TARMS Flashcards
Describe the modal distribution of mortality from trauma.
Trimodal distribution: deaths from trauma occur:
- at time of injury (seconds-minutes)
- Traumatic brain injury, spinal cord injury, cardiac, aortic rupture - minutes to hours after the injury
- Haemorrhage: intracranial, solid organ, major pelvic # - days to weeks post-injury
- Lung injury, sepsis, DIC, MOF
What injury severity score is used to define major trauma?
An ISS score of more than 15 is classed as a major trauma
Why is it helpful for pre-hospital team to pre-alert the ED of an incoming trauma?
Allows ED team to assemble and brief before arrival of patient. In case of multiple injured patients pre-alerting allows for mobilisation of adequate/additional resources
How is mean arterial pressure calculated?
(2 x diastolic BP + systolic BP) / 3
How is cerebral perfusion pressure calculated?
CPP = MAP - ICP
Therefore, haemorrhage will decrease cerebral perfusion. However, if the patient has a head injury (leading to an increased ICP) AND they are haemorrhaging, this means they are at even greater risk of losing CPP.
How does each step in the A-E assessment contribute to prevention of secondary brain injury?
A & B: prevention of hypoxia and hypercapnoea
C: maintenance of adequate cerebral perfusion pressure
D: repeating assessment (GCS, pupils, focal deficits) to spot deterioration early. Prevent hypoglycaemia.
E: identify and treat sources of haemorrhage
What are the life-threatening thoracic injuries to look out for in the ‘B’ assessment?
ATOM FC
Airway obstruction
Tension pneumothorax
Open pneumothorax (chest wound)
Massive haemothorax
Flail chest
Cardia tamponade
In addition to a chest drain kit, what else does a patient require if they having a chest drain inserted?
Oxygen
Fluids
Blood tests
Where should a chest drain be inserted?
In the triangle of safety.
Between lateral edges of pectorals major and latissimus dorsi, and between the base of axilla and 5th intercostal space.
