Multiple Injured Patient Flashcards
Pre-hospital Trauma care
Mechanism of injury
Injuries sustained by patient
Symptoms/signs pre-hospital
Treatment pre-hospital
Primary survey
(ABCDE)
Airway and cervical spine control
Breathing and ventilation control
Circulation and haemorrhage/shock control
Disability of the neurologic system-assesed by GCS
Exposure and temperature control
Airway (PEIO)
Establish patient airway and protect C-spine
Pitfalls:a progressive story of a doctor and an emergency patient on road losing their breathing
Occult airway injury
Progressive loss of airway
Equipment failure
Inability to intubate
Breathing and ventilation
Hint:RACO
Respiratory rate
Chest movement
Air entry
Oxygen saturation
Circulatory management
Control haemorrhage -Restore volume-Reassess patient
Pitfalls
-elderly
Children
Athletes
Medications
Disability
Baseline neurologic evaluation
Glasgow coma scale score
Pupillary response
Pitfalls:Observe for neurologic deterioration
Exposure/environment
Completely undress the patient
Resuscitation
Protect and secure airway
Ventilate and oxygenate
Stop the bleeding
Crystalloid/blood resuscitation
Protect from hypothermia.
When to start sec survey
After:
Primary survey is completed ABCDEs are reassessed
Vital functions are returning to normal
Component of secondary survey
History
Physical exam
Complete neurological exam
Specific diagnostic tests
Re-evaluation
Sec survey
Hint AMPLE
History
Allergies
Medications
Past illness
Last meal
Events/environment/mechanism
Maxillofacial (sec survey)
Bony crepitus
Deformity
Malocclusion
Neck(soft tissues)
Mechanism
Mechanisms:blunt Vs penetrating
Neck(soft tissues)
Symptoms
Symptoms:Airway obstruction,hoarseness
Neck(soft tissues)
Findings
Findings:crepitus hematoma stridor,bruit
Secondary survey detailed examination
Head
Neck
Chest
Abdomen
Pelvis
Back
Extremities
Secondary survey
Perineum
Confusion,hematoma ,lacerations,urethral blood
Sec survey(rectum)
Sphincter tone,high riding prostate,pelvic fracture ,rectal wall integrity,blood
Sec survey
Vagina
Blood,lacerations
Neurologic:Spinal assessment
Whole spine
Tenderness and swelling
Complete motor and sensory exams
Reflexes
Imagining studies
Neurologic:Spiral Assessment
Pitfalls
-Altered sensorium
-inability to cooperate with clinical exam
Concepts of initial assessment
Primary Survey(resuscitation,adjuncts ) and re-evaluation
Detailed sec survey(re-evaluation and adjuncts)
Re-evaluation,definitive care
Adjuncts to primary survey
Vital signs
ECG
ABGs
Urinary output
Urinary/gastric catheters unless contraindicated
Pulse oximeter
Sec survey
Abdomen
Inspect,palpate ,re-evaluate special studies
Chest
Inspect
Palpate
Percuss
Auscultate
X-rays
Sec survey
Pelvis
Pain on palpation
Leg length unequal
Instability
X rays as needed
Sec survey
Extremities
Contusion,deformity
Pain
Perfusion
Peripheral
X rays
