in our initial assessment, we need to pay attention to: 1. level of _____, attitude, _____. 2. unusual _____. 3. unusual body or limb ______. 4. positions that suggest bone ______, joint _______. 5. ____ injuries. 6. unusual ___ sounds or sounds suggesting _____ obstruction. 7. obvious ___, wounds or other gross _________.

1. consciousness ; behavior 2. activity 3. postures 4. fracture ; dislocation 5. traumatic 6. breathing ; airway 7. blood ; abnormalities

Lec 21: Principles of Trauma Management Flashcards by Caroline Appel

what type of exam do we perform when an animal becomes ill or injured with life threatening results?

initial focused examination

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what is the purpose of performing an initial focused examination?

to determine the type and extent of any life threatening injuries or medical problems.

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primary survey consists of:

rapid assessment for ____ _______ problems
target _____ _______ by priorty
should be completed in ___ or less

life threatening ; critical organs ; 2 minutes

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in our initial assessment, we need to pay attention to:

level of _____, attitude, _____.
unusual _____.
unusual body or limb ______.
positions that suggest bone ______, joint _______.
____ injuries.
unusual ___ sounds or sounds suggesting _____ obstruction.
obvious ___, wounds or other gross _________.

consciousness ; behavior
activity
postures
fracture ; dislocation
traumatic
breathing ; airway
blood ; abnormalities

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initial assessment pneumonic ABC (the old method) stands for…

A - airway
B - breathing
C - circulation

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what comes after the old method of A B C?

neurologic, wounds

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what causes cell death?

necrosis due to toxins, radiation, heat, trauma, lack of oxygen due to the interruption of blood flow

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what is one thing that airway, breathing, and circulation have in common?

RED BLOOD CELLS

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the airway provides a _____ for O2 to reach RBC’s in the lungs

pathway

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breathing allows for ____ of O2 to red blood cells

transport

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circulation allows for transportation of O2 in the red blood cells to the ______.

tissues

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if there are not enough RBC’s to transport O2 to keep the cells alive, then airway, breathing, and circulation are _______.

IRRELEVANT

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how are RBC’s lost in trauma?

hemorrhage

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what two types of hemorrhage can a patient have in a trauma situation?

compressible or non-compressible

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the NEW way to approach trauma:

M²ARCH²E

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M in M²ARCH²E stands for:

member, two things!

massive hemorrhage & muzzle

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A in M²ARCH²E stands for:

airway

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R in M²ARCH²E stands for:

respiration

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C in M²ARCH²E stands for:

circulation

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H in M²ARCH²E stands for:

(remember 2 things!)

head injury & hypothermia

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E in M²ARCH²E stands for:

evacuate / pain management /abx

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why would we need to evacuate?

transport to referral hospital

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ensure a ____ environment for you, your team, and your patient.

safe

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with major wounds that cause instantaneous death, your ___ will have little to no effect.

actions

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we should always slow down take a few seconds, and….

see what the patient is doing

ALL animals should be properly restrained and potentially \_\_\_\_\_\_.

muzzled.

what should you do first in the event of massive hemorrhage?

STOP THE BLEEDING - pressure pressure pressure!

arterial blood will be ____ in color, and squirting.

bright red

venous blood will be ____ in color and oozing.

dark red

should we use a tourniquet in the event of massive hemorrhage?

they are rarely used in practice. most of the time more beneficial to just put pressure on the bleed.

besides applying pressure, what else could you use in the event of massive hemorrhage?

hemostatic bandages!

how should we assess our patient's airway?

listen for abnormal sounds, deformities of the face/neck/chest, examine and clear the oral cavity

what safe preventative measures should we make sure to have in place when examining a patient's airway?

restrain the jaw even if the patient is unconscious

what type of repositioning will we possibly have to do in order to get the best look our patient's airway?

straighten the head and neck

clear the airway of any \_\_\_\_.

objects, blood etc

palpate the ______ and _____ in the front/center part of the neck

throat area ; trachea

look for masses, wounds or swelling that may cause ___ \_\_\_\_\_.

airway obstruction

what technique should you use to clear airway obstructions caused by toys, bones, food, sticks etc?

the 2 finger sweep technique

visually observe the patient, if unconscious….

possible needs an airway, observe and position airway placement → TRACHEOTOMY

step 1 for a tracheotomy 1. make a _____ incision through the _____ ligament between the ___ and ___ tracheal cartilages.

transverse ; annular ; third and fourth/fifth

what should we be careful of when making our tracheotomy incision?

to not extend the incision around more than half of the circumference of the trachea.

step 2 for a tracheotomy 2. facilitate ___ placement by depressing the ____ cartilages with a hemostat.

tube ; proximal

step 3 of a tracheotomy 3. elevate the ____ cartilages with an _____ suture. Insert a tracheostomy tube that does __ completely fill the lumen.

distal ; encircling ; NOT

after placing the trache, appose the _____ muscles, subcutaneous tissue, and skin cranial and caudal to the tube

sternohyoid

after apposing the tissue, secure the tube by tying it with _____ or ____ around the neck

gauze ; umbilical tape

how do we examine respiration?

look at how the animal is breathing, observe the chest and abdomen. inspect and palpate

open pneumothorax is also called a

sucking chest wound

how should we stabilize a patient with an open pneumothorax?

cover wound (can use a variety of different products)

how do we relieve a tension pneumothorax?

needle decompression

what land marks should we be aware of when relieving a tension pneumothorax via needle decompression?

* want to place our needle somewhere between the 7th and 10th intercostal space * place the needle CRANIALLY to avoid a large artery that runs caudally

the same landmarks used for needle decompression of a pneumothorax can also be used for…

thoracocentesis

for a thoracocentesis, we want to replace the needle with an…

over the needle catheter

deep, labored breathing is indicative of

lung trauma or other lung problems such as pulmonary contusions

shallow, rapid breathing suggests…

air, blood or other fluid in spaces of the lungs that shouldn't be there

if the dog is not breathing, what is this called?

respiratory arrest

irregular breathing may indicate…

a brain injury

when evaluating respiration and breathing, we should always take a peak at the \_\_\_.

gums

blue gums indicate \_\_\_\_\_.

a serious problem.

when evaluating circulation in an animal that presents with hemorrhage, we should ____ bandages to ensure control of massive bleeding.

recheck (every time the patient moves!)

after getting massive bleeding under control, we can move on to addressing _____ if necessary.

smaller wounds

when evaluating circulation, initiate ___ and ___ devices if needed.

intravenous and intraosseous

when evaluating circulation and we find a fracture, we should _____ the joint above and below the fracture, and place a ____ \_\_\_\_\_ immediately above and below the site of injury.

joint ; secure splint

when evaluating circulation, we need to pay close attention to the \_\_\_, and consider the ___ and character (strong/weak, regular/irregular).

pulse ; rate

determine the animal's ___ when evaluating circulation. Normal is less than 2 seconds. Abnormal is ___ than two seconds.

CRT ; greater than

rapid heart rate/pulse with prolonged CRT suggests….

shock, major trauma, or serious medical problem

dogs can become _____ very quickly. space blankets should be utilized but be sure to maintain access to applied treatments and be able to assess the patient.

hypothermic

when evaluating for a head injury, asses the level of \_\_\_\_\_\_.

consciousness

you can assess the level of consciousness by: giving ____ commands, looking at the gait, visual observation of the \_\_\_, unresponsive

verbal ; head

an important part to evalulate when looking for evidence of a head injury is \_\_\_\_\_.

anisicoria (pupils different sizes)

preplan and practice ____ procedures.

evacuation

pre plan ____ coverage.

veterinary

abx should be _____ quickly once the need is identified.

administered

after getting through M²ARCH²E - what else should you do?

asses the dog's body for wounds, fractures, evidence of trauma elsewhere. * examine spinal column, abdominal region, flank, limbs for signs of trauma \*