Secondary Survey Flashcards
Main components of 2ry survey
(4)
Head to to exam for other injuries
Supportive care and monitoring physiological parameters
Detailed radiological evaluation of any injured regions with CT and XR
More detailed patient history from pt/paras/police/collateral
Early signs of BOS #’s (4)
CSF otorrinos and rhinorrheoa
Haemotympanum
Subconjunctival haemorrhage
Battle’s sign and Racoon eyes can be delayed (12-36hrs later)
Concerns with middle face injuries (and how to test)
Airway threat and BOS #
Gently pull anteriorly from top teeth
When can neck wounds be cleaned and explored by ED
Who should ideally review them
No signs of aero digestive or vascular injury
Surgical registrar
Neck, vascular injury
Hard signs (5)
Soft signs (2)
Active bleeding
Large haematoma
Bruit/thrill
Dec GCS
Shock
Minor bleeding
Small haematoma
Neck, aerodigestive Injury
Hard sign (3)
Soft sign (3)
Haemoptysis
Haematemesis
Air/bubbles from wound
Dysphagia
Dysphonia
Subcutaneous air
Disposition of hard and soft neck injury signs
Hard - theatre
Soft - neck angiogram
Proportion of c-spine XR’s that will be inadequate in supine collared patients
Therefore
Up to 75%
CT superior
Findings suspicious for cardiac injury (3)
Further evaluation
Pre or post?
ECG changes
Arrhythmia
Elevated troop in levels
Bed side echo
Consult with cardiology
Tracheobronchial disruption
Failure to resolve following chest drain placement (2)
Suction
2nd drain one rib above or below
Seatbelt sign disposition
Admit and monitor for 24hrs
Fasted and serial examinations!
Traditional PR findings of pelvic fractures
Literature suggestions
High riding prostate
Bony spicules
Blood in rectum
Neither sensitive nor specific, not advised, disadvantages
Retrograde urethrogram technique
Paediatric foley
Inflate balloon in penile urethra
Inject 20-30mls contrast XR every 10
Grading of urethral injury
Goldman system
1 intact
2 stretch no extravasation
3 partial disruption, contrast in bladder
4 disruption <2cm
5 Disruption
1-3 conservative with catheter
