Rapid Primary Survery Flashcards
ABCDE”s of Trauma management
Airway and cervical spine control
Breathing and management of life threatening chest injury
Circulation and haemorrhage control
Disability and intracranial mass lesion recognition
Exposure and prevention of hypothermia
NEXUS Criteria
Posterior midline tenderness, altered mental status, intoxicated, neurologic deficit, distracting (painful) injury)
Canadian C-spine rules
If the patient is able to communicate verbally, the airway is not likely to be in immediate jeopardy; however repeated assessment of airway patency is prudent, especially in patients with respiratory compromise or maxillofacial injury. If the patient is unable to maintain spontaenous respirations or patency of the airway, then a definitive airway is indicated.
Steps in ensuring the airway
- Secure airway, assume a cervical injury in every trauma , Temporizing meausure or definituve airway management.
if a person has a C spine injury which manoeuvre would you use
Jaw thrust
Signs of Airway Obstruction
Universal sign for choking, cyanosis, failure to speak, respiratory distress
Medications that can be delievered via ETT
Navel Atropine Vasopressin Epinephrine Lidocaine
Requirement for Clearing Spine
No midline tenderness, No focal neurological deficits,
no distracting factors such as intoxication, altered LOC or distracting injuries
Signs for checking for breathing
Look- mental status, colour, chest movements, respiratory rate/ efforts, nasal flaring
Listen : auscultate for signs for obstruction, breath, sounds, symmetry of air entry, air escaping.
Feel: tracheal shift, chest wall for crepitus, flail segments, sucking chest wounds, subcutaneous emphysema .
define Shock
inadequate organ and tissue perforation with oxygenated blood.
Indication for intubation
GCS of
Signs of fluid depletion
Increased heart rate postural changes in vital signs decreased urine output hypotensice decreased skin turgor sunken eyes decreased capillary refill.
Fluid Resuscation
Give bolus until HR decreases, urine output increases, and patient stabilizes •
Maintenance: 4:2:1 rule • 0-10 kg: 4 cc/kg/h • 10-20 kg: 2 cc/kg/h • Remaining weight: 1 cc/kg/h • Replace ongoing losses and deficits (assume 10% of body weight)
3:1 rule
since only 30% of infused isotonic crystalloids remains in intravascular space, you must give 3x estimated blood loss.
steps in resuscitation
Attend to ABC
manage life threatening problems as identified
vital signs 5-15 mins
ECG, BP, O2 monitors
Foley Catheter and NG tube
Investigation: FBC, Electrolytes, BUn, CR, glucose, amylase, pt/ptt, toxicology screen, cross and typr.
Contraindications for foley catheter
blood at urethral meatus
scrotal hematoma, hih riding prostate on DRE.
NG Tube contraindications
significant mid face trauma, basal skull fractures
Relative afferent pupillary defect, what do I think of?
optic nerve damage
reactive pupils + decreased LOC… possible cause
metabolic or structural cause
non reactive pupils + decreased LOC
structural cause
signs of increased intracranial pressure
Deteriorating LOC (hallmark)
• Deteriorating respiratory pattern
• Cushing reflex (high BP, low heart rate, irregular respirations) •
Lateralizing CNS signs (e.g. cranial nerve palsies, hemiparesis) •
Seizures •
Papilledema (occurs late)
• Nausea/vomiting and headache
unilateral, dilated, non reative pupil
focal mass lesion
epidural hematoma
subdural hematoma
Injuries fall into 2 categories
Blunt: MVA, pedestrian automobile impact, motorcycle collision, falls, sports.
Penetrating: gunshot, stabbing, impalement.
vehicles vs pedestrian crash> Waddle’s triad
Tibula- fibula or femur fracture
truncal injury
craniofacial injury
