The Multiply Injured Patient Flashcards
Pre-hospital trauma services?
Ambulances, fire service, etc.
What is meant by a pre-alert?
Call from trauma team ahead of patient arriving so roles can be assigned, and drugs equipment can be set up
What is discussed in the paramedic handover?
Tome of injury
Mechanism of injury
Suspected serious injuries
Vital signs
Interventions carried out
->paramedics have such a broad base of knowledge so very useful
Primary survey for trauma assessment?
ABC- detects and treats immediate threats to life
->done before secondary survey to identify all injuries
ATLS survey?
ABC
Airway
Breathing
Circulation
Disability
Expose and environment
->A-C in primary survey, D and E part of secondary
What is mostly controlled in circulation section of ATLS?
Catastrophic haemorrhage control
->leading cause of death in military trauma due to explosives etc.
While third in the list, delays in treating C for haemorrhage while assessing A and B lead to deterioration. Important teamwork required
How is airway assessed?
Noises- speech, gurgling, stridor
Visual- vomit/blood/debris
How is airway managed?
Manoeuvres
Suction
Adjuncts
Intubation
What part of the spine is managed initially during A part?
Cervical spine
In which patients would you have to assume there is a cervical spine injury?
Dangerous mechanism
Reduced conscious level- as cannot tell you about their neck
Injury above clavicles
Neurological signs
What is done for cervical spine management?
Neck support to limit movement
What is done in the B section of ATLS?
Look at chest for visible injuries, RR
Feel and percuss for fluid or air in chest
Listen to chest
Oxygen, analgesia and drainage in required
How is circulation assessed?
HR
Palpable radial pulse
CRT
BP
Urine output
Confusion
Which blood tests are done to assess circulation?
Haemoglobin
Lactate
Which imaging may be done to assess circulation for potential sources of bleeding?
Ultrasound
CT
What are the five main sites for blood loss?
Floor if open bleeding!!
Chest
Abdomen
Pelvis
Long bones
What is done initially for haemorrhage control in the cases of RTA, etc?
Tourniquet
->tight bands to prevent bleeding
What needs to be considered for volume replacement in the management of circulation?
IV access
IO access (if cannot gain IV access)
Type and amount of fluid
Transfusion protocols
How is volume replacement monitored?
Vital signs e.g. pulse and BP
Urine output
Lactate
The lethal triad may be seen in significant bleeding.
What makes up the lethal triad?
Coagulopathy
Acidosis
Hypothermia
What is done to assess disability?
Neurological examination:
GSC
Pupils
Tone and reflexes
Log roll
What is the point of the expose section of management of a trauma patient?
To allow identification of any other injuries that might of been missed earlier
What is one thing often checked in any trauma patient after ABCDE?
Glucose
->ABCDon’tEverForgetGlucose- patient may be diabetic and may have played a part in their injury
