The multiply injured patient: trauma Flashcards
What is the most common cause of death in the first 4 decades of life?
Trauma
What is the usual procedure for when a trauma patient is taken into hospital?
A pre-alert call is made to alert the trauma team
The team is made up of the ED doctors, anaesthetists, radiologists and surgical specialities as required
The leader of the team (usually ED doctor) assigns the roles
Equipment and drug set up takes place prior to patient’s arrival.
When the patient arrives there is a paramedic handover
What should be covered in a paramedic handover?
Time of injury
Mechanism of injury - speed/forces, people involved/deaths of others/ejected/damage to vehicle
Paramedic should identify what they suspect are the major injuries
Vital signs
Any interventions that have been carried out
What is the standard trauma assessment?
Primary survey using standard ABC (airway, breathing and circulation). This detects and treats immediate threats to life.
After the patient has been stabilised a more detailed history should be obtained and all injuries should be identified. This is called the secondary survey. This may be done after ED or emergency surgery etc
ABC approach
Airway with C-spine control Breathing with O2 Circ. with haemorrhage control Disability Expose and environment
D and E are part of the secondary survey
What is BATLS?
Battlefield advanced trauma life support
C before the ABC
which stands for catastrophic haemorrhage control. This is common in blast/explosive injuries or military trauma.
By stopping/reducing the haemorrhage before airways and breathing there is a large increase in survival
What should be assessed when looking at the patient’s airways?
Can they talk? or are they making noises like gurgling or stridor
Visual - Can you see any swelling/deformity in the airway? Any vomit/blood/debris
Airway management - suction, adjuncts (airways), intubation
Must also assess and protect the cervical spine.
When should you assume that a patient has had a cervical spine injury?
Dangerous mechanism i.e diving into a pool or head injury
Reduced conscious level
Injury above clavicles
Neurological signs
Apply a neck support to prevent mobilisation until safe to do so
How should you check breathing and oxygen?
Expose the chest and look for visible injuries, respiratory rate, effort/expansion (equal?)
Feel - palpate, percuss
Listen to chest
Provide O2, analgesia
May need to insert drain to remove blood and air
Circulation assessment
Heart rate Palpable radial pulse CRT - Cardiac resynchronization therapy BP Pulse pressure narrows Urine output Confusion
Hb and lactate blood test
Assess potential bleeding using USS or CT
Where are the 5 sites of blood loss? I.e where can you lose blood into?
Chest Abdomen Pelvis Long bones Floor - if open wounds
If a patient has lost a lot of fluid/blood how is it replaced?
IV access or if this isn’t possible intraosseous access (into the medulla of long bone) and can infuse fluid into bone
How do doctors monitor the volume replacement?
Vital signs - BP
Urine output
Lactate - rising lactate are indications of problems - circulatory shock is responsible for inadequate O2 delivery, resulting in tissue hypoxia, anaerobic metabolism, and lactate production.
What is the lethal triad?
Coagulopathy
Acidosis
Hypothermia
If you bleed enough you will start to get coagulopathy and your blood will no longer clot. You will then become acidotic and then hypothermic
What should be covered when assessing for disability?
Neurological examination - GCS, pupils (dilatation), tone and reflexes
Log roll them to check for any problems on their back - secondary injuries that may be missed
