Principles of Resuscitation Flashcards
What is resuscitation?
Process of correcting physiological disorders in an acutely unwell or injured patient
Who sets the standards for CPR and related disciplines in the UK?
The Resuscitation council
What is required for oxygen delivery to organs?
Adequate airway, breathing and circulation
What can inadequate oxygen delivery lead to?
Organ failure = causes cardio-respiratory arrest
Avoided by early detection and treatment
What are the objectives in initial trauma management?
Identify and treat life threatening injuries whilst considering mechanism of injury
Identify any other problem
Arrange appropriate treatment and investigations
Arrange and transfer to definitive care
What are common mechanisms of injury of trauma?
RTA = 1/3 of all major trauma presentations
Falls, interpersonal violence, suicide, work place accidents
What is the most commonly affected patient group in trauma?
Young men aged 18-40
What is the primary survey of a patient?
General impression = airways, breathing, circulation, disability, exposure
What questions should you ask yourself on the initial arrival of an unwell patient?
Are we in the best place/position?
What equipment do I need?
Do I have enough help?
Who am I going to call?
What makes up an AMPLE history?
Allergies, medications, past medications, last ate, events leading up to presentation
What should be considered alongside the airway?
Cervical spine and exsanguinating haemorrhage
What aspects of the airway are assessed?
Open/closed, action required, adjuncts, do I need anaesthetic support?
What are some causes of airway obstruction in trauma?
Loss of pharyngeal tone with posterior tongue displacement, displaced facial fracture, vomitus/blood/secretions, soft tissue swelling/oedema/inhalation burns, direct laryngeal trauma
How is the airway managed?
Basic to advanced airway management depending on skill, possible suction
What should be considered when assessing breathing?
Present/absent, adequate ventilation, oxygen source and means of delivering oxygen
Look, feel, percuss and listen, resp rate and O2 sats
Who should get high flow oxygen?
All patients
What is the management of some life threatening injuries that may affect breathing?
Tension pneumothorax = oxygen, needle thoracocentesis, chest drain
Massive haemothorax = oxygen, chest drain, circulatory resuscitation
Flail chest = oxygen, analgesia, advanced ventilatory support
What should be ensured when assessing breathing?
Oxygenation and ventilation
What should be assessed when considering the circulation?
Present/absent = pulse assessment, blood pressure, CRT, possible ECG
Adequate perfusion = colour, conscious level
What normally causes circulation problems?
Haemorrhagic shock = may be concealed
What must be considered when assessing IV access?
If present, is it working? If not, what sort of cannula? Where to put IV line? What blood samples to take? Do you want to give fluids, and if so, which fluid?
What is the first choice fluid in major trauma?
Blood = O negative/type specific or fully cross matched, ideally ratio 1 RCC:1 FFP, permissive hypotension
What are interventions for circulation issues, other than IV fluids?
Tranexamic acid 1g IV (15mg/kg in children)
Direct pressure/tourniquet
Splint long bones, pelvic binder
Does the patient need theatre/IR to stop bleeding?
What are ways to assess disability?
Is there any evidence of head trauma?
AVPU, GCS (min 3, max 15), pupils, lateralising signs
What are some interventions for problems identified when assessing disability?
Prevent secondary brain injury, early neurological signs
What should be done when carrying out the exposure part of the primary survey?
Quick top to toe = aims to pick up any other significant injuries
Completely expose patient whilst preventing heat loss
What is the main objective when assessing a major trauma patient with a suspected spinal injury?
Prevent any further injury to the spine
What are some methods of preventing secondary injury to the spine?
Manual in-line stabilisation (MILS),
Three point fixation = hard collar, blocks, tape
What is normally needed to clear cervical spine injury in major trauma?
CT scan
What is the NEXUS criteria for clearing cervical spine injury in minor trauma?
No posterior midline cervical tenderness No evidence of intoxication Patient is alert and oriented to person, place, time and event No focal neurological deficit No painful distracting injuries
What further investigations should be done after the initial primary survey?
Usually whole body CT = aim for CT scan within 30 mins
What should b e done after the initial management of the patient has been completed?
Re-evaluate = continuous monitoring
Co-ordinate quick transfer, preparing for possible ongoing resuscitation in scan
Should other investigations delay CT and definitive management?
No = limb x-rays, urinary catheterisation, ECG and ABG shouldn’t delay transfer to CT or definitive treatment
How often to patients go straight to surgery?
Very rarely
What are some pre-hospital interventions?
Emergency anaesthetic and intubation, chest procedures, sedation for extrication and splinting, administration of blood products, transfer to major trauma centre
