Trauma Flashcards
What are the nexus criteria?
To assess need for C-spine imaging:
- Midline tenderness
- Neurological deficit
- Alt GCS
- Intoxication
- Distracting injury
What’s the modified parkland formula?
Formula for fluid resuscitation for burns patients
- 3-4ml/kg/TBSA over 24 hours.
- 1/2 in first 8 hours, 1/2 in next 16 hours
Titrate and adjust according to urine output
What are MTP targets?
Temp >35 Ph >7.2 Ionised Ca2 >1.1 Plts >50 INR <1.5 PT/APTT <1.5x normal Fibrinogen >1
What is Massive transfusion protocol?
Replacement of half blood volume within 4 hours (2.5L for 70kg)
Replacement of more then blood volume in 24 hours (~5L)
1:1:1 transfusion of Plts:FFP:PRBCs, typically 4 units FFp and PRBC, 4 bags of pooled platelets
How to place ICC
Triage urgency. Pt location, available assistance-airway doctor for sedation, assistent for me. Apply continuous monitoring and oxygen.
Confirm site/side, mark pt 4th intercostal space- just ant to mid ax line, in triangle of safety, gain consent
Position arm out, secured, ensure equipment ready
Scrub, Gown, Double Glove, Prep, Drape.
Ideally ED/anaesthetic support for sedation.
Inject LA - skin, course of rib, feel pop at pleural space, aspirate air, anaesthetise pleura and tract
Scalpel- 3cm incision, blunt dissection with roberts, controlled pressure enter pleural cavity and spread ribs
Follow with finger sweep, feel for adhesions, gush of air +/- blood
Place ICC, guide post and apical, advance for all holes to be in pleural cavity ~10cm and secure with silk suture, tegaderms. Connect to atrium, secure with sleek, see tube fogging, bubble and swing, record blood output.
Anticipate improve Sats, RR
Get CXR to confirm position
Connect to -20 suction
Contemporaneous documentation of procedure and ongoing plan. Daily RV and CXRs, strict drain output and fluid balance. Chest PT, analgesia, acute pain service RV. CT +/- CTS referral. Call reg if inc output, red sats or HD unstable
