Lecture 3 Mgt of LE Injuries Dr. Nelson Flashcards
Level 1 Trauma
Regional center.
Provides complete care of trauma patient.
Trauma prevention and rehab.
Education, research, systems development.
surgery residency required.
Level II Trauma Center
Initial definitive care of pt and can transfer to Level I.
Education and prevention programs available.
*Research not essential and less surgical specialties available. Residency not required.
Level III Trauma Center
Evaluative and able to transfer immediately.
General surgeon available.
Think rural and community hospitals.
Level IV and V trauma centers
Can give advanced trauma support prior to transver.
Trauma nurse available but no general surgeons.
What are the three general trauma evaluative forms?
- Asses the severity
- Check cardio-pulmonary for resuscitation.
- Physical examination
The Glasgow coma scale is a scale from…
3-15
A Glasgow coma scale of 8 or lower denotes
Severe head injury with the patient in a coma.
A Glasgow coma scale of 9-12 denotes…
Moderate head injuries
A glasgow coma scale of 13-15 denotes?
Minor head injuries.
What are the three criteria for scoring Glasgow coma scale?
Eye opening (4 pts max)
Vertebral responses (5 pts max)
Motor responses (6 pts max)
What does the revised trauma score take into account?
a physiological scoring system from 0-12.
Takes into consideration of the Glasgow coma scale, systolic BP and respiration.
What revised trauma score is considered normal and which leads to the need for treatment at a trauma center?
12 would be normal.
<4 would require treatment at a trauma center.
What is the primary physical survery in a general trauma eval?
Checking the ABCDE's to stabilize the patient. Airway Breathing Circulation Disability - CNS Exposure or Environmental Control.
What is the Secondary Survey of general trauma evaluation?
Complete head to toe eval with definitive diagnosis and treatment of injuries.
What is the tertiary survey of general trauma evaluation?
Repeat head to toe evaluation with reevaluation with laboratory and advanced studies. (Labs Radiographs etc)
Trauma scores can help in treatment choices but….
Cannot be used in isolation!
Which of the two exotoxins from clostridium tetani is the most potent toxin known?
Tetanospasmin neurotoxin.
Farm injuries are automatically Gustilo Classification level….
Class III
Whether A B or C depends on periosteal stripping extent and vascular injury.
What are the four main steps of reduction?
Slightly exagerate the deformity
Traction to relax/lengthen muscle.
Manipulation: After traction bone can be slipped into place.
Splinting/casting/framing. Highly dependent on the energy of the trauma.
What is First hit concept?
trauma activates SIRS
Soft tissues and bone trauma.
What is Second hit concept?
Surgery in the early phase accelerates SIRS.
Surgery causes increased local soft tissue damage.
What is the Lag period in the Second Hit concept?
Surgery just past the peak of SIRS may be at a time of relative immune suppression.
surgery may overwhelm the soft tissues that have already been damaged by trauma.
