Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ACC > TARMS > Flashcards

TARMS Flashcards

1
Q

When do deaths from trauma occur?

A

In a TRIMODAL distribution:

  • At time of injury (seconds to minutes)
  • Minutes to hours post injury
  • Day to weeks post injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do we assess the severity of trauma?

A

With TRAUMA SCORES
ISS (injury severity score) most commonly used, others include AIS (abbreviated injury score), RTS (revised trauma score)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How should you initially assess a patient with trauma?

A
  • Airway and cervical spine control
  • Breathing and ventilation (oxygenation)
  • Circulation with haemorrhage control
  • Disability and neurological status
  • Exposure (trauma observation) and environmental control (pain, temp)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What extra considerations should you have when assessing an airway of a trauma patient?

A

ALL NORMAL THINGS (stridor, obtundation, snoring, trachea central, paradoxical movements)
+
Facial injuries/burns
Neck wounds
Epistaxis or vomiting
Head injury leading to low GCS (GCs<8 intubate)
C-SPINE INJURY - might impact airway manoeuvres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What things should be considered in BREATHING primary survey?

A

Summarised by ATOM FC

  • Airway obstruction
  • Tension pneumothorax
  • Open chest wound
  • Massive haemothorax (>1500mL)
  • Flail chest (2 or more ribs broken in 2 or more places - indicates high force injury)
  • Cardiac tamponade
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When assessing circulation in trauma what should we be assessing/looking for and what are some common types?

A

Main concern is SHOCK:

  • Assess pulse (rate rhythm character),
  • Blood pressure
  • Heart rate
  • CRT (peripherally and centrally)
  • Skin temperature
  • Urine output / consciousness level

CAUSES OF SHOCK IN TRAUMA
- Haemorrhagic, Cardiogenic, Neurogenic, Obstructive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common form of shock in trauma and where can volume commonly be lost?

A

-Hypovolaemic (haemorrhagic). Blood loss commonly described as being OCCULT (meaning hard to discern).

‘one on the floor and four more’
CHEST, ABDO, PELVIS and LONG BONES (esp femur)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If you suspect someone is loosing a lot of blood and is shock how should they be initially managed?

A
  1. AIRWAY AND OXYGEN
  2. STOP BLEED (splints/binder/tourniquets/direct pressure)
  3. REPLACE CIRCULATING VOLUME (permissive hypotension-reduce risk of clot dislodge and further bleeding)
    • Get access 2x Wide-Bore Cannulas into each ACF
    • FBC/UsEs/LFT/amylase/coagulation/crossmatch/VBG
    • Warm crystalloid fluid whilst waiting for O-negative blood
  4. RESTORE HEAMAGLOBIN
    • Activate major haemorrhage protocol
    • Red cells and FFP in a 1:1 ratio (and 1 platelets if required)
    • Tranexamic acid if active haemorrhage <3 hours since trauma)
  5. TREAT CAUSE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does TXA work?

A

Tranexaminc acid binds to lysine receptors on plasminogen which prevents plasmin from being used and degrading fibrin (prevents clot breakdown)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does the massive transfusion protocol include?

A

4 units red cells 4 units FFP
Can give O- blood if waiting for cross match but group specific blood should be given as soon as possible because O- is scarce resource
Also always give TXA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What should be included on your disability assessment for a trauma patient?

A

A thorough assessment for any head trauma is necessary
GCS, Pupil response (important for head injury)
ALWAYS GET GLUCOSE HERE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where is the most common area of the spine to be affected in trauma?

A

Cervical region (55%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What kinds of things can cause secondary injury to the spine?

A

Hypoxia, hypotension, hypoglycaemia or mechanical disturbances due to inappropriate moving or positioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the four main types of spinal cord injury to be aware of?

A

Anterior cord syndrome
Central cord syndrome
Brown-Sequard Syndrome
Complete spinal cord syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does anterior cord syndrome present?

What causes it?

A
  • Bilateral loss of motor, pain and temp below lesion

- Caused by flexion injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does central cord syndrome present? Who is it more common in?

A
  • Sensory and motor loss
  • paralysis ARMS>legs (man in barrel)
  • OLDER people with cervical neck disease (hyperextension injury)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does Brown-Sequard syndrome present?

When does this happen

A

Hemisection of cord

  • Ipsilateral motor/vibration/proprioception
  • Contralateral pain and temperature
  • most commonly seen after knife injury or sometimes when tumour compresses one half

***this is because fibres in the spinothalamic tract decussate at the level of the spinal cord whereas dorsal column fibres cross over at the pyramid level

18
Q

How do we assess whether someone might have a C-Spine injury?

A

Using the CANADIAN C-SPINE RULE
1. Any high risk factors? (65, drive, deprived)
-sixty five
-fast drive (dangerous mechanism)
-sensory deprived (paraethesia in extremities)
IF YES>CT (image if alive) IF NO> go to question 2

  1. ANY low risk factors?
    -slow wreck (simple mechanism)
    -slow neck (delayed neck pain)
    -sitting down
    -walking round (ambulatory at any time)
    -C spine fine (absence of midline C spine tenderness)
    IF YES>range the spine IF NO>CT
  2. Able to rotate neck 45 degrees left and right?
    IF YES> DONT CT IF NO>CT
19
Q

How should a patient with a suspected spinal injury be managed?

A 
Optimise oxygenation 
Prevent blood pressure drops to maintain perfusion to spinal cord 
Immobilise 
Urinary catheter 
Definitive imagining 
Early specialist advice
20
Q

What are the three factors of the trauma triad of death?

A

Coagulopathy, hypothermia and metabolic acidosis

21
Q

Explain how the three aspects of the trauma triad of death feed into one another

A

HYPOTHERMIA LEADS TO COAGULOPATHY
- Imbalance between thromboxane and prostacyclin meaning clotting cascade not as efficient. This is why it is essential to warm a patient during trauma care (blood products and fluid resuscitations should also be warmed)

COAGULOPATHY LEADS TO METABOLIC ACIDOSIS
Poor distribution of blood means ischaemic tissues and hypoxia leading to lactic acidosis. Acidaemia reduces cardiac output, exacerbating the shocked state and causing right shift to oxygen dissociation curve

METABOLIC ACIDOSIS LEADS TO HYPOTHERMIA
Poor CO means less perfusion and worsening hypothermia

22
Q

How are pelvic fractures managed?

A

Pelvic binders commonly placed pre-hospital (prevents movement of pelvis and hopefully encourages stasis of any blood loss)

23
Q

What is an emergency complication of bone fractures?

A

COMPARTMENT SYNDROME
Pressure builds up in muscular compartment - sometimes pressure builds up so high that it can occlude blood vessels leading to death of the limb
- FASCIOTOMY needed to treat

24
Q

Landmarks for a chest drain?

A
  • lateral edge of pec major
  • lateral edge of lat dorsi
  • base of axilla
  • 5th ICS
25
Q

What do you need to know from a trauma call?

A 
ATMIST 
A – Age and other patient details
T- Time of incident
M – Mechanism
I – Injuries Sustained
S – Signs
T – Treatment and Trends
26
Q

What is an open pneumothorax?

What is the treatment

A

-Open pneumothorax is a defect in chest wall (>60% trachea), air goes through hole into pleura, instead of via alveoli

TREATMENT

  • Cover it with 3 sided taped gauze (air escapes but not allowed in)
  • Chest drain
  • Consider intubation (positive pressure)
27
Q

What is a massive heamothorax?

A 
MASSIVE HEAMOTHORAX
-Defined as >1500ml blood in chest
-it causes significant injury to major vessels in chest and 
compresses lung
-Haemorrhage also causes shock
28
Q

Treatment for massive heamothorax?

A

Chest drain and replace with fluids (vasovagal effect) ANYONE WITH CHEST DRAIN NEEDS FLUIDS BEFORE

29
Q

Signs of massive heamothorax?

A

Massive heamothorax

  • cyanosis
  • lung sound absent on affected side
  • dull to percussion on affected side
  • respiratory problems (late sign)
  • shock (compression of vessels in chest)
  • flat neck veins
30
Q

What is flail chest?

A

FLAIL CHEST

  • Indicator of very high force
  • Mobile segment of chest wall (2 or more ribs broken in 2 or more places) (mechanical)
  • Lung crushed underneath, pulmonary contusion
  • More than 5 ribs-need fixing
31
Q

Treatment for flail chest?

A

Treatment flail chest

  • Treat shock as likely to co-exist (haemothorax)
  • Analgesia
  • Anticipate worsening hypoxia
  • Early intubation and/or ventilation (may use NIV)
32
Q

What is a tension pneumothorax?

What are signs of tension pnuemothorax?

A

One way valve (air in but not out)
SIGNS
-Tension pneumothorax you can feel surgical emphysema
-SHOCK (compresses vessels)
-Severe respiratory distress
-Unilaterally hyper-expanded chest with reduced movement
-Hyper-resonant and ↓ air entry on affected side
-Tracheal deviation away (late sign)

33
Q

What is the treatment of tension pneumothorax?

A
  1. Decompression (cannula in 2nd intercostal space, midclavicular line)
  2. Chest drain, 5th IC mid axillary
34
Q

What is cardiac tamponade?

A

Cardiac tamponade

  • Injury to myocardium (usually sharp)
  • Blood leaks to pericardial sac
  • Heart is compressed and cant fill
  • Cardiac output falls dramatically (increased venous return- distended
35
Q

What are clinical signs of cardiac tamponade?

How do you treat it?

A

Signs of cardiac tamponade

  • Shock
  • Distended neck veins
  • Muffled heart sounds
  • Clinical suspicion

PERICARDIOCENTESIS
* Subxiphoid needle aspiration - unlikely to succeed if clotted blood


THORACOTOMY

  • Shocked: emergency cardiothoracic surgery

  • Traumatic cardiac arrest: clamshell thoracotomy

36
Q

what is the Cerebral Perfusion Pressure Equation

A

CPP=MAP (mean arterial pressure)-ICP

so as ICP increases the perfusion of brain decreases

37
Q

How do you prevent secondary brain injury?

A

A – prevention of hypoxia & CO2 ↑
B – prevention of hypoxia & CO2 ↑
C – keep cerebral perfusion pressure adequate
D – repeating observations, prevent hypoglycaemia

Early CT + liaison with neurosurgery

38
Q

Equation for oxygen delivery?

Therefore what are 4 types of hypoxia?

A

oxygen delivery=cardiac output conc of oxygen in blood

  • Hypoxic hypoxia - ↓ O2 supply
  • Anaemic hypoxia - ↓ haemoglobin function
  • Stagnant hypoxia – inadequate circulation
  • Histotoxic hypoxia – impaired cellular O2 metabolism
39
Q

In trauma how do we assess circulation?

A

HEPB

  • Hands (temp/sweat/CRT)
  • End organ perfusion (GCS/urine output)
  • Pulse (rate/rhythm/character)
  • Blood pressure
40
Q

4 categories of shock?

A

Shock

  1. <750ml normal physiology
  2. 750ml-1500ml ↑HR, ↑RR, altered cognitions (anxious)
  3. 1500-2000ml ↓BP occurs after 30% loss! (confused)
  4. 2000ml+ Peri-arrest! (lethargic)
41
Q

What is the triad of death in trauma?

A

Trauma triad of death

  1. Hypothermia
  2. Coagulopathy
  3. Acidosis
42
Q

What is the munro-kellie doctrine

A

If something else goes in there the brain will remove CSF from the brain into the spinal cord, then blood gets chucked out, then brain>brainstem death

ACC (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions