Multiply injured patient

Question 1

Femoral fractures -> what splint

Answer 1

Thomas splint

Question 2

Trauma network vs major trauma centers.

Answer 2

Trauma network = all spots, pre hosp services, small and larfe treana centers and rehab. Major trauma centre = multi-speciality care to seriously injured patients. Optimised for trauma care provision. If can be there in 10 mins fab, otherwise is the golden hour.

Question 3

What is the method?

Answer 3

Dr(ccc, catastrophic haemorrhage,call for help,c-spine)ABCDE(g-glucose). Trauma team get pre-alert, and then ATMIST handover from paramedics (Age, time of injury, mechanism of injury, Injuries sustained, Signs and symptoms, treatment)

Question 4

ATLS vs BATLS

Answer 4

ATLS = advanced life support
BATLS = for battlefield, includes checking for cat hem beforehand.

Question 5

When do we assume c spine?

Answer 5

If mechanism would suggest. Lowering neuro response. Unconscious/reduced conscious level, neurological signs.

Question 6

Primary vs secondary survey:

Answer 6

primary – abc -> immediate threats to life. Secondary = injuries and more detailed history.

Question 7

What do we do on breathing?

Answer 7

RIPPAS. Note EEE -> Effort (RR, wheeze, accessory muscles), Efficacy (tracea, percussion, air entry), effect (stats, cyanosis)

Question 8

What are the signs of flailed segment?

Answer 8

Ribs move inwards instead of outwards when you breath in -> rib snapped in 2 .

Question 9

5 spots for blood loss:

Answer 9

pelvis, abdo, thorax, floor, long bones (femur)

Question 10

Rti -> pelvis, need to use what?

Answer 10

Pelvic binder

Question 11

What do we do for circulation

Answer 11

Get IV access, HR, pulse, BP, narrowed pulse pressure, urine output, confusion. Check haemoglobin, lactate, ultrasound/ct imaging to look for blood loss. If IV is difficult can give blood IO (into bones). Hypovolaemic patients give blood not crystoloid where you ca.

Question 12

What is permissive hypotension?

Answer 12

Giving enough fluid to perfuse vital organs but not achieving normal bp as this can disturb developing clot

Question 13

reach 6 or 4 units, add what in fluids ->

Answer 13

clotting factors and platelets

Question 14

What is the lethal triad?

Answer 14

Acidosis, coagulopathy and hypothermia

Question 15

– What do we do in D?

Answer 15

AVPU
– GCS
– Pupils
– Tone and reflexes
– Log roll

Question 16

E?

Answer 16

Expose and environment -? Exposure will allow full examination -> remember to look out for hidden injuries posteriorly!

Question 17

What do we do in secondary survey and investigation?

Answer 17

That US/CT if not already done in C. And check everything else. Looking for other non lifethreatening things.