Multiple trauma or acute head injury Flashcards
Fast scan: How many ml of fluid can be detected
• 100-250 ml detected by FAST Scan • 100 ml detected by CT scan
Fast scan: Disadvantages
- Important to recognise limitations
- Not useful for hollow/solid organ injury • Serial examination if negative
- Obesity/Air – poor visualisation
- Operator Dependent
- Not useful in Haemodynamically stable
Artefact • Physician - Probe position, control settings • Patient -shadowing,enhancement,motion,gas anatomy • Physics - Mirror, reverberation
Fast scan: what is it?
- Focused Abdominal Sonogram in trauma (FAST)
- Focused
- goal directed
- sonographic examination of the abdomen aimed at detecting the presence or absence of haemoperitoneum.
- Extension of clinical Evaluation
- Not a Diagnostic Tool
Fast scan: Image Intepretation - what is white what is black?
high resistance - White bone/stone
grey liver/ spleen/ kidney
low resistance - Black Blood/urine/other fluid
Fast scan: Uses/ advantages /disadvantages
- FAST scan to be used as a tool for further investigation • High specificity
- Low Negative predictive value
- In unstable patients FAST may help
- Negative FAST does not rule out abdominal Injury
AT MIST trauma history
Age
Time since incident
Mechanism
Injuries
Signs & Symptoms
Treatment
Trauma: Primary/Secondary Survey
Only commence once the primary survey was done and the patient is stabilizing. Head to toe examination Log roll + remove the spinal board Lateral c-spine x-ray Investigation and treatment plan DOCUMENT HOW MUCH OF THIS HAS BEEN DONE
Inspection – wounds, swelling, bruising, FB’s, bleeding, genital involvement FAST scan DPL X-rays – Abdomen, Chest, Pelvis Urine sample
23 yr old male fell from first floor balcony onto a wall, sustained injury to abdomen/upper legs. Brought in by ambulance (Technician crew)
A: clear, self maintained, minor facial injuries
c: collar in situ
B: RR 24, chest clear, saturations 96%
C: HR 116, BP 96/50, CRT 3 secs
D: AVPU, GCS 15/15
E: No obvious major haemorrhage evident,
What are you going to do?
Lines in and fluid challenge started.
Undress for full survey
23 yr old male fell from first floor balcony onto a wall, sustained injury to abdomen/upper legs. Brought in by ambulance (Technician crew)
A: clear, self maintained, minor facial injuries
c: collar in situ
B: RR 24, chest clear, saturations 96%
C: HR 116, BP 96/50, CRT 3 secs
D: AVPU, GCS 15/15
E: No obvious major haemorrhage evident,
Lines are inserted and fluid challenge is started.
When undressed obvious contusions across lower abdomen, feet are both laterally rotated, blood evident around urethral meatus.
What are you going to do now?
Pelvic binding
Trauma Training: AMPLE history taking
allergies medications past medical history last meal time events surrounding injury
Trauma primary survey
Horizontal Resuscitation
Catastrophic hemorrhage control
A Airway & cervical spine immobilization
B Breathing and ventilation
C Circulation & hemorrhage control
D Disability
E Exposure and environment control
Trauma primary survey: How do you assess airway and C spine?
Assessment
- Obstructed/partially obstructed or threatened
- Look for any loose teeth or foreign body
- Look for any blood, secretions, vomitus
- Look for any external swelling, edema, injury
- Added sounds-gurgling, snoring, stridor
Interventions
- Position the patient –maintain c spine
- Airway maneuvers - Jaw thrust
- Suction or remove the foreign body
- Adjuncts-check the contraindications for NP, RSI, Needle or surgical cricothyrotomy
Trauma primary survey: criteria for RSI
Unconscious-GCS<8
Uncontrolled agitation
Trauma primary survey: How do you assess breathing?
Assessment
- Look: Spontaneously breathing, pattern, symmetry, wounds/bruises/deformity, skin color, jugular veins
- Feel: Crepitus, tenderness, trachea, percussion note
- Listen: Breath sounds or added sounds
- Monitor: Rate and O2 sats
Interventions
- Supplemental high flow oxygen
- Bag-valve-mask ventilation
- Needle thoracentesis
- Chest drain insertion
Trauma primary survey: How do you assess circulation and haemorrhage?
Assessment: LOOK for signs of bleeding:
- Tachycardia-rate and volume
- Poor perfusion: skin colour and temperature
- Narrow pulse pressure
- Low blood pressure
- Anxiety/confusion
