Major trauma Flashcards
What is the golden hour?
the time frame in which 80% of deaths occur following trauma. Intervention here has significant impact on mortality
What do the ABCDE’s stand for?
A- airway B- breathing C- circulation D- disability E-exposure/environment
How to manage A - airway?
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
How to manage B - breathing?
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
How to manage C - circulation?
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
signs of shock?
-pale, cold, clammy, drowsy, reduced cap refill, hypotension, tachycardia
estimated blood loss (in ml) Classes I-IV?
I - <750
II - 750-1500
III - 1500-2000
IV - >2000
CNS mental state in each class of blood loss?
I - slightly anxious
II - mildly anxious
III - anxious and confused
IV - confused and lethargic
initial fluid replacement for each class of blood loss?
I - crystalloid
II - crystalloid
III - crystalloid + blood
IV - crystalloid + blood
systolic blood pressure for each class of blood loss?
I - normal
II - normal
III - low
IV - low
what are the three aspects of the GCS scale?
- eye opening
- verbal response
- motor response
How is eye opening rated in the GCS scale?
Eye opening to:
- Spontaneous - 4
- Voice - 3
- Pain- 2
- No response - 1
How is verbal response rated in the GCS scale?
Verbal response
- Normal - 5
- Confused - 4
- Inappropriate words -3
- Incomprehensible -2
- None -1
How is motor response rated in GCS scale?
Motor response
- Normal - 6
- Localizes to pain - 5
- Withdraws to pain - 4
- Flexes to pain - 3
- Extends to painc - 2
- None - 1
How to manage exposure/environmental control?
- undress patient
- keep warm with blankets/warming device
- use warm IV fluids
what is the trauma triad of death?
- hypothermia
- coagulopathy
- acidosis
what is the AMPLE method for history taking?
A - allergies M - medications P - past medical history L - last meal E - events
how to diagnose tension pneumothorax?
CLINICALLY
Management of tension pneumothorax?
- 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
management of open pneumothorax?
- attach 3 sided dressing
- insertion of intercostal drain
what is a MASSIVE hemothorax?
-accumulation of > 1500 ml in pleural cavity
a white out on xCRAY may be from a …
massive hemothorax
Management of massive hemothorax?
- restore blood volume
- insert wide bore (32Ch) chest drain
- consider urgent thoractomy
what does becks triad suggest?
cardiac tamponade
what is becks triad?
hypotension
raised JVP
faint heart sounds
Management of cardiac tamponade?
- if critically ill - blind pericardiocentesis
- otherwise if unwell but responding arrange for urgent echo and eFAST scan
which area of the aorta is most commonly transected in trauma?
-proximal descending aorta where the mobile arch is fixed by the ligamentum arteriosum
