Theory of major trauma Flashcards
What is major trauma
an injury or a combination of injuries that are life threatening and could be life changing because it may result in long-term disability
Head injuries (primary vs secondary)
Primary head injury = immediate brain damage caused upon impact.
Secondary head injury = progressive cerebral oedema/ischemia leading to death
Signs of base of skull fracture
Racoon eyes (bruise around eyes)
Battle signs (bruise behind ears)
Spinal recap (anatomy)
Function of spinal chord = provide motor and sensory innervation to muscle and skin.
The spine has 33 vertabrae
where do the spinal injuries occur
Cervical Spine = 55%
Thoracic Spine = 15%
Lumbar Spine = 15%
Pelvic Spine =15%
Primary vs secondary spinal injury
Primary spinal injury - immediate damage caused upon impact
Secondary - progressive spinal oedema and extension of primary injury
Spinal shock vs spinal neurogenic shock
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
Chest injuries - pneumothorax
Simple
Tension
Open
Haemothorax
Haemo-pneumothorax
Where something (air or blood) fills up in the pleural cavity
Chest injuries - Tamponade
- Fluid buildup in pericardial sac
- Places pressure on heart
3.Reduces filling ability of chambers
4.Reduced output = hyper fusion
Chest injuries - Flail chest
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.
Abdominal injuries - Blunt vs penetration
Blunt = Abdominal compression or
Deceleration injury
Penetration =
Stab wound
Gunshot wound
Impalement
evisceration
Pelvic injuries facts
Mortality rate- 6.4% - 30%
What leads to death in pelvic injuries - Haemorrhage
Limb fractures major trauma
Closed femur fracture = 1-1.5 lts blood
Closed tibia fracture=500mls-1ts blood
DOUBLE THESE IF OPEN FRACTURE
Neurovascular compromise = limb threatening
Neck of femur fracture
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
Haemorrhage major trauma
What does it mean?
Bleeding to death, loss of entire blood volume
Haemorrhage major trauma symptoms
1.Pale
2.Clammy
3.Air Hunger
4.Venous Collapse
5.Hypotension
6.Low/falling ETC02
7.Abnormal sensorium
8.Pulse fast or slow
Hypothermia Major trauma
Why do patients get it?
Why do patients get hypothermic ?
1. Alcohol/Drugs
2.CNS injury
3.Hypovolemic
4.Metabolic acidosis
What is metabolic acidosis
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
Coagulation major trauma
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’
What are the equipments used in major trauma?
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
