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Module 14 > The Trauma Patient: Triage, Evaluation, Stabilization > Flashcards

The Trauma Patient: Triage, Evaluation, Stabilization Flashcards

1
Q

what does death from trauma tend to be associated with

A

intra-thoracic

intra-abdominal

CNS trauma

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2
Q

what is the primary survey and triage for

A

rank and manage injuries based on their threat to life

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3
Q

how do you survey the respiratory system

A
  1. resp pattern
  2. resp rate
  3. mucous membrane colour
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4
Q

how do you survey the cardiovascular system (4)

A
  1. heart rate
  2. pulse quality
  3. mucous membrane colour
  4. capillary refill time
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5
Q

how do you survey the neurological system (5)

A
  1. mentation:

alert (responsive to voice, pain or unconscious)

obtunded (mentally dull)

stuporous (semi-conscious)

comatose (unconscious)

  1. pupil size & PLRs
  2. eye position & movement
  3. motor responses
  4. blood pressure
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6
Q

what is done intially in trauma patients

A

stabilization

assessing pulse quality, IV access & fluid therapy, supplemental oxygen, ECG to assess cardiac rhythm

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7
Q

what are pulmonary contusions

A

compression-decompression injury following blunt trauma

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8
Q

what do pulmonary contusions cause and what does this result in

A

pulmonary interstitial & alveolar hemorrhage/edema which results in ventilation-perfusion mismatch & hypoxemia

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9
Q

why must you observe a patient with pulmonary contusions

A

may observe progessive deterioration over several hours

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10
Q

what is pneumothorax

A

accumulation of air within the pleural space –> creates atelectasis of lungs which then don’t participate in gaseous exchange (aren’t inflating)

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11
Q

what is the difference between open and closed pneumothorax

A

open: secondary to rib fracture
closed: secondary to ruptured alveolus/bronchus/trachea/esophagus

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12
Q

what is the diagnosis

A

pneumothorax

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13
Q

what is the diagnosis

A

tension pneumothorax

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14
Q

what is tension pneumothorax and why is it life threatening

A

site of air leakage acts as one-way valve

pleural pressure increases during each inspiration until it is greater than atmospheric pressure

hypoxemia develops due to atelectasis –> poor venous return results in CV collapse & shock

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15
Q

what is a diaphragmatic hernia/rupture

A

sudden increase in abdominal pressure with an open glottis is thought to result in a tear to the diaphragm –>

presence of herniated organs within the pleural space contributes to hypoxemia

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16
Q

what does a diaphragmatic hernia/rupture

A

reduced venous return may contribute to CV signs

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17
Q

what are fractured ribs often associated with

A

pulmonary contusions & pleural space disease

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18
Q

what can result in pain-associated hypoventilation

A

fractured ribs +/- pulmonary contusions

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19
Q

what is flail chest

A

fracture (dorsally & ventrally) of 2 or more adjacent rib segments results in paradoxical chest wall motion

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20
Q

how do you assess thoracic trauma (5)

A
  1. physical exam: breathing pattern, auscultation & percussion
  2. trans-thoracic ultrasonography (pleural/pericardial effusion)
  3. diagnostic (& therapeutic) thoracocentesis
  4. thoracic imaging: radiography or CT
  5. ECG
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21
Q

how do you diagnose pneumothorax with physical exam

A

dull dorsal lung sounds and hyper-resonance of the chest on percussion

“barrel-chest” as an indicator of tension pneumothorax in severely dyspneic/cyanotic patients

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22
Q

how do you diagnose diaphragmatic hernia with physical exam

A

lung sounds may be dull ventrally or you may hear borborygmi on auscultation of the thorax

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23
Q

how do you diagnose traumatic hemothorax/chylothorax with physical exam

A

dull lung sounds ventrally

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24
Q

what are the goals of therapy of pneumothorax (2)

A
  1. re-expansion of the collapsed lung
  2. improvement in venous return & cardiac output
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25
how is a pneumothorax treated
thoracocentesis or thoracostomy tube placement
26
how is a thoracocentesis or thoracostomy tube placed
intermittent or continuous pleural drainage may be required
27
what should you consider in a rapidly deteriorating pneumothorax patient
induction intubation and IPPV potential need for exploratory thoracotomy if the pneumothorax is ongoing/unresolved with intermittent drainage
28
how is an open pneumothorax treated
apply occlusive dressing
29
how are pulmonary contusions managed
supportive oxygen supplementation: intubation & ventilation may be indicated in severe cases avoid over-zealous fluids: damaged lung can be edematous
30
when do pulmonary contusions usually resolve
3-10 day period
31
how are diaphragmatic hernia/ruptures treated
surgical correction
32
how are fractured ribs treated
management of pain-associated hypoventilation local blocks (lidocaine or bupivicaine) systemic analgesics
33
how are pleural/pericardial effusions treated
drainage where effusion is having clinical impact
34
what are common neurological injuries following trauma
traumatic brain injury (TBI) spinal cord injury (SCI) may also have concurrent skeletal and soft tissue trauma affecting the head (fractured mandible, orbital fractures, soft palate trauma)
35
what are primary traumatic brain injuries (3)
1. concussion (no histological lesion) 2. contusion (parenchymal hemorrhage and edema) 3. laceration resulting in hematoma formation & brain compression either axial (within brain parenchyma) or extra-axial (epidural, subdural, subarachnoid)
36
what are secondary traumatic brain injuries
combination of intracranial and systemic insults leading to neuronal cell death
37
what are systemic insults to the brain (4)
1. hypotension & hypoxia 2. systemic inflammation (secondary to trauma) 3. hypercapnia (increased CO2) and hypocapnia (decreased CO2) 4. hyperglycemia, electrolyte imbalances, acid-base disturbances
38
what are intracranial insults (4)
1. increased intracranial pressure (ICP) 2. compromise of blood brain barrier 3. cerebral edema 4. seizures
39
what is raised intracranial pressure (ICP)
develops when the volume of the intracranial contents exceeds compensatory mechanisms
40
what does increased ICP cause
brain herniation if not identified and treated
41
what is transtentorial herniation
transtentorial: cerebrum herniating caudally
42
what is transforaminal herniation
cerebellum herniates caudally through the forament magnum
43
when should you consider ICH (3)
if you observe deterioration in neurological function 1. deterioration in mentation, brain-stem function, postural changes (decerebrate rigidity) 2. development of abnormal respiratory patterns 3. systemic hypertension and bradycardia "cushing relfex"
44
how do you assess the severity of TBI
glasgow coma scale
45
what does the glasgow coma scale assess (5)
1. level of consciousness 2. brain-stem relfexes (pupil size, PLRs and eye movements) 3. limb movements and postural reactions 4. respiratory pattern 5. blood pressure and heart rate
46
what are the goals of therapy for TBI (3)
1. ensure adequate oxygenation 2. avoid and/or correct factors that predispose to secondary brain injury 3. address raised ICP
47
what should you do in patients at risk developing ICH (4)
1. prevent hypercapnia by controlling PaCO2 between 30-35 mmHg (may require mechanical ventilation) 2. maintain PaO2 \> 80mmHg 3. elevate the head 30 degrees and prevent jugular compression 4. remove causes of increased intra-thoracic pressure
48
what should you do where there is clinical evidence of marked ICH (deteriorating neurological status)
1. reduce cerebral edema with hyperosmolar therapy 2. reduce cerebral metabolic rate
49
how do you reduce cerebral edema
hyperosmolar therapy mannitol (0.5-1 g/kg IV over 20 mins) hypertonic saline (4ml/kg of a 7.5% solution over 10 min)
50
how do you reduce cerebral metabolic rate
anesthesia barbituate therapy hypothermia
51
what are examples of abdominal therapy (7)
1. hemoabdomen/hemoretroperitoneum 2. uroabdomen/uroretroperitoneum 3. bile peritonitis 4. septic peritonitis 5. pancreatitis 6. diaphragmatic rupture 7. body wall rupture
52
how do you assess for abdominal trauma
admonial radiography/CT abdominal FAST (aFAST)
53
what is the aim of FAST
detection of free abdominal fluid
54
what are the points of aFAST
1. diaphragmatic-hepatic DH location 2. spleno-renal SR 3. cysto-colic CC 4. hepato-renal HR
55
where is the diaphragmatic-hepatic DH location and what does it evaluate
sub-xiphoid view the hepatodiaphragmatic interface, gallbladder region, pericardial sac, pleural spaces
56
where is the spleno-renal (SR) location and what does it evaluate
left flank view to access the splenorenal interface and areas between the spleen and the body wall
57
where is the cysto-colic CC location and what does it evaluate
a midline bladder view to assess the apex of the bladder
58
where is the hepato-renal HR location and what does it evaluate
a right flank view to assess the hepatorenal interface and areas between intestinal loops, right kidney, and body wall
59
what other diagnostics can be done to assess abdominal trauma
abdominocentesis and/or diagnostic peritoneal lavage
60
what would indicate hemoabdomen
parenchymal organ laceration or major vessel disruption if the PCV of the abdominal fluid approximates to the peripheral PCV trauma of \> 1 organ (combo of laceration and uroabdomen may reduce PCV)
61
what would indicate uroabdomen
if creatinine concentration in abdominal fluid is over 2 times peripheral blood or potassium is 1.4 (dog) or 2 (cat) times serum level
62
what would indicate spetic peritonitis
identify intraceullular bacteria, degenerate neutrophils on cytology (high fluid lactate: low fluid glucose)
63
what would indicate an intestinal perforation
particulate material (plant material)
64
what would indicate bile peritonitis
bilirubin content of the fluid is signifcantly higher than plasma levels as this is an inflammatory condition you'll see neutrophils
65
what is hemoabdomen caused by
bleeding from spleen, liver and kidney
66
when would you suspect hemoabdomen
RTA patient presenting with signs of hypovolemic shock
67
what is diagnosis of hemoabdomen based on
free peritoneal fluid (aFAST) which has a PCV similar to peripheral blood
68
what are the goals of therapy in hemoabdomen
management of hypovolemic control of bleeding: surgical or conservative (medical) management
69
what are conservative management of hemoabdomen
external counter-pressure using an abdominal wrap
70
what are surgical management of hemoabdomen
internal counter-pressure +/- autotransfusion potential requirement for splenectomy, liver lobectomy, nephrectomy
71
what is uroabdomen caused by
secondary to injury to the kidneys, ureters, bladder, urethra
72
when could uroabdomen develop
as a late complication of blunt abdominal trauma
73
which develops first hematuria or uroperitoneum
hematuria is often present before uroperitoneum develops
74
could a patient urinate despite trauma to urinary tract
potentially
75
how is uroabdomen diagnosed
imaging (including contrast radiography) to determine where urine is leaking from
76
how is uroabdomen managed
surgical correction but medical stabilization may be required before surgical intervention is possible metabolic consequences --\> hyperkalemia are potentially life threatening
77
what are skeletal injuries that can occur following trauma
mandibular symphyseal fractures are common
78
when is poor outcome common
intra-thoracic, intra-abdominal and CNS trauma

Module 14 (29 decks)

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