Management of multiple trauma

Question 1

What are the categories under the trimordial death distribution?

Answer 1

Immediate deaths: death within 2 hours e.g. cardiac rupture, aortic rupture, brainstem detachment (not much can be done at this stage)
Early deaths: 24-72hrs e.g. tension haemothorax, flail chest
Late death: 3 weeks

Question 2

What is the ATLS algorithm?

Answer 2

ATLS (Advanced Trauma Life Support) the algorithm follows a Primary Survey (ABCDE Approach) and Secondary Survey approach, both aimed at quickly identifying and managing life-threatening conditions

Question 3

How do you manage the airway?

Answer 3

• chin lift (however this can worsen a c-spine injury)
• jaw thrust (applying a longitudinal tracture)
  if these methods fail…
• surgical airway (tracheostomy) - long term
• needle into the trachea: a small cut is made below the cricothyroid - short term
• oropharyngeal airway: goes over the tingue and pulls the tongue forward
• endotracheal tube
• laryngeal mask airway

Question 4

What are the steps of initial assessment?

Answer 4

Airway with c-spine protection
Breathing / ventilation / oxygenation
Circulation: stop the bleeding!
Disability / neurological status
Expose / Environment / body temperature

Question 5

What are the 4 ways to stabilize a c-spine?

Answer 5

1. Rigid cervical collar (philadelphia in collar)
2. Rigid spine board
3. Sand bags (prevents the head from moving sideways)
4. Head strap (to strap the head to the spine board)

Question 6

normal respiratory rate for adults and children

Answer 6

16-20 breaths per minute - adults

Question 7

What is a tracheostomy? When is an emergency tracheostomy indicated?

Answer 7

A tracheostomy is a medical procedure in which a surgical opening is made in the trachea (windpipe) to allow for breathing. A tube is inserted into the opening to provide a direct airway, bypassing the upper airways. This is often done when someone has difficulty breathing due to an obstruction, injury, or disease affecting the upper respiratory tract.

An emergency tracheostomy is indicated if the patient is deeply cyanosed or apnoeic and an endotracheal tube cannot be inserted safely.

Question 8

What is a cricothyrotomy or needle cricothyroidotomy?

Answer 8

This is an emergency procedure used to establish an airway when someone is unable to breathe and other methods (like intubation) aren’t possible or effective
In this procedure, a needle or small catheter is inserted through the cricothyroid membrane (the space between the thyroid and cricoid cartilage in the neck) to create a temporary airway. It allows for immediate airflow into the lungs while a more permanent solution, like a tracheostomy, might be arranged if needed.

The needle cricothyrotomy is often used in life-threatening situations, such as when there is swelling or trauma to the upper airway that blocks normal breathing

Question 9

How do you manage a patients breathing?

Answer 9

• this deals with the lower respiratory tract
• it involves the lungs pleural cavity and chest wall
• Assess and ensure adequate oxygenation and ventilation
• observe for manifestation of breathing obstructions
• excessive breathing cycles will require a ventilator/ life support
• asymmetrical elevation of the chest if one lung collapses
  Check the:
  ● Respiratory rate
  ● Chest movement
  ● Air entry
  ● Oxygen saturation

Question 10

What is a normal Oxygen saturation rate and what is considered hypoxic? What intrument is used to measure it?

Answer 10

Normal is 96-100%
Hypoxia is <96%
This is measured with a pulse oximeter

Question 11

The lungs can be compressed due to what conditions?

Answer 11

Pneumothorax: The presence of air in the pleural space, causing a lung to collapse.

Haemothorax: The accumulation of blood in the pleural space, often due to injury or trauma.

Pyothorax: The accumulation of pus in the pleural space, typically due to infection.

Chylothorax: The presence of lymphatic fluid (chyle) in the pleural space, often from a disrupted lymphatic duct

Question 12

What is flail chest? How do we resusciate such a patient?

Answer 12

Segmental separation of chest wall causing inability to breath and ventilate the lungs

Clinical features:
* dyspnea & tachypnea
* paradoxical movement
* decreased breath sound

Question 13

Tension Pneumothorax: Clinical Features and Presentation

Answer 13

High pressure pneumothorax causing cardiovascular compromised status

Clinical features include:
* chest injury
* dyspnea & tachypnea
* distended neck vein
* deviated trachea
* hypotension
* tympanic on percussion
* absent breath sound

Question 13

Look, feel, palpate and listen for…

Answer 13

Tension pneumothorax
Open pneumothorax
Severe flail chest

Question 14

What is open pneumothorax? How do you resuscitate a patient with open pneumothorax?

Answer 14

Abnormal connection between pleural cavity and atmosphere causing inability to ventilate the lungs

Resuscitation:
three-sided dressing
ICD
Oxygenation

1. Three-sided dressing:

This refers to the method of covering the open wound with a dressing and securing it with tape on three sides only, leaving the fourth side open. This allows air to escape from the chest cavity but prevents it from being sucked in, helping to prevent worsening of the pneumothorax and the risk of developing a tension pneumothorax.

2. ICD (Intercostal Chest Drain):

This refers to the placement of a chest tube (also called a chest drain) between the ribs to remove air, blood, or fluid from the pleural space (the area between the lungs and chest wall). This is a more definitive treatment to relieve a pneumothorax or haemothorax and to help the lung re-expand.

3. Oxygenation:

This refers to the process of supplying the patient with oxygen, usually through a mask or a ventilator. In the case of pneumothorax, oxygenation helps ensure the patient gets enough oxygen, particularly if they are struggling to breathe due to collapsed lung or reduced lung capacity