Trauma Flashcards
4 main mechanisms of trauma
- Blunt force
- Penetrating
- Acceleration/Deceleration
- Crushing
define monotrauma
single system injury and less likely to be life-threatening
define polytrauma
two or more significant injuries/multiple body systems, assoc. w/ greater morbidity and mortality
what are the two scoring systems specifically used to assess trauma in vet?
- animal trauma triage score (ATTS)
- modified glasgow coma scale (MGCS)
what are 3 common risks to the CDV system?
- Polytrauma assoc. w/ blood loss
- Indirect myocardial injury (from shock/contusions)
- Direct myocardial injury
what are 3 causes of secondary brain injury?
inflammation, ischaemic injury, cerebral oedema
CPP =
MAP - ICP
Pressure autoregulation of CPP is intact between MAP of
50-150mmHg
Common thoracic trauma
- pulmonary contusions
- pneumothorax
- rib fractures/flail chest
- diaphragmatic hernia
- haemothorax
what are your four sites of an aFAST?
- diaphragmatic hepatic (DH) site - bleeding around liver
- Splenorenal (SR) site - bleeding around the spleen or in the retroperitoneum around the kidney
- Cystocolic (CC) site - free fluid around the urinary bladder - urine/blood
- Hepatorenal (HR) site - bleeding around the liver and right kidney in the peritoneum and retroperitoneum
inspiratory dyspnoea is associated with
pleural space disease
inspiratory dyspnoea + noise =
upper airway issue
what do B-lines/Comet Tail artefacts indicate?
fluid/cells in the lungs where they shouldn’t be –> pulmonary contusions in the trauma patient
what do you note on neurological exam (mGCS)?
- LOC
- CN/brainstem reflexes
- motor function
- external signs of head trauma
- evidence of spinal cord injury
what are signs of impending cerebral herniation?
- Cushings reflex:
- deteriorating LOC
- bradycardia (30-40bpm dogs)
- reflex hypertension - Pupil changes (dilating, loss of PLR)
- Resp. changes - ataxic/agonal
- Decerebrate posture
- hyperextension of all four limbs
- dorsiflexion (hyperextension) of tail and head
- extreme hyperextension of the spine (opisthotonus) produces concave configuration of the back
- easily toppled if made to stand on four limbs
how do you treat hypovol shock?
IVFT bolus 20-40ml/kg LRS over 10min
Hypertonic saline 3-5ml/kg slow IV if TBI
medical management of haemoperitoneum?
- IV fluid resus
- transfusion (dependent on lost BV)
- abdominal wrap = external counterpressure
thoracostomy tube indications
- > 2-3 thoracocentesis in <12-18h
- no end-point reached
management of pulmonary contusions
- supplemental O2
- careful fluid resus
- rest + time
- intubation + ventilation if severe
how can you reduce cerebral oedema?
- mannitol
- hypertonic saline
approach to management of a TBI case
- maintain MAP
- reduce ICP:
- encourage CSF drainage - elevate head
- reduce cerebral oedema w/ hyperosmolar agents - Manage seizures, pain, anxiety
NO STEROIDSS
actions if signs of impending cerebral herniation
- intubate + hyperventilation ETCO2 (30-35mmHg) --> reduce ICP via chemical autoregulation
