The Multiply Injured Patient Flashcards
Why is trauma important?
- Leading cause of death for the first 4 decades of life
- For every death there are 2 survivors with significant disability
- Trauma deaths in Scotland higher than rest of the UK
What advances have been made in trauma care?
- Advanced trauma life support
- Battlefield advanced trauma life support
- HEMS/MERT
What is in place to help doctors improve their trauma skills?
- Standard operating procedures (SOPs)
- Checklists
- Simulation
- Study days
- Debrief
- Documentation
- Audit (STAG, TARN)
When should trauma management start?
- From time of injury
- Golden hour/ platinum 10 minutes
What should be established in pre-hospital care?
- Time of injury
- Mechanism of injury
- Speed/forces involved
- Ejection/pedestrian
- Likely serious injuries
- Vital signs
- Interventions carried out
What preparation is required pre-arrival?
- A Trauma call pre-alerts the trauma team of a patient.
- Team is made up of ED, anaesthetics, radiology, ICU and surgical specialities.
- Equipment and drug set up takes place prior to arrival.
- An ABC approach for this helps.
What is involved in a primary survey?
- ABC
- Detects and treats immediate threats to life
What is involved in a secondary survey?
-Identification of all injuries and planned management
What is the goal of damage control resuscitation?
- Minimise blood loss
- Maximise tissue oxygenation
ATLS Primary Survey.
- Airway with C-spin control
- Breathing with O2
- Circulation with haemorrhage control
- Disability
- Exposure and environment
BATLS Primary Survey
- Catastrophic haemorrhage control
- Airway with C-spin control
- Breathing with O2
- Circulation with haemorrhage control
- Disability
- Exposure and environment
How is airway assessed?
Noises
- Speech
- Gurgling
- Stridor
Visual
- Swelling/deformity
- Vomit/blood/debris
How can airway be managed?
- Manoeuvres
- Suction
- Adjuncts
- Advanced procedures
When should a c-spine injury be assumed?
- Major trauma
- Reduced conscious level
- Dangerous mechanism
- Injury above clavicles
- Neurological signs
- If distracting injuries during clinical assessment
How is breathing assessed?
Expose the chest
- Look for work of breathing/expansion and effort
- Feel (palpate and percussion)
- Auscultate
How is circulation assessed?
Clinical
- HR
- Palpable radial pulse
- CRT
- BP
- Pulse pressure narrows
- Urine output
- Confusion
- Blood tests (HB and lactate)
- US and CT
What are the 5 sites for blood loss?
- Chest
- Abdomen
- Pelvis
- Long bones
- Floor
How can fluid be replaced?
- IV access
- IO access
- Massive transfusion protocols
How can volume replacement be monitored?
- Vital signs
- Urine output
- Lactate
What is the lethal triad?
- Coagulopathy
- Acidosis
- Hypothermia
What neurological examination should be carried out for disability?
- AVPU
- GCS
- Pupillary responses
- Tone and reflexes
How should ‘E’ be assessed?
- Expose to allow full examination
- Then cover and keep warm
What does ‘G’ stand for?
Glucose
What bedside tests can done for glucose?
- ECG
- ABG
- Urine dip
What is the traditional method for secondary survey and investigations?
Primary survey x-rays
- C-spine
- Chest
- Pelvis
Secondary survey
- Meticulous head to toe
- Log roll
- “Spring the pelvis”
- Check all orifices – PR etc
What is the modern approach for secondary survey and investigations?
Ultrasound
- Pneumothorax
- Fast scan
Minimal handling
-Possibly no log roll
CT secondary survey
-NNtB 17
Where do trauma patients usually get transferred for further management?
Theatre
-Operative management (DCS)
Interventional radiology
-Control of bleeding
ITU
- ICP monitoring
- Ventilation
- Continued resuscitation
