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ECC > Trauma-1 (Lynch) > Flashcards

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
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2
Q

Initial assessment of trauma

A
  • Triage
    • brief hx and primary survey
  • Full patient hx
  • Secondary survey
  • Diagnostic tests
  • Emergency treatment
  • Re-assessment
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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

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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
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5
Q

Primary survey

A
  • physical exam focused on major body systems
  • cardiovascular
  • respiratory
  • neurological
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6
Q

Cardiovascular

A
  • physical exam findings - perfusion parameters
    • heart rate
    • pulse quality
    • MM color
    • CRT
    • Mentation
    • Temp
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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
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8
Q

Shock in cats

A
  • Cats tend to be different
  • shock triad in cats is more common
    • bradycardia
    • hypothermia
    • hypotension
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9
Q

Respiratory assessment

A
  • Distant observation can be very helpful
  • Respiratory rate
  • Respiratory effort
  • Breathing pattern
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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
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11
Q

Neuro assessment

A
  • Mentation and attitude
    • alert
    • appropriate
  • Locomotor ability
    • do the legs work
    • if non ambulatory, sensation? Pain?
    • Assess before analgesia
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12
Q

Schiff sherrington posture

A
  • imp to recognize
  • suggests spinal cord injury
    • traumatic spinal fractures and luxations
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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
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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?
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15
Q

Roll over injuries associate with

A
  • bladder trauma
  • pelvic fractures
  • body wall rupture
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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
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17
Q

Secondary survey

A
  • Full exam
  • Orthopedic injuries common
    • fractures
    • luxations
  • Wounds
    • superficial wounds can be deceiving
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18
Q

Jaw injuries

A
  • common in cats
    • mandibular symphysis separation
    • TMJ luxation
    • Lip avulsion
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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
  • 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

ECC (18 decks)

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