Polytrauma (2)

Question 1

26-year-old male cyclist, involved in RTA with spine and chest trauma and hemorrhagic shock secondary to hemothorax.

What is your initial management?

Answer 1

Ensure a trauma call , resus bay, ATLS approach starting with primary survey

C-SPINE & AIRWAY:
Triple immobilization, Neck collar, blocks and straps

Speak/Screaming → Clear

Anaesth to intervene if necessary

Assessment
- Look: struggle to breath, cyanosis
- Listen: snoring, stridor
- Feel: breath on hand or cheek if unsure

Management
1. Remove FB
2. Jaw thrust better for C-spine
3. Adjunct: Oro-pharyngeal, naso-pharyngeal
4. Surgical Airway
5. Definitive airway by anaesthetist

BREATHING
1. Examine:
a. Look: Trachea position, Accessory Msls, Paradoxical movement, Rib tenderness
b. Listen: asymmetrical air entry, additional sounds
c. Feel: Hyperresonance/dullness
2. RR, O2 sat
3. Sit upright, 15L non-rebreathe mask, ATTACH TO MONITOR
- Needle decompression, Tube thoracostomy, 3 way occlusive dressing
4. ABG, CXR

CIRCULATION
1. Peripheral and Central pulse (RADIAL AND DP/PT), CRT
2. HR, BP
3. Cannula, Bloods, IV fluids, catheter
4. ECG, Massive Transfusion

• Sources of bleeding
  
  1. Chest, abdomen, pelvis, long bones
  2. Apply pelvic binder, tourniquets, compression, splinting
  3. Bone fractures

DISABILITY
1. Pupils (Neurological Signs lateralization), GCS, LogRoll
2. RBS, Temp
3. IV analgesia, IV antipyretic
4. CT head

EXPOSURE
while avoiding hypothermia
Head to toe → signs or symptoms for Dx

IF PATIENT STABLE
1. Escalate
2. AMPLE history
3. CT trauma, FAST, XRays
4. Secondary survey head to toe exam
-

Question 2

What are the types of shock? please do not confuse with stages of shock

Answer 2

Hypovolaemic
- Haemorrhagic
- Non-Haemorrhagic

Distributive
- Sepsis
- Anaphylactic
- Neurogenic

Cardiogenic
- Cardiomyopathy
- Arrythmia

Obstructive
- Pneumothorax
- hemopericardium

Combined

Question 3

What is the Bulbocavernosus reflex?

Answer 3

internal/external anal sphincter contraction in response to squeezing the glans penis or clitoris, or tugging on an indwelling Foley catheter.

Question 3

How would you differentiate between Spinal Vs Neurogenic Shock?

Answer 3

Question 4

Management of neurogenic Shock?

Answer 4

• Stabilize the spine and treat any associated injuries
• Administer intravenous fluids
• Administer medications to increase blood pressure, such as dopamine or norepinephrine
• Consider mechanical ventilation or surgery in severe cases
• Monitor the patient’s vital signs closely

Question 5

What can you see on this CT scan?

Answer 5

C3 cervical spine fracture with possible cord compression

Question 6

What is the pathogenesis and clinical presentation of the central cord syndrome OR the anterior cord syndrome OR Brown Sequard Syndrome?

Answer 6

Question 7

Describe the location and function of the Conspiratorial tract OR the spinothalamic tract OR the Dorsal Columns?

Answer 7

Question 8

How would diagnose Compartment Syndrome?

Answer 8

Clinical Signs
1. severe pain out of proportion to the injury
2. numbness or tingling
3. muscle weakness.

Measure the pressure within the affected compartment using a needle or catheter if compartment syndrome is suspected.
- If the pressure is above 30 mmHg, it may be necessary to perform a fasciotomy to relieve the pressure.