Trauma Flashcards

1
Q

Describe the point of primary survey + components

A

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.

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2
Q

When is definitive airway management indicated?

A
  • GCS <8
  • Significant maxfax trauma at risk of obstruction
  • Severely HD unstable
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3
Q

Describe some measures to manage an airway

A
  • Manoeuvres: head tilt chin lift or jaw thrust (injuries)
  • Adjuncts: nasopharyngeal, oropharyngeal (Guedel)
  • Supraglottic airway eg. LMA
  • Definitive airway: intubation
  • Surgical airway: tracheostomy
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4
Q

What are some sources of haemorrhage in trauma patients?

A
External haemorrhage: injuries
Internal haemorrhage:
-Thorax eg. haemothorax
-Abdomen eg. splenic rupture
-Pelvis eg. pelvic fracture
-Long bones eg. femur fracture
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5
Q

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

A
Unstable:
-CXR
-Pelvic Xray
-FAST
Stable: 
-CT
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6
Q

Describe the classes of haemorrhage

A

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

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7
Q

Describe secondary survey

A

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

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8
Q

Describe the initial assessment of head injury

A

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

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9
Q

What are the indications for CT head in ED?

A

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
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10
Q

Describe the different equipment for C spine immobilisation

A

Rigid cervical collar
Backboard, straps
Blocks

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11
Q

Describe the assessment of burns size

A
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
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12
Q

Describe the assessment of burn depth

A

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

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13
Q

Describe the initial assessment of burns injuries

A

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
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