Trauma Flashcards
What does the pneumonic TWELVE stand for?
T - Tracheal deviation
W - Wounds to the neck
E - Empysema
L - Laryngeal disruption
V - Veins
E - Evaluate
Example Exam Question: You have been called to a 20 year old male who has been involved in an argument and has subsequently been stabbed. He has a puncture wound approximately 2cm in length around the mid clavicular line 5th intercostal space on the left side of his chest. He is complaining of feeling short of breath, the weapon is no longer in situ. The patient is alert and orientated (GCS 15) and the scene is safe to approach.
a) Discuss your immediate assessment of this patient as per the UK Ambulance Services Clinical Practice Guidelines (2019) incorporating the pneumonic TWELVE. (13 marks)
- Introduction/Consent & Capacity
- DR©ABCDE
- Assess breathing adequacy, respiratory rate, volume and equality of air entry
- Expose patient for assessment of any other injuries
- Inspection, palpation, percussion and auscultation of the chest
- Monitor EtC02
- Attach ECG monitor
- Tracheal deviation
- Wounds/haematoma
- Emphysema (surgical/subcutaneous)
- Laryngeal crepitus
- Venous distension
- Exclude open/tension pneumothorax, flail segment and massive haemothorax
Example Exam Question: You have been called to a 20 year old male who has been involved in an argument and has subsequently been stabbed. He has a puncture wound approximately 2cm in length around the mid clavicular line 5th intercostal space on the left side of his chest. He is complaining of feeling short of breath, the weapon is no longer in situ. The patient is alert and orientated (GCS 15) and the scene is safe to approach.
While on scene you obtain the following information: Respiratory rate 29, no air entry heard on auscultation of the left side of the chest, Heart rate 124, Blood pressure 80/50.
b) Discuss the treatment you would provide this patient incorporating your triage decision as per the UK Ambulance Services Clinical Practice Guidelines (2019). (10 marks)
- High flow oxygen until normal Sp02 obtained – 94-100%
- Chest seal applied over wound -Needle chest decompression on left side
- Repeat needle chest decompression en route if indicated
- Vascular access
- Administration of Tranexamic acid
- Minimal on scene time/Rapid extrication due to time critical features
- Time critical transfer to Major Trauma Centre
- Administration of IV paracetamol
- Consideration for spinal immobilisation
Example Exam Question: You are called to an adult male who has sustained a central penetrating stab wound to the chest. On your arrival, the patient has Glasgow Coma Score of 15 and he is escorted onto the ambulance by police officers. The scene is safe.
a) Formulate a list of abnormal vital signs a patient suffering with a tension pneumothorax may have. (9 marks)
- Reduced GCS
- Tachyponea
- Failing ventilations
- Cardiac/Respiratory arrest
- Reduced Sp02
- Tachycardia
- Bradycardia
- Hypotension
- Narrowing pulse pressures
You are called to an adult male who has sustained a central penetrating stab wound to the chest. On your arrival, the patient has Glasgow Comal Score of 15 and he is escorted onto the ambulance by police officers. The scene is safe.
b) Discuss the pathophysiology behind an adult patient suffering with a tension pneumothorax. (15 marks)
- Caused by penetrating or blunt trauma
- Can be a spontaneous medical tension pneumothorax
- Open and closed tension pneumothorax
- Sucking chest wound
- Damage to the pleural lining of the lung
- Air fills the pleural cavity
- The air within this space expands
- This expanding area compresses the lung Gaseous exchange is reduced
- Mediastinal shift then occurs
- The heart and major blood vessels are compressed
- Cardiac output and stroke volume falls
- Tissue hypoperfusion/multi organ failure occurs
- Obstructive shock
- Cardiac/Respiratory arrest can occur
You are called to an adult male who has sustained a central penetrating stab wound to the chest. On your arrival, the patient has Glasgow Comal Score of 15 and he is escorted onto the ambulance by police officers. The scene is safe.
c) Discuss a paramedic’s management of this patient. (12 marks)
- DR©ABCDE
- Focused respiratory exam – Inspection Palpation Percussion Auscultation
- Applying chest seals
- High flow Oxygen
- Record vital signs
- Consideration for c-spine management
- Needle Chest Decompression
- IV/IO access
- IV/IO Tranexamic acid
- Pain relief – IV/IO Morphine/Paracetamol
- Consideration for IV Sodium chloride 0.9%/Blood/Plasma
- Priority/Blue call/Rapid transfer to nearest major trauma centre
You are called to an adult male who has sustained a central penetrating stab wound to the chest. On your arrival, the patient has Glasgow Comal Score of 15 and he is escorted onto the ambulance by police officers. The scene is safe.
d) Evaluate the effectiveness and risk of the procedure a paramedic can perform to reduce the tension pneumothorax. (10 marks)
- IV cannulas are not designed for this procedure, they have been adapted for it
- Often the cannula is not long enough to enter the pleural cavity
- It is difficult to know if you are in the pleural cavity
- The cannula lumen is very small
- It only converts a tension pneumothorax to a pneumothorax
- Puncturing the neurovascular bundle
- Puncturing major blood vessels and/or organs
- The cannula can become blocked Introducing an infection
- Pain
