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A&E > Knowledge > Flashcards

Knowledge Flashcards

1
Q

Define Major Trauma?

A

Serious injuries of multiple where there is a strong possibility of death or disability.

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2
Q

What is an ISS?

A

Injury Severity Score - Used for multiple traumatic injuries

> 15 More = Major trauma

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3
Q

What is the most common injury causes long term harm and expense to the NHS?

A

Scaphoid Fracture

  • Arthritis
  • Affects the patient’s occupational activity
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4
Q

Which is more severe and why?

Stabbing or Shooting

A

Stabbing - Follows track of the knife, better outcomes, predictable

Shooting - Bullets can tumble, causes displacement of tissues, Multiple variables (Depends on bullets and kinetics)

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5
Q

Explain the 4 categories of injuries caused by blasts?

A

Primary - Blast disrupts gas filled structures (e.g Bowel perf, Lungs, Stomach
Secondary - Impact airborne debris (Surrounding detonation
Tertiary - Transmission of body (Your body is thrown)
Quaternary - All of forces (Building collapses on you)

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6
Q

What are the top priorities of trauma?

4 Marks

A

Stop bleeding
Prevent hypoxia
Prevent acidaemia
Avoid traumatic cardiac arrest

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7
Q

According to NICE, what is the expected time frame for securing an airway in Major Trauma?

A

45 Mins

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8
Q

What are the ABSOLUTE indications for intubation?

A 
Inability to maintain airway. 
GCS <8 (Reduced LOC) 
Airway injury
High aspiration risk 
Larynx trauma, Penetrating injuries to the neck, abdomen or chest
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9
Q

What findings would make you flag a MAJOR TRAUMA ALERT?

A

RR<10 or 30+
Systolic < 90 (2 Readings)

Suspected fractured Pelvis
2+ long bone fractures 
Amputation proximal (above) to wrist and ankle
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10
Q

GI Bleeds

Main Major complication of what condition?

A

PUD - Peptic ulcer disease

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11
Q

Main Presentation Signs of a GI Bleed?

A

Haematemesis + Melena [Both or separate]
Abdo discomfort
Dizziness

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12
Q

Causes of a GI Bleed

A 
Varices - Oesophageal 
Gastric malignancy 
Oesophagus 
Duodenal Ulcer 
Gastric Ulcer
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13
Q

Main Ix

GI Bleeds

A

Bloods - MONITOR HB, LFTs, FBC, Clotting

OGD - Gastroscopy

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14
Q

What are the key differentials to consider for life-threatening blood loss?

A

Ruptured AAA, GI Haemorrhage, Obstetric Emergencies - APH/PPH, Recent surgery

BLOOD on the FLOOR and 4 MORE -

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15
Q

What are the main sources of bleeding in trauma?

A

Blood on FLOOR and 5 MORE

Floor - Obvious external bleeding 
Thorax 
Abdomen 
Pelvis 
Long bones 
Retroperitoneal - Non-obvious concealed bleeding
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16
Q

What are the primary survey investigations that should be completed for trauma?

A

Looking for blood loss
AP CXR
AP Pelvis XR
FAST Scan - Occult intra-abdominal/cavity bleeding
Polytrauma CT Scan (Pan-CT) - Identify missed injuries/sources of bleeding
Lactate bloods

17
Q

What marker is useful for assessing shock severity?

A

Lactate - <4mmol/L associated with INCREASED MORTALITY

18
Q

Immediate actions that can be done A+E to control bleeding?

A

Tourniquet application
Splint/bind fractures
Suture/Tie off bleeding vessels
Direct pressure/haemostatic dressings to wounds

19
Q

What is the LETHAL TRIAD in trauma that are irreversible and lead to DEATH?

How each lead to compromise?

A

HAC

Hypothermia - Impairs platelet function and enzymatic function within the clotting cascade

Acidosis - Inadequate tissue perfusion leads to lactic acidosis which can impair clotting

Coagulopathy - Hypothermia and acidosis both help to aggravate it (Multifactorial)

Primary - Acute, traumatic (Tissue injury, Shock, Hyperfibrinolysis, systemic anticoagulation mediated by protein C)
Secondary - Iatrogenic - HAC (Dilution, Consumption of coagulation factors)

20
Q

How can Acidosis be avoided in Trauma?

A

Maximise oxygenation and minimise causes of hypoventilation to avoid any additional respiratory acidosis.

Avoid giving 1-2L of crystalloid at the outset. (crystalloid administration which also has a dilutional anaemia effect. Restore tissue perfusion ASAP with haemostatic resuscitation)

21
Q

Define Haemostatic resuscitation?

A

Process of restoring and sustaining normal tissue perfusion of a patient presenting in uncontrolled haemorrhagic shock.

2:1:1
Packed RBCs: Fresh Frozen Plasma: Platelets
Tranexamic acid (1g Bolus + 1g over 8Hrs)

Maintain circulating volume
Preservation of effecting clotting
Prevent lethal triad

22
Q

Define Permissive Hypotension?

AKA Hypotensive Resus

A

Act of maintaining a blood pressure lower than physiologic levels to maintain adequate vasoconstriction, organ perfusion, and prevent an undesired coagulopathy during initial fluid resuscitation.

TARGET - 65mmHg (Head injury - Higher value)

23
Q

Reasons Permissive hypotension is used?

A

Avoid disruption of an unstable clot by higher pressures and worsening of bleeding (“don’t pop the clot”)

Lower SBP as a compromise pending emergency surgical intervention

24
Q

Target values for permissive hypotension?

A

TARGET - 65mmHg (Head injury - Higher value)

If MAP < 65 – give fluids/ blood products
If MAP > 65 – check perfusion (strong pulse, warm peripheries)

> 65+good perfusion = Masterful inactivity
65+ poor perfusion = Fentanyl 25mcg(Vasodilation + reducing adrenaline release)

Allow SBP to fall low enough to avoid exsanguination but keep high enough to maintain perfusion.

25
Q

What factors should be reviewed with Haemostatic Resus?

A

Temperature
Acid Base
Ionised Calcium ABG/VBG - <1.1 (CaCL 10ml 10% 10min)
PT/APTT/Fibrinogen and platelets
FBC
INR - If Px was on Warfarin (Consider Vit K + PCC)

26
Q

4 Steps in a Major Haemorrhage?

A
  1. Recognise and Identify bleeding
  2. Control and stop the bleeding
  3. Avoid the lethal triad
  4. Start Damage control resus - Permissive hypotension, Haemostatic resus, Early damage control surgery
27
Q

ATLS SHOCK CLASSIFICATION?

A

ENTER

28
Q

How to avoid coagulopathy in trauma?

A

Avoid large volumes of crystalloid or unbalanced blood products which can cause dilutional coagulopathy.

Liase with haematology from the outset - initial coagulation screen is often normal in the acute situation (despite an evolving coagulopathy)
BECAUSE

Behind real time, provides no indication of platelet function or interaction between red cells and platelets and is not representative in hypothermic patients (as it’s carried out at 37 °).

29
Q

Define Coagualapathy from coag blood test?

A

prolonged PT or APTT > 1.5 X normal

30
Q

How to avoid hypothermia?

A

Limit exposure, remove wet clothing and ensure ambient temperature is appropriate
Use warming blankets
Rapid transfusion of warmed blood products
Continual temperature monitoring - Rectal probe

31
Q

What ages are a Paediatric Airway defined as?

A

Age 1 to 8

32
Q

What are the 6 Injuries that will kill patient on the way or in Resus if untreated?

A

ATLS FC

A-irway compromise (Upper part of chest, neck)
T-ension Pneumothorax
L-arge Haemothorax
S-ucking Chest wound (2/3 diameter of trachea, Open pneumothorax, air goes through the path of least resistance)

F-lail Chest
C-ardiac Tamponade

A&E (4 decks)

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