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CORE SURG > Major trauma > Flashcards

Major trauma Flashcards

1
Q

What is the golden hour?

A

the time frame in which 80% of deaths occur following trauma. Intervention here has significant impact on mortality

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2
Q

What do the ABCDE’s stand for?

A 
A- airway
B- breathing
C- circulation
D- disability
E-exposure/environment
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3
Q

How to manage A - airway?

A

Airway -assess for patency (is patient speaking?), secretions, foreign body, fractures of jaw, tracheal trauma,

  • protect spinal cord with in-line mobilization
  • consider naso/oropharyngeal airway
  • secure definitive airway
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4
Q

How to manage B - breathing?

A

BREATHING
Administer 100% O2 using nonrebreather masker
Full cardioresp exam - tracheal deviation, distended neck veins, air entry, chest wall expansion/symmetry, resp rate
-percuss and auscultate

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5
Q

How to manage C - circulation?

A

CIRCULATION

  • look for signs of shock
  • control external bleeding with pressure
  • obtain IV access
  • send blood for cross-match, coag, FBC, U&E
  • bolus of warmed hartmanns solution
  • unmatched O- blood
  • surgical control of blood loss if necessary
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6
Q

signs of shock?

A

-pale, cold, clammy, drowsy, reduced cap refill, hypotension, tachycardia

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7
Q

estimated blood loss (in ml) Classes I-IV?

A

I - <750
II - 750-1500
III - 1500-2000
IV - >2000

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8
Q

CNS mental state in each class of blood loss?

A

I - slightly anxious
II - mildly anxious
III - anxious and confused
IV - confused and lethargic

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9
Q

initial fluid replacement for each class of blood loss?

A

I - crystalloid
II - crystalloid
III - crystalloid + blood
IV - crystalloid + blood

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10
Q

systolic blood pressure for each class of blood loss?

A

I - normal
II - normal
III - low
IV - low

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11
Q

what are the three aspects of the GCS scale?

A
  • eye opening
  • verbal response
  • motor response
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12
Q

How is eye opening rated in the GCS scale?

A

Eye opening to:

  • Spontaneous - 4
  • Voice - 3
  • Pain- 2
  • No response - 1
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13
Q

How is verbal response rated in the GCS scale?

A

Verbal response

  • Normal - 5
  • Confused - 4
  • Inappropriate words -3
  • Incomprehensible -2
  • None -1
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14
Q

How is motor response rated in GCS scale?

A

Motor response

  • Normal - 6
  • Localizes to pain - 5
  • Withdraws to pain - 4
  • Flexes to pain - 3
  • Extends to painc - 2
  • None - 1
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15
Q

How to manage exposure/environmental control?

A
  • undress patient
  • keep warm with blankets/warming device
  • use warm IV fluids
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16
Q

what is the trauma triad of death?

A
  • hypothermia
  • coagulopathy
  • acidosis
17
Q

what is the AMPLE method for history taking?

A 
A - allergies
M - medications
P - past medical history
L - last meal
E - events
18
Q

how to diagnose tension pneumothorax?

A

CLINICALLY

19
Q

Management of tension pneumothorax?

A
  • immediate needle decompression - insert 14g cannula into 2nd intercostal space in the mid-clavicular line
  • then insert chest drain in fifth intercostal space between the axillary and midaxillary line
  • attach underwater seal drain
20
Q

management of open pneumothorax?

A
  • attach 3 sided dressing

- insertion of intercostal drain

21
Q

what is a MASSIVE hemothorax?

A

-accumulation of > 1500 ml in pleural cavity

22
Q

a white out on xCRAY may be from a …

A

massive hemothorax

23
Q

Management of massive hemothorax?

A
  • restore blood volume
  • insert wide bore (32Ch) chest drain
  • consider urgent thoractomy
24
Q

what does becks triad suggest?

A

cardiac tamponade

25
Q

what is becks triad?

A

hypotension
raised JVP
faint heart sounds

26
Q

Management of cardiac tamponade?

A
  • if critically ill - blind pericardiocentesis

- otherwise if unwell but responding arrange for urgent echo and eFAST scan

27
Q

which area of the aorta is most commonly transected in trauma?

A

-proximal descending aorta where the mobile arch is fixed by the ligamentum arteriosum

CORE SURG (14 decks)

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