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
what are the different liver injury scale?
- **Grade I **= Hematoma, Laceration: Sucapsular <10^ SA, <1cm deep capsular tear
- Grade II = Hematoma, laceration; 10-15% SA subcapsular, <10cm diam; 1-3cm deep, <10cm long capsular tear
- **Grade III **= Hematoma, Laceration: >50% SA, >10cm, laceration is 3cm deep
- Grade IV = Laceration = parenchymal disruption of 25-75% or >3% segments
- Grade V = >75% lacteration, Vascular: juxtahepatic venous injuries
- **Grade VI **= hepatic avulsion
what are the different liver injury scale?
- **Grade I **= Hematoma, Laceration: Sucapsular <10^ SA, <1cm deep capsular tear
- Grade II = Hematoma, laceration; 10-15% SA subcapsular, <10cm diam; 1-3cm deep, <10cm long capsular tear
- **Grade III **= Hematoma, Laceration: >50% SA, >10cm, laceration is 3cm deep
- Grade IV = Laceration = parenchymal disruption of 25-75% or >3% segments
- Grade V = >75% lacteration, Vascular: juxtahepatic venous injuries
- **Grade VI **= hepatic avulsion
what are the tx of liver injuries?
- expectant/observatoin
- drainage
- hepatorrhapy
- debridement/reseection
- packing
- angiography/embolization
what is the step of BLS where injured organs are repaired or removed?
defintiive care
on what criteria do we sort in triage?
- urgency
- probability of survival
- availability & capability of the resources
what are the diff priorities in the triage?
- 1st priority = immediately life-threatening injuries
- 2nd priority = major system injuries require treatment wihin 1 hr
- 3rd priority = walking wounded
- 4th priority = not expected to survive, near dead
what is lethal triad needed to do damage control?
hypothermia
acidosis
coagulopathy
what are common scenarios where damage control is done?
- stable px with >2 of triad
- hypotensive px w/ >1 of triad
- mass casualty incident
- anticipated need for massive transfusion
- shortage of blood product supply
- complex multisystem injuries
what are the phases of damange control?
- Phase 1 = ER assessment, decide to do damage control
- Phase 2= damage control surgery, surgical control of hemorrhage & contaminatio
- Phase 3 = ICU resuscitation, correction of hypthermia and coagulopathy in ICU
- Phase 4 = repoeration with def surgical managenet of intra-abdominal injuries
what are the diff types of hazards
natural
technological
biological societal
what are the diff disasters in the NDRP?
- I = hydro-meterological hazards
- II = seismic hazards: earthquakes, landslides
- III = tsunami
- IV = volcano
- V = pandemic/epidemic
- others = fiore, transpo, pollution, civil disturbance, etc
what is the risk formula?
risk = [(hazard x vulnerability)/capacity]
what is an actual threat to public safety and or public health?
emergency
what are the different factors that can determine the type and severity of consequences?
- community
- capacity
- vulnerability
what is the RA of National disaster irsk reduction management?
RA 10121
what is the cycle of disaster?
- prep for disaster
- disaster occurrence
- disaster response
- recovery from disaster
- mitigation against the impact of future disasters
- risk reduction agsint the future disasters
- prevention of future disasters
- preparation for next disaster
what is the part of disaster management cycle where it eliminates or reduces the probability of disaster occurrence
prevention
what is the part of disaster management cycle where activties are reduced to either chance of hazard taking place or turning into a disaster?
mitigation
- building codes
- zoning and land use management
- regulations and safety codews
- preventive health care
- public education
what is the management system used in responding to an incident?
incident command system (ICS)
only 1 person is in-charge
what are the 2 types of ICS?
single commant = 1 agency
unified command = several agencies
q
what are the different color tags?
- red = immediate care, 1st for evacuation, life-threatening
- yellow = needs care, not life-threatening, urgent condition
- green = 3rd, minor injuries, delayed conditions
- blue = 3/4th, near dead, after red & yellow condition
- black & white = dead
