Trauma Flashcards
Describe the point of primary survey + components
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.
When is definitive airway management indicated?
- GCS <8
- Significant maxfax trauma at risk of obstruction
- Severely HD unstable
Describe some measures to manage an airway
- Manoeuvres: head tilt chin lift or jaw thrust (injuries)
- Adjuncts: nasopharyngeal, oropharyngeal (Guedel)
- Supraglottic airway eg. LMA
- Definitive airway: intubation
- Surgical airway: tracheostomy
What are some sources of haemorrhage in trauma patients?
External haemorrhage: injuries Internal haemorrhage: -Thorax eg. haemothorax -Abdomen eg. splenic rupture -Pelvis eg. pelvic fracture -Long bones eg. femur fracture
What are some imaging modalities used in assessment of trauma patients?
Unstable: -CXR -Pelvic Xray -FAST Stable: -CT
Describe the classes of haemorrhage
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
Describe secondary survey
Full top-to-toe examination +history after resus is in progress, to identify any injuries
Describe the initial assessment of head injury
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
What are the indications for CT head in ED?
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
Describe the different equipment for C spine immobilisation
Rigid cervical collar
Backboard, straps
Blocks
Describe the assessment of burns size
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
Describe the assessment of burn depth
Hard to do. Main thing is to distinguish between partial + full thickness
Partial: painful, red, blistered
Full: insensate, painless, grey-white
Describe the initial assessment of burns injuries
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