Initial Assessment and Management Flashcards
In a trauma patient with hypotension, what are the two most important causes to consider in order of importance?
- Tension pneumothorax
- Hemorrhage - once you’ve ruled out a tension pneumothorax, assume that hemorrhage is the cause of hypotension until proven otherwise
What is the best way to manage rapid external blood loss?
Direct manual pressure on the wound
When should you consider use of a tourniquet for rapid external blood loss?
Use a tourniquet only when direct pressure is not effective and the patient’s life is threatened
-blind clamping can result in damage to nerves and veins
What are the major areas of internal hemorrhage? (5)
- Chest
- Abdomen
- Long bones
- Retroperitoneum
- Pelvis
How should fluids be administered in trauma patients with shock?
- WARM IV crystalloids - either run through a level 1 infuser
- give 1 L NS bolus initially - If unresponsive to initial crystalloid therapy, give blood transfusion immediately. Do not keep giving NS boluses
What are the uses for ETCO2? (3)
- Can detect ROSC
- Confirm endotracheal intubation
- Help avoid hypoventilation and hyperventilation - helps you target a CO2 range you want
You would like to insert a urinary catheter for a trauma patient but you notice urethral injury. What test should be performed prior to the insertion of a urinary catheter?
Retrograde urethrogram
What is your DDx for blood in gastric aspirate in a trauma patient? (3)
- Swallowed blood
- Traumatic gastric tube insertion
- UGI injury
What is a contraindication to the insertion of a NG tube in a trauma patient?
Fracture of the cribiform/midface fractures
-in this case, insert OG instead
What are key questions to ask in any automobile collision? (7)
- Position of patient in the vehicle
- Seat belt use
- Ejection of patient from the vehicle
- Steering wheel deformity
- Extent of damage on the vehicle (intrusion into the passenger compartment
- Air bags deployed
- Direction of impact
What injuries are at high risk of compartment syndrome in trauma patients? (4)
- Long bone fractures
- Crush injuries
- Circumferential thermal burns
- Prolonged ischemia to the limb
What adjuncts/diagnostic investigations are used in the primary survey? (8)
Overall, these diagnostic tests are used to identify life-threatening injuries
- Continuous cardiac monitoring
- Pulse oximetry
- Urinary catheter to detect urine output/assess for hematuria
- Gastric catheter to decompress gastric contents
- CXR
- Pelvic xray
- Blood gas
- E-Fast
What adjuncts/diagnostic investigations are used in the secondary survey?
Overall, these diagnostic tests are used to identify specific injuries
- Xrays of spine/extremities
- CT scans of the head/chest/abdomen/spine
- Contrast urography
- Contrast angiography
There are many others to consider based on your clinical exam
***These tests should not be performed until the patient’s vitals have been stabilized
What is normal urine output for:
- adult
- child
Adult: 0.5 ml/kg/hr
Child: 1-2 ml/kg/hr
On arrival of the patient, how do you ensure adequate hand-over by EMS personnel?
No team member should begin workingon the patient until hand-over by EMS is complete unless there is an immediate life-threatening condition
-“hands-off hand over”
