Trauma

Question 1

Describe the point of primary survey + components

Answer 1

Used to identify any life-threatening injuries + commence resus
A: airway. Protect C spine, use airway adjuncts
B: breathing. RR, sats, chest expansion + auscultation. Treat as required eg. tension, haemothorax -> CXR
C: circulation. Check pulse, BP, peripheries. Treat as required eg. shock, cardiac arrest
D: disability. Assess level of consciousness, pupils
E: exposure. Check from injuries, abdo, etc.

Question 2

When is definitive airway management indicated?

Answer 2

• GCS <8
• Significant maxfax trauma at risk of obstruction
• Severely HD unstable

Question 3

Describe some measures to manage an airway

Answer 3

• Manoeuvres: head tilt chin lift or jaw thrust (injuries)
• Adjuncts: nasopharyngeal, oropharyngeal (Guedel)
• Supraglottic airway eg. LMA
• Definitive airway: intubation
• Surgical airway: tracheostomy

Question 4

What are some sources of haemorrhage in trauma patients?

Answer 4

External haemorrhage: injuries
Internal haemorrhage:
-Thorax eg. haemothorax
-Abdomen eg. splenic rupture
-Pelvis eg. pelvic fracture
-Long bones eg. femur fracture

Question 5

What are some imaging modalities used in assessment of trauma patients?

Answer 5

Unstable:
-CXR
-Pelvic Xray
-FAST
Stable: 
-CT

Question 6

Describe the classes of haemorrhage

Answer 6

1: <15% blood volume. HD stable
2: 15-30%. Early signs of instability eg. tachycardia
3: 31-40%. Usually unstable. Give blood products
4: >40%. Very unstable. Start massive transfusion

Question 7

Describe secondary survey

Answer 7

Full top-to-toe examination +history after resus is in progress, to identify any injuries

Question 8

Describe the initial assessment of head injury

Answer 8

A to E approach
A: immobilise C spine. Consider intubation
B: oxygen if low sats
C: IV access, fluid resus if needed
D: assess GCS, +/- ICU/anaesthetics for airway management
E: rapid assessment for injuries

History if possible
Thorough examination: 
-Neuro 
-Lacerations, fractures
-CSF leak 
-Neck tenderness/deformity 

Imaging: CT head + spine if indicated
Discuss with neurosurgery early

Question 9

What are the indications for CT head in ED?

Answer 9

Within 1 hour:

• GCS <13 on arrival or <15 2 hours post incident
• Suspected basal skull fracture, open/depressed skull fracture
• Post-traumatic seizure
• Focal neurology
• > 1 episode of vomiting

Within 8 hours if loss of consciousness/amnesia +:

• > 65 years
• On anticoagulation, or history of bleeding disorder
• Retrograde amnesia >30 mins
• Dangerous mechanism of injury

Question 10

Describe the different equipment for C spine immobilisation

Answer 10

Rigid cervical collar
Backboard, straps
Blocks

Question 11

Describe the assessment of burns size

Answer 11

Can use Lund + Browder chart or Rule of Nines
Rule of nines:
9% head and neck
18% front of trunk
18% back of trunk
9% per arm 
18% per leg
1% perineum

Question 12

Describe the assessment of burn depth

Answer 12

Hard to do. Main thing is to distinguish between partial + full thickness
Partial: painful, red, blistered
Full: insensate, painless, grey-white

Question 13

Describe the initial assessment of burns injuries

Answer 13

A to E:
Airway: beware obstruction if inhalational injury- look for soot in nose, hoarse voice, Hx of enclosed space. Involve anaesthetics + intubate early
Breathing: look for constricting burns. Give high flow O2. ABG for CO.
Circulation: IV fluid resus
Disability
Exposure: assess burns size + depth

Treatment:

• IV morphine
• Cool the burn, warm the patient
• Dressings