Trauma 1 Flashcards
2 main forces of trauma?
Blunt and penetrating trauma
A fall greater than ___ in an adult is a major trauma
20ft (2 stories)
A fall greater than ___ in a child is a major trauma.
10ft or 2-3x height of child
Other mechanism criteria to call major trauma? (6)
Death in same vehicle, patient ejection, vehicle rollover, intrusion of 12cm in occupant compartment or 18cm anywhere, auto-pedestrian/bicycle >20mph, MCA >20mph
Anatomic criteria for major trauma? (8)
Penetrating injury to head/neck/torso, 2 more more proximal long bone fx, amputation proximal to wrist or ankle, open or depressed skull fx, neuro deficits, pelvic fx, flail chest
Physiologic criteria for major trauma?
GCS <13, SBP <90, RR<9 or >30, HR>100
Primary survey of a trauma patient includes?
Airway Breathing Circulation Disability (neuro) Environment
List some mandatory indications for airway management.
Massive facial injuries Head injury with GCS<8 Penetrating injury to cranial vault Missile injury to neck Blunt injury to neck with alteration of voice or expanding hematoma
Signs of tension pneumothorax?
JVD
Absent breath sounds unilaterally
Tracheal deviation
First step in management of tension pneumothorax?
Decompression
What type of dressing should be applied to a sucking chest wound?
Some type of 1 way valve, such as a asherman chest seal.
In the circulation assessment, how do you chest for blood volume status?
Color, pulses, cap refill, BP
At what stage of hemorrhage are blood products always needed?
Class III, moderate hemorrhage
Will you see any changes in HR, BP, or GCS in class 1 hemorrhage?
No
What changes in HR, BP, and GCS will be seen in class II/mild hemorrhage?
Increase HR, no change in GCS or BP
What changes in HR, BP, and GCS will be seen in class III/moderate hemorrhage?
Increased HR, Decreased BP, decreased GCS
What changes will be seen in class IV/severe hemorrhage?
Very increased HR, decreased BP, decreased GCS.
How long can a tourniquet stay on?
6 hours
Where do you want to place a tourniquet?
As close to the axilla/groin as possible.
Stages of hypovolemic shock?
Initial
Compensatory
Progressive
Refractory
What is the triangle of death in trauma?
Bleeding
Hypothermia
Coagulopathy
In a hemorrhage, what fluids should be given to your patient?
ONLY 1 liter of crystalloids, then blood
After __ units of blood, start massive transfusion protocols.
3
What is checked in the disability assessment?
GCS
Drops in GCS of __ are concerning. Drops of __ are VERY bad.
- 3.
List the scores for the eye portion of the GCS.
Eye opening: Spontaneous - 4 To loud voice - 3 To pain -2 None - 1
List the scores for the verbal portion of the GCS.
Verbal response: Oriented - 5 Confused/disoriented - 4 Inappropriate words - 3 Incomprehensible sounds - 2 None - 1
List the scores for the motor portion of the GCS.
Best motor response: Obeys - 6 Localizes - 5 Withdraws - 4 Abnormal flexion posturing -3 Extension posturing - 2 None -1
What is the decorticate response?
Flexion in response to pain.
What is the decerebrate response?
Extension in response to pain
What is a FAST exam?
Focused assessment with sonography for trauma.
Where do you US in a FAST exam?
Peri-hepatic space
Peri-splenic space
Pericardium
Pelvis
What is included in a secondary survey?
H & P head to toe exam blood/urine analysis X rays Consider CT, vascular imaging or surgery
FGH should also be done at some point during a trauma exam, what does it stand for?
Fetus- are they pregnant?
Glucose - check it
Hypertet - give them a tetanus shot
Damage to a carotid artery causes what signs/symptoms?
Bruits
TIAs
Horner Syndrome (Ptosis, miosis, anhydrosis)
Damage to a vertebral artery causes what signs/symptoms?
Dizziness Vertigo/ataxia nystagmus Dysarthria Diplopia
How should you diagnose a tension penumothorax?
Physical exam!!!
Do NOT need X ray
What type of shock is caused by tension pneumothorax?
Obstructive shock
Cardiac tamponade can be recognized by what triad?
Becks triad
JVD, muffled heart tones, and hypotension
A patient with hypotension after a blunt chest force should make you consider?
Thoracic aorta injury
X ray findings of a thoracic aorta injury?
Wide mediastinum on CXR
What is considered a wide mediastinum?
Greater than 1.5x the width of the vertebrae
What is the complication of a pulmonary contusion?
Pneumonia
A fracture of what rib is the most concerning?
1st rib - indicates high force injury
What patients qualify for a thoracotomy?
Patient with loss of vitals within 2-3 minutes of arrival to ER with active CPR and penetrating trauma.
