Management of Major Trauma

Question 1

Which device provides a definitive airway?

Answer 1

Cuffed ET tube

Question 2

Which devices can be used to achieve a temporary airway?

Answer 2

Oropharyngeal (guedel)

Nasopharyngeal

Question 3

What can be done as a last resort if unsuccessful at achieving an airway?

Answer 3

Emergency cricothyroidotomy

Question 4

Which other point needs to be addressed along with Airway in management of major trauma?

Answer 4

C-spine stabilisation

Question 5

What is the best measure of breathing and ventilation?

Answer 5

Pulse oximetry

Question 6

How is a tension pneumothorax managed?

Answer 6

Large bore needle into 2nd intercostal space, mid clavicular line

Question 7

How is an open pneumothorax managed?

Answer 7

Chest drain away from puncture site

may turn into tension pneumothorax

Question 8

How is a haemothorax managed initially?

Answer 8

Chest drain

Question 9

What is a flail chest?

Answer 9

Segmental fractures of 2 or more ribs –> discontinuity of thoracic cage –> reduced expansion of underlying lung

Question 10

How should a flail chest be managed?

Answer 10

Assisted ventilation via definitive airway

Question 11

What is pulmonary contusion?

Answer 11

Blood filling alveoli with reduced ventilation

Question 12

What is the initial fluid management in major trauma?

Answer 12

Bilateral large bore cannulas + 2 litres of IV crystalloid initially

Question 13

What is the minimum accepted urine output?

Answer 13

30ml/hour

Question 14

What is usually the first sign of hypovolaemia?

Answer 14

Increased HR (then reduced BP)

Question 15

If giving fluids results in a transient response (reduced HR, increased BP), what might this indicate?

Answer 15

Ongoing bleeding

May be cardiac tamponade

Question 16

Which sign may indicate intra-abdominal bleeding and how might this be investigated?

Answer 16

Peritonism

USS, CT, peritoneal lavage

Question 17

Where might the bleeding becoming from in a pelvic fracture?

Answer 17

Internal iliac + branches
Pelvic venous plexus
Broken bone

Question 18

How should a pelvic fracture be managed initially?

Answer 18

Emergency pelvic binder

Question 19

How should obvious external bleeding be initially managed?

Answer 19

Apply direct pressure/tourniquet

Question 20

Which GCS score would indicate definite loss of airway control?

Answer 20

< 8

Question 21

How should you investigate a patient with history/signs of significant head injury?

Answer 21

CT head + C-spine

Question 22

What is included in the primary survey?

Answer 22

ABCDE

Question 23

Give some examples of further assessments done at the end of the primary survey?

Answer 23

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

Question 24

What might suggest injury to the urinary tract?

Answer 24

Bleeding at urethral meatus –> call urologist, do not catheterise

Question 25

When is the secondary survey done and what is included?

Answer 25

Only once patient is stable –>

• head-to-toe examination looking for any other injuries
• more thorough history of injury, PMH, fasting status

Question 26

What is polytrauma?

Answer 26

Injury of more than one major long bone OR

major fracture associated with chest/abdominal trauma

Question 27

Which syndromes can occur as a result of polytrauma?

Answer 27

SIRS (systemic inflammatory response)
ARDS (adult respiratory distress)
MODS (multi-organ dysfunction)

Question 28

What causes SIRS in polytrauma?

Answer 28

Increased activation of inflammatory cascade

Question 29

What might cause ARDS in polytrauma?

Answer 29

Hypoperfusion
SIRS
Aspiration
Fat embolism

Question 30

How does MODS result from polytrauma?

Answer 30

Hypovolaemia + SIRS + ARDS

Question 31

How should polytrauma be managed to avoid developing these syndromes?

Answer 31

Rapid skeletal stabilisation with external fixators

–> ‘damage control orthopaedics’