Major Trauma - Initial Assessment Flashcards
What mnemonic is used to transfer information between the prehospital team and trauma team?
ATMIST
- Age
- Time of injury
- Mechanism of injury
- Injuries sustained
- Signs (clinical)
- Treatment so far
How would you conduct a primary survey of someone?
- Airway and c-spine
- Breathing
- Circulation and haemorrhage control
- Disability/dysfunction of CNS
- Exposure and environmental control
When would you assume C-spine damage?
- High-speed impact
- Head injury
- Neck pain
- Any positive neurology
If the patient is talking, what does this imply?
- Airway is patent
- Brain is perfusing adequately with oxygenated blood
If a patient is struggling to maintain their airway, what can be done?
In order of which manoeuvre you would use first
- Head tilt/chin lift/jaw thrust
- Guedel airway
- Nasopharyngeal airway
- LMA
- I-Gel
- ET tube
- Sugrical airway
When would you use jaw thrust only as an airway manoeuvre?
Suspected c-spine
Once airway is secured, how much oxygen should every patient receive?
15 L/min 100% oxygen
What would you examine the neck for in a trauma situation?
- Wounds
- Tracheal position
- Venous distention
- Surgical emphysema
- Laryngeal crepitus
If you had a restless thrashing patient, how would you manage the c-spine?
Cervical spine can be damaged by immobilising the head and neck while allowing the rest of the body to move. Suboptimal immobilisation with just a semi-rigid collar is therefore accepted
What are life threatening breathing problems that need to be dealt with immediately?
- Airway obstruction/dysfunction
- Tension pneumothorax
- Open chest wound
- Massive Haemothorax
- Flail Chest
- Cardiac Tamponade
When assessing breathing, what would you assess?
- SpO2 using sats probe (centrally loacted preferable)
- Resp Rate
- Inspection - symmetry, effort, injuries/bruising
- Palpation
- Percussion
- Ascultation
When listening to the chest, what is important to remember?
Listening to front of chest assesses air entry to large airways, whereas listening to the axilla gives an idication of pulmonary ventialtion. Tension pneumothorax/haemothorax can be identified this way
What are common causes of reduced bilateral air entry?
- Obstruction of URT
- Leak between face and mask
What are common causes of unilateral reduced air entry?
- Pneumothorax
- Haemothorax
- Intubaton of right main bronchus
- Foreign body in main bronchus
- Significant lung contusion
How would you assess circulation and haemorrhage control?
- HR
- BP
- PEripheral/central Cap refill
- Colour
- Peripheral perfusion
- Look for signs of haemorrhage (internal/external)
- ECG
How much blood do you need to lose before blood pressure starts to drop?
Roughly 30% - tachycardia and reduced pulse pressure occur at <30%
When would you use a tourniquet to control bleeding?
When the limb is deemed unsalvagable
What access options are available in trauma situations?
- Wide bore cannulas - antecubital fossa
- Wide bore central lines
- Intraosseous
Once you have access, what tests should you do?
- Crossmatch
- ABG
- FBC, U+Es
What BP do you need to have to have a radial pulse?
80 mmHg
What BP do you need to have to have a palpable femoral pulse?
70-80 mmHg
What BP do you need to have to have a plapable carotid pulse?
60-70 mmHg
What is the aim of fluid resuscitation?
To restore critical organ perfusion until haemorrhage that is amenable to surgery is stemmed
How would you reduce the risk of hypothermia when giving fluids?
Warm the fluids
If, when giving resus fluids, the individuals vital signs initially improve but then begin to deteriorate again, what does this indicate?
The individual is still actively bleeding and has lost more than 20% BV. They require transfusion and often surgical intervention
If someone does not respond to resus fluids, what does this indicate?
Suggests either that the shock has not been caused by hypovolaemia or that the patient is bleeding faster than blood is being infused
What are the major anatomical sites for major haemorrhage?
On the floor and 4 more:
- External haemorrhage
- Chest
- Abdomen
- Pelvis and retroperitoneum
- Around long bone fractures - esp femur
What percentage blood loss has occured in someone who does not respond at all to fluid resus?
40%
How would you assess disability/CNS dysfunction?
- AVPU
- GCS
- Pupillary response
- Focused/Gross neuro exam - stick tongue out, squeeze finger, wiggle toes, limb movements
- Blood glucose
What is involved in exposure and environmental control?
All clothing impeding the primary survey should have
been removed with minimal patient movement. Remaining clothing should now be removed.
To prevent patients subsequently becoming cold, they should be covered with warm blankets (and/or a Bair Hugger) when not being examined and the resuscitation room kept warm.
when would you consider moving onto secondary survey?
Only when all ventilatory and circulatory problems have been corrected (which may mean surgery) can the team continue with the more detailed secondary survey (in the resuscitation room or later after surgery)
