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Critical Care > Primary Survey (Trauma) > Flashcards

Primary Survey (Trauma) Flashcards

1
Q

Principle of Primary Survey

A

To identify immediate life threatening conditions and rectify it once identified

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2
Q

Components of Primary Survey

A

A: Airway + cervical immobilization
B: Breathing and Ventilation
C: Circulation and Hemorrhage control
D: Disability
E: Exposure and environment control

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3
Q

Indication for definitive airway

A
  • GCS 8 or below
  • Severe maxillofacial trauma
  • Aerodigestive tract injury (larngyeal/tracheal injury)
  • Protect from aspiration (bleeding/vomiting)
  • Need for ventilation
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4
Q

How to assess for difficult airway?

A

LEMON

  • L: Look for evidence
  • E: Evaluate using 332 rule
  • M: Mallampati classification
  • O: Obstruction
  • N: Neck mobility
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5
Q

Mallampati classification

A
  • Class 1: soft palate, uvula, fauces, pillars
  • Class 2: soft palate, uvula, fauces
  • Class 3: soft palate, base of uvula
  • Class 4: only hard palate
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6
Q

What is the 332 rule?

A
  • Intercisor distance: 3FB btw incisor teeth
  • Hyomental distance 3FB btw hyoid and chin
  • Thyromandibular distance: 2FB btw thyroid notch and floor of mouth
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7
Q

What is rapid sequence induction?

A

Rapid intubation without need for manual ventilation. Induction agent given immediately followed with muscular relaxant

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8
Q

Preparation of equipment for RSI

A
  • Pre-oxygenation (+/- bag valve mask)
  • IV access
  • Drugs: induction, muscle relaxant
  • Direct laryngoscope, ET tube, bougie, suction
  • CO2 capnogram
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9
Q

Mneumonic for RSI equipment and planning

A

SOAPME

  • Suction
  • Oxygen (BVM)
  • Airway: ET tube, stylet / bougie, direct laryngoscope (blade + handle), syringe for test balloon, backup surgical cric kit
  • P: preoxygenation
  • Monitoring equipment/ Medication
  • End-tidal CO2
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10
Q

Induction agents for RSI

A

Etomidate (0.3mg/kg)

Propofol (2mg/kg)

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11
Q

Muscle relaxants for RSI

A

Succinylcholine (2mg/kg) (preferred) depolarizing NMB

Rocuronium (1mg/kg) non-depolarizing NMB

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12
Q

Indication for surgical airway

A
  • Failed intubation
  • Glottis edema
  • Laryngeal fracture
  • Severe oropharyngeal bleeding obstructing airway
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13
Q

Needle cricothyroidotomy

A

12-14G angio-catheter + jet ventilation

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14
Q

How to perform a surgical cricothyroidotomy

A
  • Supine with neck in neutral position + c-spine immobilization
  • Aseptic technique +/- LA
  • Stabilize thyroid cartilage with left hand
  • Palpate cricothyroid membrane with right hand + transverse incision over
  • Incise through membrane
  • Use left hand to insert tracheal spreader
  • Use right hand to insert ET tube
  • Inflate and check position
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15
Q

What is the technique for C-spine immobilization

A

Use two palms to hold shoulders

Keep C-spine inline with body using ulnar side of both forearm

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16
Q

Life threatening conditions related to Breathing

A

Tension pneumothorax

Open pneumothorax

Massive hemothorax

Flail chest with lung contusion

Cardiac tamponade

17
Q

How to insert a central venous line to IJV

A
  • Supine, head down
  • Large bore needle
  • Locate R IJV by apex of triangle formed by 2 heads of SCM
  • insert needle at 30 degrees with syringe toward ipsilateral nipple
  • remove syringe, occlude needle to prevent air embolism
  • insert guidewlire, removed needle, insert catheter
18
Q

Landmark of subclavian artery

A
  • 1 cm below the junction of middle and medial third of clavicle
  • Direct medially, slightly cephalad and posteriorly behind the clavicle, towards sternal notch
19
Q

Puncture site for intraosseous needle

A
  • Anteromedial surface of proximal tibia, 1 FB below the tubercle
  • First at 90 degree, after gaining purchase, direct at 45 towards to foot
  • Flush catheter
20
Q

Definition of rapid responder

A
  • responds quickly
  • estimated blood loss < 20%
  • no further fluid/blood needed
21
Q

Definition of transient responder

A
  • responds initially but slowly deteriorate afterward
  • likely inadequate resuscitation or ongoing blood loss
  • estimated 20-40%
22
Q

Definition of transient responder

A
  • responds initially but slowly deteriorate afterward
  • likely inadequate resuscitation or ongoing blood loss
  • estimated 20-40%
23
Q

Definition of non-responder

A
  • Exsanguinating hemorrhage, >40%
  • Immediate blood transfusion with unmatched blood
  • Activation of massive blood transfusion protocol
24
Q

Primary survey adjuncts

A

ECG

Foley

Blood test

XR (lateral C-spine, AP CXR, AP Pelvis)

FAST

25
Q

Standard positions for FAST

A

Right mid-axillary position: Morrison’s pouch

Left mid-axillary position: Splenorenal recess

Suprapubic: Pouch of Douglas

Subxyphoid: Pericardium

26
Q

How to perform a Diagnostic Peritoneal Lavage

A
  • Decompress bladder and stomach
  • Aseptic technique
  • Vertical incision below umbilicus
  • Insert peritoneal dialysis catheter
  • Instill 1 L warm NS
  • Gentle agitation of abdomen, wait 5-10 minutes
  • Drain fluid
27
Q

What is a positive DPL?

A

RBC> 100,000/mm3

WBC > 500/mm3

Presence of bile/GI content/ amylase/ bacteria

Critical Care (12 decks)

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