S21C250 - Trauma in Adults

Question 1

Primary survey

Answer 1

• identifies and treats immediately life-threatening conditions with simultaneous resuscitation and treatment
• things to immediately identify and address: airway obsrruction, tension pneumo, massive hemorrhage, open penumo, flail chest, cardiac tamponade

Question 2

Airway

Answer 2

Assess:

• facial injuries or FB causing obstruction?
• assess, clear, protect

Intervention:

• if poor resp effort try jaw thrust and oral/nasal airway
• intubate if

Question 3

C-spine injuries

Answer 3

• NEXUS rule
• Canadian c-spine rule
• plain xr may miss up to 15% of c-spine #
• CT is 98% sensitive

Question 4

Breathing

Answer 4

Assess:
-inspect, ausculatate and palpate thorax and neck for abnormalities such as a deviate dtrache, crepitus, flail chest, sucking chest wound, # sternum, penumo, hemo

Intervention:

• oxygenate with 100% O2
• chest tube = 36F for hemopneumothorax
• occlusive dressing for a sucking chest owund
• massive hemothorax = >1000 cc initial chest tube output or 200cc/h
• needle thoracostomy

Question 5

Circulation

Answer 5

Assess:

• LOC, sking color, peripheral pulses, HR, pulse pressure
• FAST

Intervention:

• direct pressure to bleeding
• 2 x large bore IV
• type and screen
• 2L NS if hypotensive, if no improvement then give blood
• pelvic binder, reduce #
• give plateletes, PRBC and FFP in ratio 1:1:1
• consider central line
• consider pericardiocentesis

Question 6

Trauma coagulopathy

Answer 6

• acidosis and hypothermia make it worse

- bleeding diathesis occurs as a result of defective clotting and platelet fxn

Question 7

Disability

Answer 7

Assessment:
-assess pupils, move all 4 limbs? , GCS

Intervention:
-check blood glucose

Question 8

Exposure

Answer 8

Assess:

• inspect for burns, other injuries, log roll, palpate spine
• examine perineum

Question 9

Secondary Survey

Answer 9

• identify scalp wound, place staples
• identify facial instability, or potential for airway instability
• check for hemotympanum
• identify epistaxis or septal hematoma
• identify avulsed teeth, jaw instability
• evalutate for abdo distention and tenderness
• adientify penetrating chest, back flank or abdo injury
• assess pelvic stability, consider pelvic wrap/sling
• inspect perineum for laceration/hematoma
• inspect urethral meatus for blood
• consdier DRE
• assess peripheral pulses
• identify extremity deformities and immobilize open and closed # and dislocations

Question 10

NEXUS criteria for omitting c-spine imaging

Answer 10

• no posterior midline c-spine tenderness
• no evidence of intoxication
• alert mental status
• no focal neurologic deficits
• no painful distracting injuries

–If no to all then can clinically clear (can use canadian c-spine in conjunction to further clear it)

Question 11

Canadian C-Spine rule

Answer 11

Xray c-spine if:
-high-risk factor: age >65yo, dangerous mechanism, paresthesias in extremities

If low-risk:

• simple rear-ender
• sitting up in the ED
• ambulatory at any time
• delated (not immediate) onset of neck pain
• absence of midline c-spine tenderness

THEN rotate neck 45 deg L and R.
If able to do so then no xr.

Question 12

Head injuries in trauma

Answer 12

-if GSC 3-8, defer any procedures that do not address problems in the primary survey until after a head CT

Question 13

Blood loss classification

Answer 13

Class I: 2L loss, 40% blood volume loss, decr BP, decr PP

Question 14

GSW to abdomen

Answer 14

FAST exam contraindicated except to r/o cardiac tamponade

Question 15

Thoracotomy

Answer 15

3.9% survival, neurologically intact
23% survival if thoracic stab wound and breathing or pulse in field that is lost en route
38% survival if the above plus signs of life in the ED (resp or pulse)