Theme 13 - Max Fax trauma Flashcards
From a legal perspective, what should you write down when examining an injured patient?
- Mode of attack
- By whom
- Where they were
- What time
- Witnesses
- Have they got the police involved
What type of injury is bilateral periorbital ecchymosis (racoon eyes) a sign of?
Base of skull fracture
or Localised trauma
Why might pupil reaction time be affected when examining in injured patient?
On high dose opiates
Head injury/ increase intracranial pressure
Retrobulbar haemorrhage
As age increases where does the site of injury change to in the face?
As age increases site moves from upper face to lower face
What could be the possible causes of airway obstruction in an injured patient?
- Foreign body
- Broken tooth/denture
- Blood clot
- Tongue (remember to do head tilt chin lift or jaw thrust)
- Fracture displacement
What are the steps in advanced trauma life support (ATLS)?
Airway
Breathing
Circulation
Disability
Exposure
Secondary survey ie inspection and palpation, CSF leaks, eyes, paraesthesia, occlusion
What types of fractures can cause an airway obstruction?
Bilateral parasymphyseal mandibular fracture - genioglossus displaces anterior mandible lingually, no support to tongue which then occludes airway
Posterior displacement maxilla
Mid-facial fracture - directly occludes airway
As part of circulation assessment:
a) How can you stop a bleed
b) What should you be wary of and how is this managed
a) Pressure, ties for arterial bleeds, diathermy (electrocauterize), fracture reduction if bleeding from cancellous bone
b) Hypovolaemic shock - from external or internal bleeding. Major haemorrhage protocol. Volume replacement with fluid while blood is ordered.
What are the 5 Ps for retrobulbar haemorrhage?
Pain
Proptosis
Paralysis
Pupil
Poor vision
Why is a retrobulbar haemorrhage concerning and what is the treatment?
Sight threatening as bleed behind eye causes compartment syndrome and puts pressure on optic nerve
Pressure released through lateral canthotomy
If teeth are missing why is a chest xray good to get?
Risk of aspiration pneumonia
In what window of time should facial fractures be treated?
2 week window - else will need osteotomising to achieve reduction
If there is a foreign body in the neck, how should this be managed?
Do not remove as any wound deep to platysma has risk of involving major neck vessels and weapon may tamponade vessels
CT angiogram to assess vascular damage
Remove under GA so bleed controlled in optimum environment
(lateral ST xray or US if small)
How is a soft tissue wound decontaminated?
Washout, copious irrigation with saline (not CHX as kills fibroblasts and inhibits wound repair)
Surgical scrub under GA to remove ingrained dirt
What is primary closure?
Where edges of wound can be brought together tension free with sutures, glue or staples. Ensure wound edges well opposed and slightly everted to counteract contraction from fibroblast and collagen maturation
When should sutures be removed from the a) face b) scalp?
a) 5 days
b) 7 days
What are the methods used for healing when there is soft tissue loss?
- Secondary intention - allow granulation
- Split thickness skin graft
- Full thickness graft
- Local flaps
- Regional flap
- Free flap
If a patient presents with a bite (animal or human) how should this be treated?
Thorough decontamination
Always give antibiotic prophylaxis: flucloxacillin and/or co-amoxicalav
