Trauma 1 Flashcards
Peaks of Trauma death
1: 0-30 mins -> heart lac, aorta, brain/spinal cord
2: 30 mins - 4 hrs -> head injury then hemorrhage (can be saved in golden hour)
3: days to weeks -> multisystem organ failure/sepsis
MC organ injured in blunt injury
Liver
Falls survival predictors
Age and body orientation biggest predictors of survival
LD 50 = 4 stories
MC injury in penetrating
SB
MC cause of death in 1st hour
hemorrhage, BP okay until 30% of blood volume gone
MC cause of death after getting to ER alive
Head injury
MC cause of long term death
infection
MC cause of upper airway obstruction
Tongue -> perform jaw thrust
MC injury from seat belts
SB perf, lumbar spine fracture, sternal fractures
Best cutdown venous access site
Saphenous vein cutdown @ ANKLE
Hemostatic resuscitation for patients receiving how many pRBCs in how many hours?
4 U in 1st hour
10 U in >= 24 hrs
Coagulopathy in severly injured patient before or after resuscitation?
Before
What is Hemostatic resuscitation?
RBCs:FFP:platelets 1:1:1
Principles of Damage control surgery
Control bleeding and contamination
Give blood
Hemostatic resuscitation
Limit crystalloids (2 L initially)
Allow permissive hypotension (SBP > 70) until hemorrhage controlled then SBP > 90; unless TBI then want > 90 initially
Correct hypothermia, hypocalcemia, acidosis early
When to use DPL
Hypotensive pts w/ blunt trauma
Must be supraumbilical if pelvic fracture
Misses retroperitoneal bleeds and contained hematomas
+ DPL?
> 10 cc blood, > 100,000 RBCs/cc, food particles, bile, bacteria, > 500 WBC/cc
If + then Ex lap
Where FAST
Perihepatic fossa, perisplenic fossa, pelvis, pericardium
Ex lap if +
Downside of FAST
operator dependent, obesity obstrucs view, hard to detect fluid < 50-80 cc, misses retroperitoneal bleed and hollow viscous organs
If hypotensive with - FAST -> where to look?
Chest, pelvic fracture, extremities
CT scan for blunt trauma w/
Abd pain, getting general anesthesia, close head injury, intoxicants, paraplegia, hematuria, distracting injury
Misses hollow viscous injury and diaphragm injury
Need Ex lap for
Peritonitis, evisceration, + DPL/FAST, uncontrolled visceral hemorrhage, free air, diaphragm injury, intraperitoneal bladder injury, contrast extrav from hollow viscous organs, usually penetrating abd injury
Local penetrating abd injury next step (knife, low velocity injury)
Local wound exploration to see if fascia violated
Abd compartment syndrome
HypoTN, distended abd, low UOP, Inc airway pressures, prolonged transport time
Bladder pressure > 25-30
IVC compression (dec cardiac output)
Visceral and renal malperfusion (dec urinary output)
Tx: Decompressive laparotomy
When does abd compartment syndrome happen
After massive fluid resusciation, trauma, abd surgery
Pneumatic shock garment
Controversial
For SBP < 50 and no thoracic injury, release compartments one at a time in ED
ED thoracotomy
Blunt: Only if pulse lost in the ED
Penetrating if pulse/pressu lost on way to or in ED
Thoracotomy: oper pericardium anterior to phrenic nerve, cross clamp aorta, was for esophagus
