Lecture 6: Trauma Flashcards
What are the components of the primary survey?
ABCDE A - Airway B - Breathing C - Circulation D - Disability (Neuro Exam) E - Environment/Exposure
In what situation should you always leave a C-collar to maintain a patient’s airway?
blunt multisystem trauma (esp if altered LOC or fracture above the clavicle)
A trauma patient is brought to the ER, she not communicating with anyone but has a patent airway, does this means she has adequate ventilation?
NO
Airway patency doesnt ensure adequate ventilation
A patient is brought to the ER d/t blunted forced trauma injury, while examining her you note paradoxical movement of part of her chest wall. What should you do to confirm the Dx?
Obtain CT
- Dx: flail chest
(2 fractures per rib in at least 2 ribs)
When assessing circulation what are the 3 most important issues to consider?
BV, CO and Bleeding
Tracheal shift, absent breath sounds, respiratory distress, and hyper-resonance to percussion are indicators for what treatment intervention?
Needle Decompression
Dx: Tension Pneumothorax
What is the placement for Needle Decompression for Tension Pneumothorax?
Chest tube inserted at the 2nd ICS mid-clavicular line
What are the different categories for the Glasgow Coma Scale, and how many points can be earned in each category?
Eye opening (4 points) Verbal responses (5 points) Motor responses (6 points)
A patient from an MVA is brought to the ER, when you calculate his GCS what determines whether you need a definite airway-cuffed, and what is an example of one?
GCS <8 –> needed a ET tube (definite airway cuffed)
What are 2 methods use to help prevent hypothermia in trauma patients?
Warm blankets/device
Warm IV fluids
What is required for immobilization of trauma patients? What must you check before & after immobilizing them?
- Semi-rigid cervical collar
- Head immobilization (blocks)
- Backboard
- Tape/straps
Check PMS before and after
In the initial management of an unconscious patient, what three interventions can be done to decrease cerebral edema?
Give 1 time dose of mannitol, moderate hyperventilation (to a PCO2 32-35) and give hypertonic saline
For a patient who is unconscious what should given for fluid resuscitation?
1-2 L warm bolus of NS or LR
What is the definition of a massive transfusion?
> 10 units of pRBCs within 24 hours of admission
A patient is brought to the ER after a massive bleed from a gunshot wound, she has lost a significant amount of blood and is not responding to standard hemostatic therapy, what should you give her?
Activated Factor VII
Note: indicated for rescue therapy w/life threatening bleed, not responding to std hemostatic Tx
What are the indications for Recombinant Factor VIIa (other than trauma)?
Congenital VII deficiency
Hemophilia
Warfarin related intracerebral hemorrahge
TXA is what type of drug?
TXA = anti-fibrinolytic –> prevents breakdown of clots
A patient is having a total knee replacement performed, what agent can be given to combat bleeding associated w/fibrinolysis?
TXA (Tranexamic acid)
Others: cardiac surg, prostatecetomy
What the 5 conditions that TXA is used for?
- Heavy menstrual bleeding
- Tooth extraction in hemophiliacs
- Blood loss prevention/reduction in high blood loss surgeries
- Trauma associated hemorrhage
- Traumatic hyphema
A patient who was found unconscious outside presents to the ER with a pulse of 140 and a temperature of 95.0F, what must you consider?
shock
Pts who are cool and tachycardic are considered to be in shock until proven otherwise
What is the most common type of shock, and how do you initially try to manage it?
Hypovolemic shock
Initially give crystalloid fluids–> immediately admin 2L of NS or LR
A patient comes in w/hypovolemic shock and you administer 2L of isotonic fluids (NS/LR) but the patient continues to remain in critical condition, what is the appropriate next step?
Administer 2 units of pRBCs rapidly
Common cause of Cardiogenic shock and common MOA for cardiac injury?
Cardiac tamponade
MOA to thorax= rapid deceleration (wearing seatbelt)
A patient presents to the ER with tachycardia, muffled heart sounds, and dilated engorged neck veins with hypotension resistant to fluid therapy. What is the immediate step in managing this patient?
Thoracotomy (to treat cardiac tamponade)
How do you differentiate a tension pneumothorax from cardiac tamponade as a cause of a patient’s HoTN?
They can look similar on CT but:
tension pneumo has absent breath sounds, tracheal deviation, and hyper-resonance
Typical MOA causing neurogenic shock?
Cervical or upper thoracic spinal cord injury –> HoTN
A patient with a neck injury from a MVA presents w/HoTN without narrowed pulse pressure (BP 90/50), a pulse of 60 and no cutaneous vasoconstriction is seen on exam, what is the most likely Dx and next step?
Neurogenic Shock
(Presents w/HoTN w/out tachycardia and no narrowed pulse pressure)
Give crystalloids or colloids to Tx the HoTN…must be done before going to OR
In what type of shock is onset of the infection often delayed several hours and is often caused by a penetrating abdominal injury?
What are the initial steps to managing this type of shock?
Distributive (septic) Shock
All w/in the first 3 hrs:
- Get lactate level (if >4 give crystalloids)
- Get blood cultures
- Give broad spectrum ABX
After the primary survey of a hypotensive patient in an emergency setting, what is the order of the interventions that need to be administered?
Fluids -> Blood/Blood Products -> Anti-Hypotensive agents (Epinephrine, Dopamine)
What must the Dx of shock include?
Evidence of inadequate organ perfusion
What is the purpose of the peritoneal lavage in penetrating/blunt abd trauma?
What indicates a positive result?
To determine if there is free floating fluid in the abdominal cavity
(+) result –> blood in the initial sample
What is the purpose of the FAST exam?
look for free fluid in abdomen or look for pneumothorax in lungs
looks at peritoneal, pericardial, & pleural cavities
What two drugs are given to provide hemodynamic support in cardiogenic shock?
Dopamine, Epi, Dobutamine
What drug is given for septic shock?
NE
