Principles in trauma, BLS, Preparedness Flashcards
What are the 2 classifications of trauma?
- blunt trauma = motor vehicle accidents, fall, assault
- penetrating trauma = stab wounds, hacking, gunshot, shotgun, impalement
What is the goal of initial management of trauma px?
- identify & treat IMMEDIATELTY life-threatening injuries
What is are important information for the hx of the patient?
- allergies
- medications
- pas medical hx
- last meal
- events &environment surrounding injury
what do you do during evaluation & diagnosis?
- Primary survey & resuscitation
- secondary survey & diagnostics
what are the steps in primary survey & resuscitation?
- airway - make sure it is patent & protected
- breathing = assess RR, O2 sat, chest wall trauma & expansion, breath sounds
- circulation = life-threatening injuries
- disability
what are interventions for breathing difficulties?
- closed tube thoracostomy
- open thoracotomy
- neck exploration
what are the possible sources of bleeding?
- external
- chest
- abdomen
- retroperitoneum
- pelvis
- extremities
what do u assess if the px’s bleeding?
- pulse (peripheral pulses)
- skin color
- capillary refill
- blood pressure
what are the normal PR in radial pulse, femoral pulse, & carotid pulse?
- radial pulse = SBP is 80mmHg
- femoral pulse = SBP is 70mmHg
- carotid pulse = SBP is 60mmHg
what are interventions in bleeding px?
pressure
packing
surgery
in assessing for disability, what should u do?
- pupils
- GCS score
- Anal sphincter tone
- bulbocavernous reflex
in assessing for disability, what should u do?
- pupils
- GCS score
- Anal sphincter tone
- bulbocavernous reflex
what are the indications of diff GCS scores?
GCS 13-15**= mild head injury
**GCS 9-12= moderate head injury
GCS <8 = severe head injury
what are secondary survey & diagnosis done?
- x-ray
- CT scan
- ultrasound
- diagnostic peritoneal lavage
- local wound exploration
- diagnostic laparoscopy
what are secondary survey & diagnosis done?
- x-ray
- CT scan
- ultrasound
- diagnostic peritoneal lavage
- local wound exploration
- diagnostic laparoscopy
what is the guidelines with Creatinine determnation & CT scan?
get creatinine determination first bcos contrast medium can push a px with marginal kidney function to AKI
what are C/Is of CT scan?
- clear indication for surgery
- hemodynamically unstable px
- agitate px
- allergy to contrast
what is the aim of ultrasound in trauma?
to detect present of free fluid
advantages:
* non-invasive
* repeatable, intial eval
* no radiation
* low cost
what is done in focus assessment with sonography (FAST)in trauma?
- check 4 windows: R subcostal, Subxiphoid, L subcostal, Suprapubic
- look at subhepatic space, pericardial window, left upper quadrant, pelvis
what is done in Extended focus assessment with sonography in trauma (EFAST)?
- pleural cavities, visualize any fluid in the chest
- if there is hemothorax & pneumothorax -> chest tube must be inserted
When do u do a diagnostic peritoneal lavage?
- if utlrasound cannot be done
- unexplained shock or hypotension
- altered sensorium
- gen anesthesia for extra-abdominal procedures
- spinal cord injury
what are C/Is of Diagnostic Peritoneal Lavage?
- clear indication of surgery
- relative: pregnancy, obesity, previous abdominal surgery
what are the results of a positive peritoneal lavage?
- aspiration of atleast 10mL gross blood
- bloody lavage effluent
- RBC >100,000mL3
- WBC >500mL3
- amyalse >19IU/dL
- bile, bacteria, food fibers
what technique involves more than simple visualization w/ scope & requires multiple ports and manipulation of the tissues?
diagnostic laparaoscopy