Resuscitation in Major Trauma Flashcards

1
Q

What are the possible reasons for an accident?

A
Alcohol
Drugs
Seizure
Hypoglycaemia
In older populations
- Stroke
- MI
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2
Q

In a trauma situation, what does significant alteration of vital signs mean?

A

Major trauma

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3
Q

What preparations should occur at the hospital before a trauma case arrives?

A
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
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4
Q

What are the initial steps when the patient arrives as a major trauma patient?

A
Assess ABC and correct reversible problems
Primary survey
CXR +/- PXR
IV fluids and analgesia
Take bloods for initial investigations
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5
Q

What sort of analgesia should be given in major trauma?

A

IV morphine/fentanyl - small doses

If line hasn’t been established yet, can give intranasal fentanyl

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6
Q

What initial bloods are taken in a major trauma setting?

A
Group and hold
Clotting profile
Blood glucose level
FBE
UEC
LFT
Amylase
Pregnancy
Police bloods required, but you won't see the results
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7
Q

If you are concerned about a person’s airway, what should you do?

A

Call for help early

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8
Q

What are the possible causes of airway obstruction in trauma?

A
Inflammation - gradual oedema
Blood
Teeth
Vomit
Collapsed airway in unconscious patient
External bleeding
Laryngeal/tracheal trauma
Maxillofacial trauma
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9
Q

What are the signs of airway obstruction?

A
Talking patient generally has patent airway
Wheeze
Stridor
Hoarse voice
Coughing
Laboured breathing
Displacement of trachea
Subcutaneous emphysema
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10
Q

What is the emergency treatment of an obstructed airway?

A

Suction
Guedel airway
NO nasopharyngeal/nasogastric tube because of risk in base of skull fracture
Intubate - have your most experienced anaesthetist on hand

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11
Q

What is a risk of hard cervical collars?

A

Necklaces, earring, low pony tails, etc can cause pressure ulcers

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12
Q

Is there any evidence for the use of cervical collars to prevent neck injury in the setting of trauma?

A

No - follow local guidelines

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13
Q

What can be used to remind people of the cervical spine?

A

Soft collars

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14
Q

If there is real concern about the cervical spine, what is an alternative to the hard collar?

A

Have someone hold neck

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15
Q

What is the NEXUS criteria for clearing the C-spine?

A
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

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16
Q

What does assessment of breathing in trauma involve?

A
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
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17
Q

What are the causes of life-threatening breathing problems in trauma?

A

ATOMFC

  • A = airway
  • T = tension pneumothorax
  • O = open pneumothorax
  • M = massive pneumothorax
  • F = flail chest
  • C = cardiac tamponade
18
Q

What are the signs of massive pneumothorax?

A

Respiratory distress
Dull percussion note
Signs of shock

19
Q

What is the emergency management of a tension pneumothorax?

A

Needle thoracocentesis - 18g needle in 2nd intercostal space, above rib below, in midclavicular line > hear rush of air
Chest tube
Thoracotomy

20
Q

What are the causes of tachycardia in major trauma?

A
Blood loss
Tension pneumothorax
Pericardial tamponade
Myocardial contusion
Neurogenic, including cerebral irritability
Pain
Drugs
Anxiety
Sepsis
21
Q

To where can blood be lost in major trauma?

A
To street
Into
- Chest
- Abdomen
- Pelvis
- Limbs; eg: femoral fracture
Retroperitoneal
22
Q

Is it strictly necessary to follow ABC in that order?

A

In many cases, it’s better to stop exsanguinating haemorrhage before airway and breathing

23
Q

How can bleeding be managed?

A
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
24
Q

Does a negative FAST mean no haemorrhage?

A

No

25
Q

What is the amount of crystalloid usually given in resuscitation of major trauma?

A

Stop at 1.5-2 L generally

26
Q

What is a danger of using colloids for fluid resuscitation?

A

Risk of anaphylaxis

27
Q

When should blood be used for resuscitation?

A

If you’ve got blood available, and they’re shocked

28
Q

How much blood should be given?

A

10 mL/kg

And then 5 mL/kg

29
Q

How can you combat hypothermia in major trauma?

A

Keep patient warm > warm blood and saline

30
Q

What blood products are required in a massive transfusion, and in what ratios?

A

Packed red cells
Fresh frozen plasma
Platelets
In 1:1:1 ratio

31
Q

When should tranexamic acid be given, and why?

A

Give 1 g IV within 3 hours of trauma

Stops clot lysis, helping control bleeding

32
Q

Under which body temperature do clotting factors start to alter?

A

32 degrees

33
Q

How can fractures be dealt with in order to help control bleeding?

A

Limb fractures > splint

Pelvic fracture > pelvic sling

34
Q

What are the considerations in hypotensive resuscitation?

A
Consider optimum blood pressure
Tissue perfusion vs plasma loss
Vigorous fluid resuscitation prior to surgery worsens outcome
Hypotension relative to usual BP
Time to definitive surgery priority
35
Q

With what sort of GCS are patients usually transferred to Melbourne for further treatment?

A

GCS <14, unless due to

  • Drugs
  • Alcohol
  • Dementia
36
Q

What is usually included in a trauma series?

A

Head, neck, spine, chest, and pelvis imaging

37
Q

What imaging is done in deceleration injuries, and why?

A

CT aortogram, due to risk of aortic dissection

38
Q

When is FAST used?

A

Most major traumas

39
Q

When is DPL used?

A

Mass casualty

40
Q

What is the imaging modality of choice in major trauma?

A

CT supplemented with plain films