Severe Trauma Flashcards
In severe trauma, how soon can neurological injury be assessed?
Neurological injury cannot be reliably assessed until the patient has been resuscitated to normal physiological endpoints
What adj intervention is useful after intubating a trauma patient?
Inserting an oral gastric tube to prevent gastric dilatation
What are the three conditions which most often compromised ventilation in trauma patients?
Tension pneumothorax
Open pneumothorax
Large flail segment with underlying pulmonary contusion
In severe trauma, what are the indications for mechanical ventilation?
Intubation for airway protection
Severe head injury
Need for urgent surgery under general anaesthesia
How much blood needs to be lost to result in loss of consciousness?
Around half the blood volume
How much blood loss is suggested by an ashen grey face and white extremities?
At least 30%
In the bleeding patient how much blood loss is required for a change in respiratory rate?
15 to 30%
What are some of the earliest signs of blood loss?
Anxiety and narrow pulse pressure may be seen in blood loss of less than 15%
How much blood loss is required for a delay in capillary refill time
15 to 30%
How much blood loss is required for a drop-in systolic blood pressure?
30 to 40%
If a trauma patient is shocked and has distended neck veins what are the likely causes?
Tension pneumothorax
Cardiac tamponade
Myocardial contusion
What blood tests can be used to guide the degree of shock and the adequacy of resuscitation in the first few hours?
Base access and serum lactate
What systolic blood pressure should you target in the bleeding trauma patient?
80 to 100 mmHg
Unless the patient has a brain injury, in which case higher pressures should be targeted.
How many people are required to log roll a patient?
At least 4.
One person at the head, two people to roll the body, and the fourth person to examine the back and perform a rectal exam.
What size opening in the chest wall causes a sucking chest wound?
Any opening of more than two-thirds the diameter of the trachea will cause at to pass preferentially through the hole in the chest wall.
When should you suspect cardiac tamponade?
Any penetrating injury to the chest or abdomen
How is cardiac tamponade identified in the resus room,
Immediate echocardiography as part of the FAST scan.
What is the treatment for a cardiac tamponade?
Pericardiocentesis to buy time followed by emergency thoracotomy or sternotomy.
What is the definition of massive haemothorax?
More than 1500 ml of blood in the chest cavity.
What is a sign of a traumatic aortic rupture?
Widened mediastinum on chest x-ray.
How is myocardial confusion identified?
Echocardiography and 12 lead ECG
What are the indications for laparotomy?
Shocked patients with signs of intra-abdominal haemorrhage
Signs of intra-abdominal haemorrhage include peritonism or increasing distention or a positive FAST scan.
Also any patients with penetrating trauma.
What is the role of urine dipstick in the trauma patient?
Microscopic haematuria is a sensitive marker of solid organ injury within the abdomen.
What is the alternative to CT or ultrasound scanning in diagnosing abdominal injuries in the trauma patient?
Diagnostic peritoneal lavage.
Outline an abbreviated neurological examination in the trauma patient
Assess level of consciousness pupils the presence or absence of limb movements.
