Initial assessment and management Flashcards
Multiple casualty vs mass casualty
Multiple:
- number of pt and severity of pt do not exceed the capability of the facilities
- those with life-threatening problems prioritised
Mass:
- Does exceed
- those with the greatest chance of survival and requiring least expenditure of time and equipment prioritised
What GCS level requires a definitive airway
Less or equal to 8
Manual cervical immobilisation
Airway assessment
Look for foreign bodies/blood/secretions
Identify facial/mandibular/tracheal/laryngeal fractures
Airway management
Head tilt/chin lift or Jaw thrust
Oropharyngeal or nasopharyngeal airway
LMA
Definitive ET intubation
Things to assess in breathing
Look:
- Jugular venous distention
Feel:
- Position of trachea
- Chest expansion
- Percussion
Auscultation
Oxygen in ATLS
Every injured patient must get O2
Management of massive external bleeding
Apply direct pressure
If doesnt work consider tourniquet
Fluid temperture for resus
All needs to be warmed to 37-40 degrees either through a machine or via storage in warm environment
Medicine for control of bleeding
Tranxaemic acid bolus within 3 hours followed by by 8 hour infusion
Primary survey
Quick A-E to r/o
airway obstruction
Pneumo/haemothorax
Bleeding
Reduced GCS
When to do secondary survey
After primary is completed or if can be done without interfering with primary survey
What is involved in the secondary survey?
Head to toe evaluation including AMPLE history and physical examination
AMPLE hx
Allergies
Meds
Past illness
Last meal
Events/environments related to the injury
Blunt vs penetrating trauma examples
Blunt: car collisions, falls
Penetrating: gunshot, stabbing
Sequence of secondary survey
Head, maxillofacial, cervical spine and neck, chest, abdomen and pelvis, perineum/rectum/vagina, MSK system and neurological system
Assessment of head in secondary survery
Assess scalp, head for lacerations/ contusions/evidence of fractures
Examine eyes for size, haemorrahge and AFRO
Examination of maxillofacial structures
Palpation of bony structures
Assessment of occlusion, intra-oral examination and assessment of soft tissue
How to insert NG tube in presence of base of skull injury
Insert it orally
Where to auscultate for pneumothorax
High anterior side
Where to auscultate for haemothorax
Posterior base
Handover from ambulance service
MIST Mechanism (and time) of injury
Injuries found and suspected
Symptoms and signs
Treatment initiated
