Initial Assessment and Resuscitation Flashcards
PRIMARY SURVEY
A— Airway management with cervical spine immobilization
B— Breathing and ventilation
C— Circulation
D— Disability, assessment of neurologic status
E— Exposure and environment
The number one cause of preventable deaths in trauma patients ?
hemorrhage
After Intubation Lung Collapse or absent Breath ?
-The ETT should be adjusted if there is a possibility of right main stem tube placement on examination postintubation.
-Absent breath sounds typically indicate a hemothorax or pneumothorax with a confirmed ETT placement,
Circulation , Palpable Pulses and Bp ?
-palpable dorsalis pedis pulses > Sbp over 100 mm Hg
-femoral pulses 70 to 80 mm Hg
-carotid pulses over 60 mm Hg
What is a better Shock Indicator than Hr or Bp ?
The shock index (SI) [heart rate (HR) divided by systolic blood pressure (SBP)]
A SI > 0.9 is highly suggestive of critical bleeding.
How Many Liter to give patient Stopped Bleeding
1 L of warmed isotonic fluid can serve as the initial fluid resuscitation.
Aggressive resuscitation in the absence of hemorrhage control can cause ?
Additional bleeding (“ pop the clot”)
creating hemodilution
hypothermia
thrombocytopenia
coagulopathy
acidosis
edema
What is a controlled resuscitation strategy ?
250-mL boluses to target a systolic blood pressure of 70 mm Hg or palpable radial pulse with permissive hypotension
shown to decrease mortality compared with a standard resuscitation strategy (2-L bolus to target systolic blood pressure of 110 mm Hg)
What type Of blood to use , and in pregnant or child bearing age ?
Blood that is type-specific but not crossmatched can be used in an emergency setting
Type O negative blood should be used in pregnant females and is preferred in females of childbearing age if available.
when to give TXA ?
TXA should be given as soon as possible and no later than 3 hours postinjury
Principle of Damage Control
-Apply direct pressure or a tourniquet
-Pack junctional wounds with hemostatic dressings
-Early transfer to the operating room or angiography
-Minimize crystalloid infusions
-Controlled resuscitation with permissive hypotension
-Massive transfusion protocol early
-Transfuse with balanced plasma, platelets, and red blood cell
-Use thromboelastography to transition from empirical transfusions to targeted therapy
-Selectively administer pharmacologic or procoagulants adjuncts (tranexamic acid, PCC) to reverse anticoagulants.
How to Prevent secondary brain Injury ?
-Prevention of hypoxia,
-hypercarbia or hypocarbia (target CO2 35– 40 mm Hg)
-maintenance of adequate perfusion
-correction of coagulopathy
-management of intracranial hypertension
FAST Views ? and strongest indication
pericardium, the right upper quadrant, the left upper quadrant, and the pelvis.
hemodynamically unstable patients with blunt trauma.
How long the Needle for Tension pnemo
2.5-inch (5-cm) needle placed in the fifth intercostal space, anterior axillary Line
Longer (8-cm) needles are also useful in larger adults.
In children, the second intercostal space, midclavicular line is still recommended
Sbp Target in Resuscitation
-systolic goal of 80 to 90 mm Hg
-systolic Bp goal in the setting of TBI
100 mm Hg
Small fluid boluses (250– 500 mL) can be administered if necessary to achieve these goals.
