Myhow Flashcards
Rapid primary survey
Airway Breathing Cirulation Disability Exposure/ environmental control
Airway & cervical spine control
Initial mx
1- assess? 5
2- create and maintain airway? 5
3- position
1- assess airway patency
- speak in full sentences
- no foreign body ij object
- no facial injuries
- no cervical tenderness & full ROM
- c-collar on
2- create or maintain airway by
- looking with suction
- chin lift or jaw thrust
- naso/oropharyngeal airway
- orotracheal intubation
- cricothyroidectomy
3- check for cervical spine injury
-maintain spine in safe neutral position (c-collar) until clinical exam and radio findings exclude injury
Breathing
- give what?
- what to assess? 4
-what to recognize & treat?
1- high flow oxygen
2- assess chest
- inspection- breathing spontaneous
- palpation and feeling of trachea- trachea not deviated, chest rise equal, chest spring negative, no crepitus, no chest wall trauma
- percussion- percussion resonant
- auscultation-lungs clear air entry equal
3- recognise and treat ATOM-FC
ATOM-FC
Airway obstruction or disruption Tension pneumothorax Open pneumothorax Massive pneumothorax Flail chest Cardiac tamponade
Disability? - - - -
1- GCS & DXT
2- pupillary size and response
3- examine lateralising sign and signs of cord injury
4- moving all four limbs?
Circulation
What to assess?
- inspect
- palpation 8
- auscultation
Assess circulation
Inspect:
-looking for external hemorrhage or active bleeding
Palpation:
- skin color, temperature & capillary refill
- pelvic spring
- abdominal trauma
- pulse
- blood pressure
- neck veins
Auscultation: muffled heart sound
5 N
Noggin- raccoon eyes, Battle’s sign
Neck- C spine, neurogenic shock, nuchal ridgidity
eNt- otorrhea, rhinorrhea, tongue biting, hemortympanum
Needles- iv drug abuser
Neurological- GCS, posture, movement, pupils, reflexes, corneal reflex, gag reflex, doll’s eye reflex, oculovestibular reflex
Airway maintenance with C-spine control
- airway normal? Compromised?
- cervical spine- normal? Suspect injury?
1) airway patency
- NORMAL breathing/speech
- Compromised: stridor, cyanosis
2) Cervical Spine
- NORMAL: non tender, ROM full - Suspect Injury: tender
Breathing and ventilation
Vitals: SpO2, RR
NORMAL: spontaneous
Compromised: stridor, unequal chest rise
Inspection: trachea deviation, chest rise, flail chest
Palpation: chest spring, crepitus/emphysema
Auscultation - normal breath sound/Crepts/Silent Chest?
Percussion - resonant/hyperresonant/dull
Intervention- breathing
- head tilt-chin lift / jaw thrust
- remove foreign body by sweeping - O2 mask
- oropharyngeal airway + bag
- Intubation
-protect C spine with collar
Circulation
Pulses, hemorrhage control
Vitals: HR, BP / CRT, peripheries warm?
Inspection: active bleeding/bruises/open wound
Palpation: pelvic spring/PA tender
Ausc: muffled heart sounds
Perc: PA dullness
Intervention- circulation
- 2 large bore branula
- FBC/RP/VBG/Coagulation/RBS
- IV fluids
- Hemorrhage control- compression bandage/tourniquet
Disability
Neurologic status
Vitals: DXT
1) GCS: EVM
2) Pupils equal/reactive to light?
3) Gross Motor fn: Limbs – movement / deformity
4) Spinal injury? priapism, loss of anal sphincter tone/ bulbocavernosus reflex
Exposure and environment
Vitals: Temperature
1) Remove clothes, inspect for wounds
2) warm blanket and saline
Intervention- environment control & exposure
- Cover with blanket
- Analgesic
Adjuncts
1- Log roll
2- FAST scan
Intervention- disability
- Hypoglycemia: Dextrose 50% 50cc stat + IVD D10%
- Seizure control: midazolam 5-10mg IV, followed by phenytoin 18mg/kg IV over 30 minutes
- Fracture: immobilization/splint
- GCS
Log roll
A) Involves at least 3 person:
Stabilize head + pelvis + limbs
- turn body together at the count of 3, turn away form injured limb
B) Examine back
- check for bruises/open wound
- check for spinal tenderness/step deformity
- PR – anal tone, high riding prostate (in semi-conscious pt, CBD tug can elicit anal tone –BCR-bulbocavernous reflex)
FAST exam
Where does blood collect?
4 potential spaces where fluid collects
- Morison’s pouch - blood in RUQ - hepatorenal recess (Morison’s pouch) between liver and right kidney, will also flow into right paracolic gutter into pelvis blood in LUQ - often between diaphragm and spleen, will also flow into splenorenal recess, then into left paracolic gutter into pelvis
- Subdiaphragmatic - blood in LUQ, // the phrenocolic ligament often shunts fluid to Morison’s pouch before filling the left paracolic gutter
- Pericardial - blood around heart
- Posterior cul de sac - blood in pelvis; rectovesical or rectouterine pouch, then into paracolic gutters
Secondary survey
Head
Scalp: laceration
Skull: depression/basal #
face: L/w or #, midface or maxilla instability eyes: Orbit/globe/eyelid injury
ears: haemotympanum, CSF leak
nose: bleeding
Mouth: Tooth #
Neck - C spine injury, soft tissues (larynx)
Chest
- chest wall injury, # ribs, flail chest, open Pneumothorax, emphysema, Haemothorax, pulmonary contusion
Abdomen
- skin contusion/abrasion, distension, tenderness, guarding PR: lax anal tone, blood, high prostate
PV: injury/bleed
Perineum : blood at urethra, hematuria
Extremities: limb fractures/deformities
ATOM FC 2
Aortic dissection
Thorax injuries
(non-massive haemothorax, simple pneumothorax),
Oesphageal perforation,
Muscular diaphragmatic injury,
Fistula (bronchopleural) and other tracheobronchial injury
Contusion to the heart or lungs
Rapid sequence intubation 9P’s
1) Preparation
- Yourself: PPE-Mask, apron, gloves, - Your team
- Equipment
2) Preoxygenation
- HFM 15L/min for 3-5mins
3) Position
- sniffing position, flex neck, extend head
4) Premedication
IV Fentanyl 3mcg/kg
IV Lignocaine Lidocaine 1.5mg/kg
5) Put to sleep (Induction agent)
IV Etomidate 0.3mg/kg IV Ketamine 1-4.5mg/kg IV Propofol 2-2.5mg/kg IV Midazolam 0.3mg/kg
6) Pressure (cricoid) - BURP” Backward, Upward, Rightward Pressure
7) Paralysis
IV Succinylcholine 1-1.5mg/kg IV Rocuronium 0.6-1.2mg/kg
8) Placement confirmation
Auscultation, Lung expansion, Spo2
9) Postintubation care
Secure ETT
Initiate mechanical ventilation
Sedation
CXR
Equipments
1- ETT tube
2- Stylet
3- syringe 10cc
4- Suction catheter
5- Carbon dioxide detector
6- Oral and nasal airways
7- Ambu bag and mask attached to oxygen source
8- Assistant for cricoid pressure
Indications for intubation
- unable to protect airway
- inadequate spontaneous ventilation
- O2 saturation
COMA
GCS
Eyes 1 2 3 4
Verbal 1 2 3 4 5
Motor 1 2 3 4 5 6
