Paramedic - Major Trauma Flashcards
What are the different methods used to control external cat Hem
1) direct pressure - hands, haemostatic gauze,
2) indirect pressure - tourniquet, blast bandage
Why should times be taken when tourniquet are applied
Over 2 hour increase risk of ischemia post isolation point. Rabdomutlsis compartment syndrome, nerve damage, tissue death
What does the first c stand for I’m drccabc
Cat hem
What is the 1st collum in the trauma triage tool (WMAS) - vital signs
Respiratory rate - 10-29 (outside problem)
Bp: under 90mmgh - (problem )
GCS : mother score less than 4
What is the second column in trauma triage tool (WMAS) - anatomy (full body)
Any depressed or open skull fracture
Any chest injury with hypoxia
Any torso penetration trauma
Any spinal injury with paralysis
Major pelvic injury
2+ long bone injury
Any amputation /open fracture / or mess above ankle and wrist
Where do major trauma patient go
MTC - major trauma centre
What is silver trauma safety net: + what is the age range for this to be in place
Patient must be over 65 with
-Bp of under 110 post injury
-Any femur or open fractures
-Hugh mechanism of injury
when you attended any patient especially children, elderly and vulnerable people - what should you ensure matches id the incident is accidental or intentional think safeguarding
Does the history, match the presentation match what I know about a&p
What does DRCCABC stand for
Danger
Response
Cat hem
C spine
Airway
Breathing
Circulation
In a CAR RTC - frontal impact. What types of injuries are more likely.
Quick stop - delegation
Up and over
Chest - hit steering wheel
Abdominal - hitting steering wheel
Down and under
Knee hit under steering
Face plant into steering wheels
In a car RTC - rear impact what is the likely injuries.
Neck - quick flextion and extension.
Whip lash
I’m a car RTC with Lateral impact.
What are the suspected Injuries
Injuries to impact side - arm, pelvis
Rational of neck
I’m a car RTC with rotational collision what are the suspect injuries
Combination of frontal and lateral
Person closest to impact = worse injuryies
In a car RTC with roller over
What are suspect injuries
All types. With person not wearing seatbelt - will be in the front out out of the car.
in a RTC - car vs predestrian, what are the suspected injuryies
hip and leg - from inual impact
torso - from hitting windscreen
head- from hitting ground
in a RTC - pedestrian vs car - adult vs child, where do you suspect they will have injuries ( posterior/ anterior and why
child - anterior = they look at th vechile and freeze
adult - posterior - they tend to run away
what are the managment principle of DR CCABCde
c– Control of exsanguinating haemorrhage
ca– Airway and cervical spine control
B– Breathing with high-flow oxygen
C– Circulation with haemorrhage control
D– Disability with prevention of secondary injury
E– Exposure with temperature control
what are the main point for cat hem to occur
injury site
junctional areas - axilla, neck groin, perituim
when dealing with petrating chest injury what is the preferable bandage to apply
Russel chest seal - valve - air out not in = less chance of tension pneumothorax
how to apply a cat hem torniquet
Identify site needs bleed stop
2/3 cm above
Clip on and tighten
Twist to further close and secure
how di you apply a kendrick traction splint
Measure bar against good leg
Place blue strap against the groin
Get the ankle strap lengthen the orange strap
Fix the ankle strap on the ankle
Place the bar peg bit on the orange bit
Get the knee strap on
Place traction via the red strap
Fix the leg in place via the traffic light system
Recheck leg - pulse and cap refill
how do you apply a pelvic binder
Make sure patient is trauma naked
Open the binder
Place black side under patients knees
Slide it up so the middle of the minder is against the greater trochontor
Cut the binder
Get the straps on
Apply equal strength and secure the binder
what is the algorium used for the management of traumatic cardiac arrest
HOTT
H- Hypovolemia = stop cat hem, 2L saline rapid, binder and straight legs, TXA
O- Oxygenation = 15L bvm
T- Tension pneumothorax - bilateral needle
T- cardiac tamponade - merit
how does a paramedic manage the “A” in DRCCABCDE
P- patient
V - voice
B- bone ( teeth / jaw
L - liquid ( vomit/ Blood - where from ( tongue gums vomit)
how does a paramedic manage the “B” in DRCCABCDE
through 12 flaps
Tracheal Deviatio n
Wounds
Surgical Emphysema
Laryngeal Fracture
Distended Neck Veins
evaluate - IPPA
PLACE PATIENT ON 15L OF O2 any raise in RR or in dropped RR with profound trauma - peri arrest
DO NOT Rely on spo2 - lack volume ( remaining blood full saturated)
what is the mnemonic to remember the cavities in the body for internal haemorrhaging
blood on the floor and 4 more -check:
chest
abdomen
pelvis
long bones
how does a paramedic manage the “c” in DRCCABCDE
-check pulses - rate, quality (strong ect)
-Check skin - colour ( 02 / perfusion)
-check capillary refill
-blood on the floor and 4 more- check chest abdomen pelvis long bones
how does a paramedic manage the “D” in DRCCABCDE
Head injury
GCS
pupils
Bm + temp + alcohol/ drugs check
Sensation + move each limb
how does a paramedic manage the “E” in DRCCABCDE
coldness - trauma naked (prevent hypoxia
what is COMA in trauma
clothing
oxygenation
montering
access (IV/IO)
how long can the heart and brain last without oxygen before coming ischemic
4-6 minutes
how long can the abdomen and last without oxygen before coming ischemic
45 minutes
how long can the peripheries last without oxygen before coming ischemic
4-6 hours
-what generates hydorstatic pressure
-what happens if the pressure is too high/low
pressure generated by the heart - 2 mcuh water leaves blood, 2 less no blood movement
how can you work out pulse pressure
systolic - diastolic = pulse pressure ( 120-80=40)
what is MAP
what is it a measure of
What is the normal range
Mean arterial pressure - measures end organ prefusion- normal map is 70-100mmgh
what is the normal valves of MAP
70- 100mmgh
what is shock
hypoperfusion of organs leading to change in rr - problem with cardiac ouput and o2 supply therfore kidney failure = death
what is the key in preventing worsening of shock
02 and glucose
how does shock cause decrease in cardiac output
lack of blood flow to pumonary veins and vena cava - less fill = less strech = less force of contraction = less stroke volume
what is oncotic pressure
the pull of water from the outside into the blood via the solutes in it
why is having to much water ( oedema ) in the intercial space a bad thing
creates a barrier stopping oxygen getting to the cell - facilitating anaerobic respiration
When the body is experiencing shock ( hypovolemic) what pathway is activated - what are the action on of this
Sympathetic pathway
Increase RR and HR due to adrenline
Vasoconstriction of peripheral circulation - started anaerobic respiration periphery
What is a sign of irreversible shock also known as the switch from compensation to decomposition
Drop in blood pressure - volume loss to great
How many stages of hemorrhagic shock are. There
4
What is classified as 1st stage hemorrhagic shock
Upto 750ml - no signs
What is classified as 2st stage hemorrhagic shock
Upto 1500ml of blood - tachycardia + tachponea + decreased pulse pressure
= Fluids
What is classified as 3st stage hemorrhagic shock
Upto 2000ml of loss
Tachycardia - 130++++
Tachypnea - 30++++
What is classified as 4th stage hemorrhagic shock
Loss of 2000ml +++
HR - high 130 +++
Rr - 35+++
BP below 90mmgh systolic
Confused
What is distributive shock
Problem with pipes
Pipes bigger than blood supply - vasodilation
What are the sign of neurogenic shock
Low BP but NO TACHYCARDIA
Vasodilation past injury site - warm, perfused ect
Widening pulse pressure
Should be treated same as hypovolemic pt
What are the clinical signs of hypovolemia
Weak pulse
Sweaty cold cyanotic skin
Delayed CRT
Loc or.confusion
What is cardiogenic shock
Problem with the pump
Electrical mechanical - causing lack of blood flow
Cool clammy cyonosed skin
Delayed cap refill
What is a tension penumothorax
Air enter into the pluerix space
Causes pressure on lung - reducing inflation = lack O2 for RBC - shock
What is valvular disruption
Sudden force direct on heart - causes defect with heart valves
- causes acute heart failure - odema
New heart murmur
What is cardiac tamponade
When blood or fluids fill the pericardial sack - compressing and rigidity to the heart muscle - eventually stopping movement = cardiac arrest
What are the signs of life threatening conditions in major trauma ( Phbts w
Pulses - absent radial or peripheral
Tachycardia -120+
Breathing - quick
Hypothermia - cold
Skin - cyanosis or pale
Thirst
If the patient RR is above 30 what should the clinician do
BVM
What is the guidelines for fluid resuscitation - peripheral or blunt
To maintain a palpable radial pulse or BP of 90mmgh in penetration or blunt
What is the guidelines for penetrative trunk injury
Maintain a central pulse or a BP of 60mmgh - in all other injury’s a BP of 90mmgh or radial pulse
What is permissive hypotension
When you give fluids increase BP but not to normal non trauma values
Why is promissive hypotension a thing
As fluid = increased hydodtatic pressure - blowes clots
Can slow down bleed internally by not diluting clotting factors left
What is the fluid resuscitation guidelines on burns coving over 25% BSA
Give 1L over 1 hour
What is a drug given to patients who have severe bleeding within 3 hours and what is the pathophycology of the drug
TXA
stop the breakdown of clots to plasmin and stabilisers the clots
Why is preventing hypothermia important in trauma patients
Under 36 degree it affects the clothing process
What is the trauma triad
What are signs of larageal obstruction ( cartilage breakage
Horse or changed voice
Stidor
How can a person be hyperventilating but still be a dropping sats rate
Due to shallow breaking - tidal volumes 500ml + 150 dead space - reduced tidal volume = shit
Why is over infusion of saline bad or why is permissive hypotension good
As it prevent water leakage in-between the intrsuiual space - barrier for O2
Your arrive to patient who is gurgling or snoring - what the cause and what’s the difference
Obstruction - giggling= fluid, snoring - tongue to debree
What is the effect of hypoventilation
co2 build up = blood acidic increase and anaerobic respiratorn
What is the effect of hyperventilation
Vasoconstriction - causes worsening tbi
