Theory of major trauma

Question 1

What is major trauma

Answer 1

an injury or a combination of injuries that are life threatening and could be life changing because it may result in long-term disability

Question 2

Head injuries (primary vs secondary)

Answer 2

Primary head injury = immediate brain damage caused upon impact.

Secondary head injury = progressive cerebral oedema/ischemia leading to death

Question 3

Signs of base of skull fracture

Answer 3

Racoon eyes (bruise around eyes)
Battle signs (bruise behind ears)

Question 4

Spinal recap (anatomy)

Answer 4

Function of spinal chord = provide motor and sensory innervation to muscle and skin.

The spine has 33 vertabrae

Question 5

where do the spinal injuries occur

Answer 5

Cervical Spine = 55%
Thoracic Spine = 15%
Lumbar Spine = 15%
Pelvic Spine =15%

Question 6

Primary vs secondary spinal injury

Answer 6

Primary spinal injury - immediate damage caused upon impact

Secondary - progressive spinal oedema and extension of primary injury

Question 7

Spinal shock vs spinal neurogenic shock

Answer 7

Spinal shock
. Loss of neurological function below level of injury
. Paralysis can last 24-72hours after injury

Neurogenic shock
. Cord injuries above T6
. Results in loss of sympathetic function
. Generalised vasodilation and hypotension

Question 8

Chest injuries - pneumothorax

Answer 8

Simple
Tension
Open
Haemothorax
Haemo-pneumothorax

Where something (air or blood) fills up in the pleural cavity

Question 9

Chest injuries - Tamponade

Answer 9

1. Fluid buildup in pericardial sac
2. Places pressure on heart
   3.Reduces filling ability of chambers
   4.Reduced output = hyper fusion

Question 10

Chest injuries - Flail chest

Answer 10

A flail chest is a chest in which sections of broken ribs are isolated from, and interfering with, normal chest movements. That means the chest cannot expand properly and cannot properly draw air into the lungs.

Question 11

Abdominal injuries - Blunt vs penetration

Answer 11

Blunt = Abdominal compression or
Deceleration injury

Penetration =
Stab wound
Gunshot wound
Impalement
evisceration

Question 12

Pelvic injuries facts

Answer 12

Mortality rate- 6.4% - 30%
What leads to death in pelvic injuries - Haemorrhage

Question 13

Limb fractures major trauma

Answer 13

Closed femur fracture = 1-1.5 lts blood
Closed tibia fracture=500mls-1ts blood
DOUBLE THESE IF OPEN FRACTURE
Neurovascular compromise = limb threatening

Question 14

Neck of femur fracture

Answer 14

mechanism=
high energy in young pts
low energy falls on older pts

symptoms=
.Pain in the groin or pain referred along the medial side of the thigh and knee
•Leg in external rotation and abduction, with shortening
•Requires Surgery – high mortality rate

Question 15

Haemorrhage major trauma

Answer 15

What does it mean?

Bleeding to death, loss of entire blood volume

Question 16

Haemorrhage major trauma symptoms

Answer 16

1.Pale
2.Clammy
3.Air Hunger
4.Venous Collapse
5.Hypotension
6.Low/falling ETC02
7.Abnormal sensorium
8.Pulse fast or slow

Question 17

Hypothermia Major trauma
Why do patients get it?

Answer 17

Why do patients get hypothermic ?
1. Alcohol/Drugs
2.CNS injury
3.Hypovolemic
4.Metabolic acidosis

Question 18

What is metabolic acidosis

Answer 18

The buildup of acid in the body due to kidney disease or kidney failure. When the body fluid contains too much acid it means the body is not getting rid of it, making too much or cannot balance the acid in your body

Question 19

Coagulation major trauma

Answer 19

Prevention of blood loss – Haemostasis

Haemostasis - day to day balance of pro-coagulants vs anti-coagulants

When injury occurs:
Vasoconstriction → platelet activation → clot formation

When platelets in blood detect tissue damage they change shape and join to form platelet plug - ‘become sticky’

Question 20

What are the equipments used in major trauma?

Answer 20

1) Helmet Removal
2) Kendrick Traction Splint
3) Pelvic Binders
4) Orthopaedic Stretcher
5) Suction Splint
6) Box Splint
7) Combat Tourniquet
8) Blast and Olaes Dressings
9) Chest Seal
10) Burns Dressing
11) Haemostatic Gauze/Agents