Primary survey

Question 1

Post trauma, Airway abnormalities

Answer 1

1. Subcutaneous emphysema
2. Expanding hematoma

gurgling, noisy sound
GCS <8

Question 2

Ways to secure airway in the field

Answer 2

1. Intubation …
   2 Cricothyroidotomy

Question 3

Ways to secure airway in the ED

Answer 3

1. Rapid induction, orotracheal intubation, pulse oxy
   (best)
2. Nasotracheal intubation over a fiberoptic bronchoscope
3. Cricothyroidotomy in severe maxillofacial injuries
   -not preferred for >72 hrs
   -causes subglottic stenosis
   -change to tracheostomy

Question 4

Airway mx in blunt/penetrating neck injury

Answer 4

Early intubation

Avoid rapid-sequence intubation (anaesthetic+muscle relaxant)
=causes airway prolapse

Question 5

Which airway mx to be avoided before checking for base of skull #

Answer 5

Nasopharyngeal airway insertion

If already intubated, record
1. Position - lip
2. End-tidal CO2 trace
3. Cuff pressure
4. Intubation difficulty
5. Mallampati score (base of tongue vs oropharyngeal opening)

Question 6

Can you try intubation in cervical spine injuries

Answer 6

Yes, orotracheal intubation can be done
In-line stabilisation maintained

Question 7

Signs of end-organ hypoperfusion in hypovolaemic shock

Answer 7

1. Low urine output
2. Acidosis
3. High lactate
4. Altered mental state

Maintain >90mmHg
Lower pressures okay when pt is conscious

Question 8

Ways to secure airway in paediatric population (<12yrs)

Answer 8

Tracheostomy (b/w 2 and 3 tracheal rings)»
intubation

Question 9

How do you assess satisfactory ventilation, oxygenation

Answer 9

Breath sounds - absent in pneumo/hemothorax
Pulse oxymetry (>95%)

Question 10

Clinical signs of *shock

Answer 10

1. Low BP <90
2. Tachycardia >100
3. Low urinary output <0.5ml/kg/hr
   cold, clammy

Question 11

Types of shock in trauma setting

Answer 11

1. Hypovolaemic
2. Cardiogenic - tamponade, tension pneumothorax
3. Vasomotor shock - anaphylaxis, high spinal (rx - epinephrine, fluids)
4. Neurogenic
5. Septic

Question 12

Difference b/w hemorrhagic and cardiogenic shock

Answer 12

1. Hemr -
   collapsed neck veins (low CVP central venous pressure)
2. Cardio -
   raised JVP (high CVP)

Question 13

Pericardial tamponade vs tension pneumo thorax

Answer 13

●Both seen in cardiogenic shock
●Tamponade
- no resp distress
- Becks triad: low breath sounds, raised JVP, low BP

●Tension pneumo -
- resp distress
- ↓breath sounds
- tracheal deviation to other side

Question 14

Mx of hemorrhagic shock

Answer 14

1. Fluid resuscitation - RL 2lts, blood products
2. Stop bleeding

Question 15

Minimum amount of blood loss to cause haemorrhagic shock

Answer 15

Grade
1 - 15% (min), HR >100, BP- normal
2 - 15-30%, HR >100, BP- normal
3 - 30-40%, HR >120, BP - ↓
4 - >40%, HR >140,, BP - ↓↓

Question 16

Mx of pneumothorax

Answer 16

1. 14G needle @2 ICS, mid-clavicular line
2. Finger thoracostomy - digital decompression + PPV
3. +Intercostal catheter + underwater seal drain