Initial assessment and management Flashcards
Outline the hospital preparation for a trauma pt
- Trauma bay
- Tested and functioning airway equipment
- Warmed Crystalloid
- Means to ensure prompt bloods and radiology
What does non purposeful motor movements suggest
the need for definitive airway
How should c spine be managed in suspected trauma
Triple immobilization
What does ventilation require?
Adequate function of the trachea chest wall and diaphragm
What injuries impair ventilation
Pneumothorax
Haemothorax
Flail chest
Tracheal or bronchial injuries
how is a simple pneumothorax converted to a tension pneumothorax?
patient is intubated and positive pressure ventilation is provided before decompressing the pneumothorax with a chest tube
What examination findings are particularly pertientn to blood volume and cardiac output
Level of consciousness
Skin perfusion
Pulse - bad if therady and rapid
How is rapid external blood loss managed
Direct pressure onto the wound
Tourniquet are effective in massive exsanguination but carry risk of ischaemic injury (only use when direct pressure ineffective and life is at risk
What are the 5 areas of internal haemorrhage?
Chest abdomen, pelvis long bone retroperitoneum
What are immediate management of bleeds in ATLS
Chest decompression, Pelvic blinder, long bone immobilisation
True or False - Aggressive and continued volume resuscitation is a substitute for definitive control of haemorrhage
FALSE it isn’t. If unresponsive to initial fluid boluses, they should receive a blood transfusion.
In the primary survery what is a change in conscious level attributed to?
CNS injury
- Ensure to maintain adeqaute oxygenation and perfusion
What are adjuncts to the primary survey?
Gastric catheter
Urinary catheter
ABG
VBG
Continuous oxygen monitoring
CXR
Pelvic XR
How is ventilation measured?I
End-tidal carbon dioxide - capnography, colorimetry or capnometry
When is a urethral catheter contraindicated?
In a urethral injury suspected with blood at the meatus, a high-riding prostate or perineal ecchymosis
When is a NG tube entered through the mouth?
suspicion of cribriform plate fracture
What does finding intra-abdominal blood via FAST indicate?
HD Unstable - urgent surgical intervention
HD stable - surgical opinion
Name patient groups which warrant special consideration
Paediatric, Elderly Athlete obese and pregnant patient
Describe the physiological properties of the paediatric group
Abundant physiological reserve, thus few signs of hypovolaemia and severe volume depletion. When deterioration occurs, it is catastrophic
When does the secondary survey begin?
Once the primary is complete, resuscitative efforts are underway and vitals improved.
What is the secondary survey?
head to toe examination - hx, examination vital signs assessment to look for any missing injuries
What is an ample history
Often taken from prehopsitla staff and family
Allergies
Medication
Past illness
Last eaten
Events/enviroment related to the injury
