings on examination of neck

A

Crepitus
Haematoma
Stridor
Bruits

44
Q

Examination of perineum

A

Contusions
Haematomas
Lacerations
Urethral blood

45
Q

Examination of rectum

A

Sphincter tone
Pelvic fracture
Rectal wall integrity
Blood

46
Q

Examination of vagina

A

Blood
Lacerations

47
Q

Contraindication to catheter insertion

A

High suspicion of urethral injury

48
Q

Injuries with high risk of developing compartment syndrome

A

Long bone fractures
Crush injuries
Prolonged ischaemia
Circumferential thermal injuries

49
Q

How to minimise blood loss from pelvic fracutes

A

Pelvic binder or sheet

Do not repeatedly / vigorously manipulate the pelvis in patients with fractures as can dislodge clots

50
Q

Examination of neurological system

A

GCS
Pupil size and reactivity
Lateralising signs
Motor / sensory of extremities
Frequent re-evaluation

51
Q

How to minimise secondary brain injury

A

Optimising oxygenation / perfusion

52
Q

Specialised diagnostic tests

A

XRs of extremities
CT trauma series
Contrast urography / angiography
TOE
Bronchoscopy
OGD

53
Q

Multiple casualties definition

A

Number or patients and their injury severity does NOT exceed capabilities of the facility

54
Q

Mass casualties definition

A

Number or patients and their injury severity DOES exceed capabilities of the facility

ATLS (14 decks)

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