Trauma-1 (Lynch) Flashcards
1
Q
Classification of trauma
A
- Blunt vs penetrating
- may be an overlap
- Anatomical location
- head
- thoracic
- spinal
- polytrauma
- Cause of injury
- high rise injury
- malicious attacks
2
Q
Initial assessment of trauma
A
- Triage
- brief hx and primary survey
- Full patient hx
- Secondary survey
- Diagnostic tests
- Emergency treatment
- Re-assessment
3
Q
Phone triage
A
- First contact
- helps team determine
- when will pet arrive
- size of animal
- injuries
- try to calm owner, provide advice
- first aid advice
*generally no meds before they come in
4
Q
In person triage
A
- brief pertinent hx
- was trauma witnessed
- what actually happened
- how long ago
- tx given already?
- did they stand or walk afterward?
- permission to initiate tx
5
Q
Primary survey
A
- physical exam focused on major body systems
- cardiovascular
- respiratory
- neurological
6
Q
Cardiovascular
A
- physical exam findings - perfusion parameters
- heart rate
- pulse quality
- MM color
- CRT
- Mentation
- Temp
7
Q
Tachycardia
A
- common in dogs
- shock is most serious cause
- pain
- anxiety
- Ensure shock not present first
- analgesics may mask signs of shock
- treat shock
- fluids before treating pain
- Do not need to withold analgesia for long
8
Q
Shock in cats
A
- Cats tend to be different
- shock triad in cats is more common
- bradycardia
- hypothermia
- hypotension
9
Q
Respiratory assessment
A
- Distant observation can be very helpful
- Respiratory rate
- Respiratory effort
- Breathing pattern
10
Q
Careful auscultation
A
- Loud lung sounds common
- think about respiratory rate and effort
- Lung crackles suggestive of pulmonary contusions
- Dull sounds suggestive of pleural space disorder
- pneumothorax most likely
- Traumatic diaphragmatic hernia possible
- Hemothorax less common
11
Q
Neuro assessment
A
- Mentation and attitude
- alert
- appropriate
- Locomotor ability
- do the legs work
- if non ambulatory, sensation? Pain?
- Assess before analgesia
12
Q
Schiff sherrington posture
A
- imp to recognize
- suggests spinal cord injury
- traumatic spinal fractures and luxations
13
Q
Two things to check early on
A
- Palpate abdomen
- can you feel urinary bladder
- any abdominal pain
- unlikely to detect fluid wave
- acute hemorrhage typically low volume
- PAIN
- delaying analgesics helps assess patient, but don’t delay for more than a few minutes
14
Q
Assessment after triage
A
- Is patient stable?
- stable patients
- get full history
- perform full physical exam
- decide next steps
- unstable patients
- what can be done to stabilize patient
- will emergency diagnostics help?
- stable patients
15
Q
Roll over injuries associate with
A
- bladder trauma
- pelvic fractures
- body wall rupture
16
Q
Cause of trauma in cats
A
- often unwitnessed
- don’t dwell on the cause
- frayed claws common after trauma
- unlikely to be seen with malicious trauma
17
Q
Secondary survey
A
- Full exam
- Orthopedic injuries common
- fractures
- luxations
- Wounds
- superficial wounds can be deceiving
18
Q
Jaw injuries
A
- common in cats
- mandibular symphysis separation
- TMJ luxation
- Lip avulsion
19
Q
Don’t forget the eyes!
A
- Corneal injury
- Hyphema
- Traumatic uveitis
- Eyelid lacerations
20
Q
Limitations of PE
A
- some injuries slowly progresive
- urinary tract trauma hard to characterize from PE
- Pulmonary contusions may progress
- Pelvic fractions hard to appreciate from PE
21
Q
Emergency lab tests
minimum emergency database
A
- Packed cell volume, total solids
- Glucose
- Estimation of BUN and creatinine
- Lactate (if available)
22
Q
PCV and TS
A
- Imp to identify acute hemorrhage rapidly
- If total solids less than 6 look for bleeding
- Early correction of hemorrhage increases likelihood of good outcome
- small deviations from normal can be significant
- assume patient was normal before trauma
- PCV
- splenic contraction
- time to equilibrate
- TS
- will not lie to you if previously normal
23
Q
Common sources of internal bleeding
A
- Cavitary hemorrhage
- hemoabdomen
- hemothorax
- Fracture sites
- long bones (FEMUR)
- Pelvic fractures
- Potential for coagulopathy
24
Q
Glucose
A
- Mild elevation common with catecholamine release
- More profound hyperglycemia seen wtih TBI
- rarely requires tx
- hypoglycemia most relevant for bite wounds
- are they infected
- could patient be septic
25
Q
BUN and creatinine
A
- urinary tract trauma
- may cause subtle post-renal azotemia
- creatinine and potassium used to dx uroabdomen
- urea is osmotically active, can’t use for dx
26
Q
Lactate
A
- By product of anaerobic respiration
- trauma => poor tissue perfusion
- could be source of tachycardia
- improved lactate after tx
- good prognostic sign
27
Q
Coagulation
A
- May not always be needed
- Disorders of primary hemostasis (Platelets)
- blood smear
- automated CBC machine
- Disorders of secondary hemostasis (Clotting factors)
- activated clotting time
- prothrombin time
- activated partial thromboplastin time
28
Q
Thromboelastography
A
- Allows ‘global’ view of hemostasis
- Clot initiation, strength, and breakdown
- hyperfibrinolysis may be present in these cases
29
Q
Platelet function test
A
- new area of research
- may be present in trauma cases too
30
Q
Analysis of effusions
A
- PCV and totally solids
- close to peripheral values => hemorrhage
- Creatinine and potassium
- higher than peripheral levels => urine
- Glucose and lactate
- low glucaose and high lactate => septic
- Bilirubin
- higher than peripheral value => bile
31
Q
Primary way to ID septic peritonitis
A
Cytology, neutraphils with intracellular bacterial
32
Q
Minimum considerations dx imaging
A
- Abdominal FAST scan
- Thoracic FAST scan
- Thoracic rads
- +/- pelvic rads
33
Q
FAST
Focused assessment with sonography for trauma
A
- AFAST - abdomen
- TFAST - thorax
- may see sugg diaphragmatic rupture
34
Q
TFAST pericardial views
A
- pericardial effusion
- cranial pleural effusion
- left ventricular volume
35
Q
TFAST Chest tube sites
A
- Caudolateral views
- Pleural effusion
- Diaphragmatic injury
- Pneumothorax
- Contusions
36
Q
Thoracic rads
A
- VERY useful
- can wait if patient unstable
- VD projections avoided specifically
-
Thoracocentesis
- perform before obtaining thoracic rads if unstable
37
Q
Abdominal rads
A
- AFAST may be better choice for identifying effusion
- Specific injuries that may be noticed
- diaphragmatic hernias
- body wall ruptures/hernias
38
Q
Pelvic rads
A
- Pelvic fractures common
- weight bearing axis
- if disrupted, surgical repaire likely recommended
- young cats heal well with rest and time
- If pelvic fxs, check for spinal fractures too
39
Q
Tail injury
A
- can indicate neuro inj
- fecal/urinary incontinance
- may affect future prognosis
40
Q
Ancillary cardiovascular tests
Ancillary respiratory tests
A
- Ancillary cardiovascular tests
- ECG
- Blood pressure
- Ancillary respiratory tests
- pulse ox
- arterial blood gas analysis
41
Q
Blood pressure
A
- Later marker of shcok
- may be falsly normal initially
- should complement physical exam
- low BP in bright active animal
- probably incorrect
- low BP in bright active animal
- Hypertension may be seen with TBI
- cushing’s response-sinus bradycardia with hypertension
42
Q
ECG
A
- allows continuous monitoring in busy situations
- arrhythmia may be seen
- likely shock related
- traumatic myocarditis less commonly seen
43
Q
Pulse ox
A
- hard to get accurate reading
- may not change assessment
- avoid in conscious/stressed patients
44
Q
Arterial blood gas
A
- best eval to quantify oxygenation
- uncommonly done in conscious patients
- May not change assessmet of patient
45
Q
Re-assessment
A
- frequent re-assessment a imp
- Trauma patients may be in a dynamic state
- improving with tx?
- decompensating despite tx?
- are txs appropriate in light of changes?
- Not all injuries are immediately identifiable
- pulmonary contusions
- urinary tract trauma
46
Q
First hour conclusions
A
- First hour can be stressful
- be logical
- be methodical
- Assess major body systems first
- Unstable patients require emergent tests/tx
- re-assess these patients frequently
