Multiple injuries Flashcards
ISS- Injury SeverityScore
Head and neck (+ cervical spine)
Face (facial skeleton, nose, mouth, eyes, ears)
Chest (thoracic spine, diaphragm)
Abdomen and pelvic content (organs, lumbar spine)
Extremities or pelvic girdle (pelvic skeleton)
External
AIS (abbreviated injury scale)
anatomically based global severity scoring system which classifies each injury in every body region according to it’s relative severity on a six-point ordinal scale
9 Head Face Neck Thorax Abdomen Spine Upper Extremity Lower Extremity External and other
Minor Moderate Serious Severe Critical Maximal (currently untreatable)
management of massive haemorrhage
Two large bore cannulae/trauma line Rapid warm IV fluids High-flow oxygen Urgent X-match Group specific or O negative blood Direct pressure +/- tourniquet Avoid coagulopathy, hypothermia and acidosis (‘Deadly Triad’) Clotting products – FFP, PCC, platelets, etc. Tranexamic acid Damage Control Surgery
causes of secondary brain injury
hypotension hypoxia hypercapnia hypoglycaemia hyperglycaemia pain
how are head injuries classified?
skull
- fracture (open/closed/depressed) (vault/base)
brain
- haematoma (extradural, subdural, subarachnoid, intracerebral)
- DAI (diffuse axonal injury)
racoon eyes and battle’s sign
racoon eyes:
bruising around eyes
base of skull injury
battle sign:
bruising behind ears
extradural haematoma
skull fracture (temporal) laceration of meningeal vessel
if arterial injury occurs the dura is stripped from the inner tale of the skull and mass lesions develops
LOC brief then lucid period
subdural haematoma
more common than extradural
tearing of the bridging veins that drain blood from the cortex to the dural sinuses
patients who have conditions that cause cerebral atrophy are vulnerable (alcohol, dementia, raging)
acute is 24 hrs after injury,
subacute can be 1-14 days post injury
chronic- 2 weeks following injury.
DAI
diffuse axonal injury initiated by the trauma process often not visible on early CT affects the brainstem, corpus callous, frontal and temporal lobes present on MRI
splenic trauma
most common injured organ following blunt trauma. presents in first 24 hours. delayed rupture is usual
history of injury to left lower ribs and upper abdomen. intra-abdominal bleeding
LUQ pain and tenderness
left shoulder pain
risk factors:
glandular fever (IM) (EBV)
lymphoma, leukaemia
malaria or other causes of splenomegaly
splenic trauma imaging and management
FAST- focused abdominal sonography for trauma
CT- consider IV and nasogastric contrast
Chest Xray - for fractured lower ribs
grade 3-4 require laparotomy even if haemodynamically stable
grade 1-2 ay also require palprotomy if other abode injuries are suspected/confirmed
fat embolism syndrome
common following fractures of femur, tibia, fibula and after elective hip injury.
clinical features
breathless, tachypnoea, hyperaemia, increased o2 dependence, confusion, agitation, coma, convulsions, petechiae.
what’s the pathophysiology of FES?
there is a mechanical obstruction of the capillaries so a V/Q mismatch = hypoxaemia
activation of inflammatory mediators like PGE, cytokines which causes capillary leak and alveolar oedema (more hypoxaemia)
decreased lung compliance so increased work of breathing
ARDS
An acute inflammatory lung condition. Non-cardiogenic pulmonary oedema.
Many possible causes (inc. FES)
(direct)
pneumonia, aspiration, trauma/contusion, smoke inhalation, fat embolus.
(indirect)
severe sepsis, pancreatitis, massive transfusions, shock
pathophysiology: endothelial injury causes activation of mediators = capillary leak. surfactant depletion so reduced complicance. increased work of breathing. V/Q mismatch causes hypoxaemia.
Associated with alveolar oedema, depletion of surfactant and decreased lung compliance
Clinically presents with hypoxaemia, tachypnoea, low grade fever, leading to respiratory failure
Onset over 6-48 hours
30 – 60% mortality
how is ARDS managed?
Oxygen Ventilation + PEEP Remove / treat underlying cause Careful fluid balance General supportive care
