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
BUN and creatinine
* 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
Lactate
* By product of anaerobic respiration
* trauma =\> poor tissue perfusion
* could be source of tachycardia
* improved lactate after tx
* good prognostic sign
27
Coagulation
* 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
Thromboelastography
* Allows 'global' view of hemostasis
* Clot initiation, strength, and breakdown
* hyperfibrinolysis may be present in these cases
29
Platelet function test
* new area of research
* may be present in trauma cases too
30
Analysis of effusions
* 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
Primary way to ID septic peritonitis
Cytology, neutraphils with intracellular bacterial
32
Minimum considerations dx imaging
* Abdominal FAST scan
* Thoracic FAST scan
* Thoracic rads
* +/- pelvic rads
33
FAST
Focused assessment with sonography for trauma
* AFAST - abdomen
* TFAST - thorax
* may see sugg diaphragmatic rupture
34
TFAST pericardial views
* pericardial effusion
* cranial pleural effusion
* left ventricular volume
35
TFAST Chest tube sites
* Caudolateral views
* Pleural effusion
* Diaphragmatic injury
* Pneumothorax
* Contusions
36
Thoracic rads
* VERY useful
* can wait if patient unstable
* VD projections avoided specifically
* **Thoracocentesis**
* perform before obtaining thoracic rads if unstable
37
Abdominal rads
* AFAST may be better choice for identifying effusion
* Specific injuries that may be noticed
* diaphragmatic hernias
* body wall ruptures/hernias
38
Pelvic rads
* 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
Tail injury
* can indicate neuro inj
* fecal/urinary incontinance
* may affect future prognosis
40
Ancillary cardiovascular tests
Ancillary respiratory tests
* Ancillary cardiovascular tests
* ECG
* Blood pressure
* Ancillary respiratory tests
* pulse ox
* arterial blood gas analysis
41
Blood pressure
* Later marker of shcok
* may be falsly normal initially
* should complement physical exam
* low BP in bright active animal
* probably incorrect
* Hypertension may be seen with TBI
* cushing's response-sinus bradycardia with hypertension
42
ECG
* allows continuous monitoring in busy situations
* arrhythmia may be seen
* likely shock related
* traumatic myocarditis less commonly seen
43
Pulse ox
* hard to get accurate reading
* may not change assessment
* avoid in conscious/stressed patients
44
Arterial blood gas
* best eval to quantify oxygenation
* uncommonly done in conscious patients
* May not change assessmet of patient
45
Re-assessment
* 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
First hour conclusions
* 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
