Resuscitation in Major Trauma Flashcards
What are the possible reasons for an accident?
Alcohol Drugs Seizure Hypoglycaemia In older populations - Stroke - MI
In a trauma situation, what does significant alteration of vital signs mean?
Major trauma
What preparations should occur at the hospital before a trauma case arrives?
Prepare resuscitation cubicle Get some O negative blood Call trauma team - Vital signs - before and after 1st line management - Mechanism of injury - Time of accident and ETA - Age and PHx - Airway injury > call anaesthetist - Call radiology
What are the initial steps when the patient arrives as a major trauma patient?
Assess ABC and correct reversible problems Primary survey CXR +/- PXR IV fluids and analgesia Take bloods for initial investigations
What sort of analgesia should be given in major trauma?
IV morphine/fentanyl - small doses
If line hasn’t been established yet, can give intranasal fentanyl
What initial bloods are taken in a major trauma setting?
Group and hold Clotting profile Blood glucose level FBE UEC LFT Amylase Pregnancy Police bloods required, but you won't see the results
If you are concerned about a person’s airway, what should you do?
Call for help early
What are the possible causes of airway obstruction in trauma?
Inflammation - gradual oedema Blood Teeth Vomit Collapsed airway in unconscious patient External bleeding Laryngeal/tracheal trauma Maxillofacial trauma
What are the signs of airway obstruction?
Talking patient generally has patent airway Wheeze Stridor Hoarse voice Coughing Laboured breathing Displacement of trachea Subcutaneous emphysema
What is the emergency treatment of an obstructed airway?
Suction
Guedel airway
NO nasopharyngeal/nasogastric tube because of risk in base of skull fracture
Intubate - have your most experienced anaesthetist on hand
What is a risk of hard cervical collars?
Necklaces, earring, low pony tails, etc can cause pressure ulcers
Is there any evidence for the use of cervical collars to prevent neck injury in the setting of trauma?
No - follow local guidelines
What can be used to remind people of the cervical spine?
Soft collars
If there is real concern about the cervical spine, what is an alternative to the hard collar?
Have someone hold neck
What is the NEXUS criteria for clearing the C-spine?
No posterior midline cervical spine tenderness No evidence of intoxication Normal level of alertness No focal neurological deficit No painful distracting injuries
If yes > no radiography
If no > radiography
What does assessment of breathing in trauma involve?
Asymmetrical chest expansion Bruising Penetrating wounds Breath sounds Percussion note Oxygen saturation Respiration rate Effects on other organs; eg: tachycardia, BP drop in tension pneumothorax Decreasing GCS
What are the causes of life-threatening breathing problems in trauma?
ATOMFC
- A = airway
- T = tension pneumothorax
- O = open pneumothorax
- M = massive pneumothorax
- F = flail chest
- C = cardiac tamponade
What are the signs of massive pneumothorax?
Respiratory distress
Dull percussion note
Signs of shock
What is the emergency management of a tension pneumothorax?
Needle thoracocentesis - 18g needle in 2nd intercostal space, above rib below, in midclavicular line > hear rush of air
Chest tube
Thoracotomy
What are the causes of tachycardia in major trauma?
Blood loss Tension pneumothorax Pericardial tamponade Myocardial contusion Neurogenic, including cerebral irritability Pain Drugs Anxiety Sepsis
To where can blood be lost in major trauma?
To street Into - Chest - Abdomen - Pelvis - Limbs; eg: femoral fracture Retroperitoneal
Is it strictly necessary to follow ABC in that order?
In many cases, it’s better to stop exsanguinating haemorrhage before airway and breathing
How can bleeding be managed?
Peripheral bleeding - Packs - Staples - Sutures CXR for thoracic blood FAST/CT/DPL for abdominal blood Complete primary survey - Examine limbs and perineum - Log roll for occult injuries and spinal exam
Does a negative FAST mean no haemorrhage?
No
