Symposium - The Multiple Injured Patient Flashcards
What are possible complications of trauma?
- Death
- Leading cause of death in first 4 decades life
- Disability
- For every death, there are 2 survivors with disability
Where is good quality trauma care provided?
- Prevention
- Pre-hospital care
- Acute trauma care
- Specialised definitive care
- Rehabilitation
What is a trauma network?
Trauma network = all providers, such as pre-hospital services, smaller local trauma units and larger trauma centres and rehabilitation services
What are major trauma centres?
Major trauma centres = centres providing multi-specialty hospital care to seriously injured patients, optimised for the provision of trauma care
Describe the process in a truma centre when a patient is inbound?
- Pre-alert
- Alerts team patient on the way
- Team made up of ED, anaesthetics, radiology and surgical specialities
- Equipment and drug set up before arrival
- Paramedic handover
- Includes – time of injury, mechanism of injury, suspected serious injuries, vital signs, interventions carried out
- Trauma assessment
- Primary survey – ABC (airway, breathing and circulation) to detect and treat immediate threats to life
- Secondary survey – done after patient stabilised to identify all injuries and more detailed history
Who makes up the trauma team?
- Team made up of ED, anaesthetics, radiology and surgical specialities
What is discussed in the paramedics handover?
- Includes – time of injury, mechanism of injury, suspected serious injuries, vital signs, interventions carried out
What is a primary and secondary survey?
- Primary survey – ABC (airway, breathing and circulation) to detect and treat immediate threats to life
- Secondary survey – done after patient stabilised to identify all injuries and more detailed history
What are the different approaches to the primary survey?
-
Advanced trauma life support (ATLS)
- “ABC” approach
- Airway with C-spine control
- Breathing with oxygen
- Circulation with haemorrhage control
- Disability
- Exposure and environment
-
Battlefield advanced trauma life support (BATLS)
- “ABC”
- C at start for catastrophic haemorrhage control
- This is haemorrhage leading to cause of death in military trauma (ballistic/explosive)
What does ATLS stand for?
Advanced trauma life support
Describe the steps of advanced trauma life support (ATLS)?
- “ABC” approach
- Airway with C-spine control
- Breathing with oxygen
- Circulation with haemorrhage control
- Disability
- Exposure and environment
What does BATLS stand for?
- Battlefield advanced trauma life support (BATLS)
Describe the steps of BATLS?
- “ABC”
- C at start for catastrophic haemorrhage control
- This is haemorrhage leading to cause of death in military trauma (ballistic/explosive)
What does management of airway and C-spine control include?
- Assessment
- Noises: speech, gurgling, stridor
- Visual: swelling, deformity, vomit, blood, debris
- Airway management
- Manoeuvres
- Suction
- Adjuncts
- Advanced procedures (intubation)
- Assume cervical spine injury in
- Dangerous mechanism
- Reduced conscious level
- Injury above clavicles
- Neurological signs
What is done for airway management?
- Manoeuvres
- Suction
- Adjuncts
- Advanced procedures (intubation)
What is used to assess the airway?
- Noises: speech, gurgling, stridor
- Visual: swelling, deformity, vomit, blood, debris
When should cervical spine injury be presumed?
- Dangerous mechanism
- Reduced conscious level
- Injury above clavicles
- Neurological signs
What is involved in the management of breathing and oxygen?
- Look
- Visible injuries
- Respiratory rate
- Effort/expansion
- Feel
- Palpate
- Percuss
- Listen
- Auscultate
- Oxygen, analgesia, drain
What is involved in the management of circulation?
- Assessment
- Heart rate
- Palpable radial pulse
- CRT
- BP
- Pulse pressure narrows
- Urine output
- Confusion
- Blood tests
- HB
- Lactate
- Imaging
- Ultrasound
- CT
- Haemorrhage control
- Volume replacement
- IV access
- IO access (into medulla of bone)
- Type of fluid
- Amount of fluid
- Massive transfusion protocols
- Monitor volume replacement
- Vital signs
- Urine output
- Lactate
How is circulation assessed?
- Assessment
- Heart rate
- Palpable radial pulse
- CRT
- BP
- Pulse pressure narrows
- Urine output
- Confusion
- Blood tests
- HB
- Lactate
- Imaging
- Ultrasound
- CT
How is the fluid replacement monitored?
- Vital signs
- Urine output
- Lactate
What are the 5 possible places for blood loss?
- Lose into
- Floor
- Chest
- Abdomen
- Pelvis
- Long bones
Describe the lethal triad that significant bleeding causes?
- Coagulopathy
- Acidosis
- Hypothermia
What is involved in management of disability?
- Neurological examination
- AVPU
- GCS
- Pupils
- Tone and reflexes
- Log roll
What is involved in exposing and environment?
- Log roll and expose to allow full examination
- Then cover up for warmth
What should be added to ABCDE of ATLS?
Don’t forget G:
- Check for glucose
- Other bed side tests
- ECG
- Arterial blood gas
- Urine dipstick
Describe the secondary survery?
- Ultrasound
- Fast scan (focus assessment with sonography for trauma)
- Then CT
- Minimal handling
- Possibly no log roll
- Trauma mattress
- Don’t spring the pelvis
What happens after the primary and secondary survery?
Transfer and further management:
- Theatre
- Operative management
- Interventional radiology
- Control of bleeding
- ITU
- Intracranial pressure monitoring
