Principles of Resuscitation

Question 1

What is resuscitation?

Answer 1

Process of correcting physiological disorders in an acutely unwell or injured patient

Question 2

Who sets the standards for CPR and related disciplines in the UK?

Answer 2

The Resuscitation council

Question 3

What is required for oxygen delivery to organs?

Answer 3

Adequate airway, breathing and circulation

Question 4

What can inadequate oxygen delivery lead to?

Answer 4

Organ failure = causes cardio-respiratory arrest

Avoided by early detection and treatment

Question 5

What are the objectives in initial trauma management?

Answer 5

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

Question 6

What are common mechanisms of injury of trauma?

Answer 6

RTA = 1/3 of all major trauma presentations

Falls, interpersonal violence, suicide, work place accidents

Question 7

What is the most commonly affected patient group in trauma?

Answer 7

Young men aged 18-40

Question 8

What is the primary survey of a patient?

Answer 8

General impression = airways, breathing, circulation, disability, exposure

Question 9

What questions should you ask yourself on the initial arrival of an unwell patient?

Answer 9

Are we in the best place/position?
What equipment do I need?
Do I have enough help?
Who am I going to call?

Question 10

What makes up an AMPLE history?

Answer 10

Allergies, medications, past medications, last ate, events leading up to presentation

Question 11

What should be considered alongside the airway?

Answer 11

Cervical spine and exsanguinating haemorrhage

Question 12

What aspects of the airway are assessed?

Answer 12

Open/closed, action required, adjuncts, do I need anaesthetic support?

Question 13

What are some causes of airway obstruction in trauma?

Answer 13

Loss of pharyngeal tone with posterior tongue displacement, displaced facial fracture, vomitus/blood/secretions, soft tissue swelling/oedema/inhalation burns, direct laryngeal trauma

Question 14

How is the airway managed?

Answer 14

Basic to advanced airway management depending on skill, possible suction

Question 15

What should be considered when assessing breathing?

Answer 15

Present/absent, adequate ventilation, oxygen source and means of delivering oxygen
Look, feel, percuss and listen, resp rate and O2 sats

Question 16

Who should get high flow oxygen?

Answer 16

All patients

Question 17

What is the management of some life threatening injuries that may affect breathing?

Answer 17

Tension pneumothorax = oxygen, needle thoracocentesis, chest drain
Massive haemothorax = oxygen, chest drain, circulatory resuscitation
Flail chest = oxygen, analgesia, advanced ventilatory support

Question 18

What should be ensured when assessing breathing?

Answer 18

Oxygenation and ventilation

Question 19

What should be assessed when considering the circulation?

Answer 19

Present/absent = pulse assessment, blood pressure, CRT, possible ECG
Adequate perfusion = colour, conscious level

Question 20

What normally causes circulation problems?

Answer 20

Haemorrhagic shock = may be concealed

Question 21

What must be considered when assessing IV access?

Answer 21

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?

Question 22

What is the first choice fluid in major trauma?

Answer 22

Blood = O negative/type specific or fully cross matched, ideally ratio 1 RCC:1 FFP, permissive hypotension

Question 23

What are interventions for circulation issues, other than IV fluids?

Answer 23

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?

Question 24

What are ways to assess disability?

Answer 24

Is there any evidence of head trauma?

AVPU, GCS (min 3, max 15), pupils, lateralising signs

Question 25

What are some interventions for problems identified when assessing disability?

Answer 25

Prevent secondary brain injury, early neurological signs

Question 26

What should be done when carrying out the exposure part of the primary survey?

Answer 26

Quick top to toe = aims to pick up any other significant injuries Completely expose patient whilst preventing heat loss

Question 27

What is the main objective when assessing a major trauma patient with a suspected spinal injury?

Answer 27

Prevent any further injury to the spine

Question 28

What are some methods of preventing secondary injury to the spine?

Answer 28

Manual in-line stabilisation (MILS), | Three point fixation = hard collar, blocks, tape

Question 29

What is normally needed to clear cervical spine injury in major trauma?

Answer 29

CT scan

Question 30

What is the NEXUS criteria for clearing cervical spine injury in minor trauma?

Answer 30

``` 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 ```

Question 31

What further investigations should be done after the initial primary survey?

Answer 31

Usually whole body CT = aim for CT scan within 30 mins

Question 32

What should b e done after the initial management of the patient has been completed?

Answer 32

Re-evaluate = continuous monitoring | Co-ordinate quick transfer, preparing for possible ongoing resuscitation in scan

Question 33

Should other investigations delay CT and definitive management?

Answer 33

No = limb x-rays, urinary catheterisation, ECG and ABG shouldn't delay transfer to CT or definitive treatment

Question 34

How often to patients go straight to surgery?

Answer 34

Very rarely

Question 35

What are some pre-hospital interventions?

Answer 35

Emergency anaesthetic and intubation, chest procedures, sedation for extrication and splinting, administration of blood products, transfer to major trauma centre