Management of Major Trauma Flashcards
Which device provides a definitive airway?
Cuffed ET tube
Which devices can be used to achieve a temporary airway?
Oropharyngeal (guedel)
Nasopharyngeal
What can be done as a last resort if unsuccessful at achieving an airway?
Emergency cricothyroidotomy
Which other point needs to be addressed along with Airway in management of major trauma?
C-spine stabilisation
What is the best measure of breathing and ventilation?
Pulse oximetry
How is a tension pneumothorax managed?
Large bore needle into 2nd intercostal space, mid clavicular line
How is an open pneumothorax managed?
Chest drain away from puncture site
may turn into tension pneumothorax
How is a haemothorax managed initially?
Chest drain
What is a flail chest?
Segmental fractures of 2 or more ribs –> discontinuity of thoracic cage –> reduced expansion of underlying lung
How should a flail chest be managed?
Assisted ventilation via definitive airway
What is pulmonary contusion?
Blood filling alveoli with reduced ventilation
What is the initial fluid management in major trauma?
Bilateral large bore cannulas + 2 litres of IV crystalloid initially
What is the minimum accepted urine output?
30ml/hour
What is usually the first sign of hypovolaemia?
Increased HR (then reduced BP)
If giving fluids results in a transient response (reduced HR, increased BP), what might this indicate?
Ongoing bleeding
May be cardiac tamponade
Which sign may indicate intra-abdominal bleeding and how might this be investigated?
Peritonism
USS, CT, peritoneal lavage
Where might the bleeding becoming from in a pelvic fracture?
Internal iliac + branches
Pelvic venous plexus
Broken bone
How should a pelvic fracture be managed initially?
Emergency pelvic binder
How should obvious external bleeding be initially managed?
Apply direct pressure/tourniquet
Which GCS score would indicate definite loss of airway control?
< 8
How should you investigate a patient with history/signs of significant head injury?
CT head + C-spine
What is included in the primary survey?
ABCDE
Give some examples of further assessments done at the end of the primary survey?
Trauma series of X-rays –> lateral c-spine, chest, pelvis + long bones
Log roll patient –> check for spinal fractures + PR for bleeding, tone and sensation
Catheter
NG tube to prevent aspiration
ABG, crossmatch, group + save, routine bloods
What might suggest injury to the urinary tract?
Bleeding at urethral meatus –> call urologist, do not catheterise
When is the secondary survey done and what is included?
Only once patient is stable –>
- head-to-toe examination looking for any other injuries
- more thorough history of injury, PMH, fasting status
What is polytrauma?
Injury of more than one major long bone OR
major fracture associated with chest/abdominal trauma
Which syndromes can occur as a result of polytrauma?
SIRS (systemic inflammatory response)
ARDS (adult respiratory distress)
MODS (multi-organ dysfunction)
What causes SIRS in polytrauma?
Increased activation of inflammatory cascade
What might cause ARDS in polytrauma?
Hypoperfusion
SIRS
Aspiration
Fat embolism
How does MODS result from polytrauma?
Hypovolaemia + SIRS + ARDS
How should polytrauma be managed to avoid developing these syndromes?
Rapid skeletal stabilisation with external fixators
–> ‘damage control orthopaedics’
