Trauma Flashcards
Recite the CPG for Haemorrhagic hypovolaemia
Recite the CPG for Chest injuries
Recite the CPG for Traumatic head injuries
Recite the CPG for Spinal Injuries
Recite the CPG for Fracture dislocation and management
Recite the CPG for Diving Related Emergencies
In what timeframe should a major trauma be transported to a trauma center?
within 1 hour from the incident
In what timeframe should a major trauma be transported to a trauma center?
within 1 hour from the incident
Whats the aim of scene time in an untrapped trauma?
20 mins
Whats the aim of scene time in an untrapped trauma?
20 mins
What are the 3 time critical categories?
- actual
- emergent
- potential
What is actual time critical?
at the time the VSS was taken, the patient was in actual physiological distress
What is emergent time critical?
At the time the VVS was taken, the patient was not physiologically distressed but does have a pattern of injury or significant medical condition which is known to have a high probability of deteriorating to actual physiological distress.
What is potential time critical?
At the time the VVS was taken, the patient was not physiologically distressed and there was no significant pattern of actual injury/illness but there is a mechanism of injury/illness known to have a potential to deteriorate to actual physiological distress.
In the setting of potential major trauma an adult is considered ACTUAL time critical if they meet these vital sings…
- HR < 60 or > 120
- RR < 10 or > 30
- BP < 90
- GCS < 13 (if pt > 16 yo)
- GCS < 15 if pt < 15
- SpO2 < 90%
What specific injuries meet Major trauma criteria (emergent)
All penetrating injuries
- (except superficial limb)
Blunt injuries
Specific injuries
- limb amputation or limb threatening injury
- suspect SCI or #
- Burns >20% TBSA (<10% if <15 years) or suspected resp tract burn
- High voltage (>1000 volts) burn injury
- Serious crush injury
- Major compound fracture or open dislocation
- Fracture to two or more of femur/tibia/humerus
- Fractured pelvis
What is the high risk criteria for Major trauma?
- MVA/cyclist impact >30km/hr
- high speed MVA >60km/hr
- Pedestrian impact
- Ejection from vehicle
- Prolonged extrication
- Fall from height >3m
- Struck on head by onject falling >3m
- Explosion
and co-morbidities
- Age <12 or > 55
- Pregnant
OR
- significant underlying medical condition
From what gestational age is considered a pregnant trauma, and In what time frame should a pregnant trauma be transported and where
- > 24 weeks gestation
- transported within 45 mins
- to RMH
What vital signs indicate ‘red flags’
- HR > 120
- RR >30
- SBP <90
- SpO2 <90%
- GCS <13
What specific condtiions are considered red flags
- stridor
- first presentation seizure
- anaphylaxis
- ACS
- ectopic pregnancy
- primary obstetric issue
- stroke/TIA
- sudden onset HA
- unable to walk (when usually able)
- post-tonsillectomy bleeding (of any amount) up to 14 days post op
what are the clinical yellow flags?
- ongoing patient or carer concern
- infection non responsive to community care
- immunocompromised with suspected infection
- surgical procedure in last 14/7
- unexplained pain >5
- syncope
- abdo pain
what are the paediatric TCG?
Recite the CPG for Tension Pneumothorax
What is the NEXUS criteria?
Increased injury risk
- Age >65
- Hx of bone or muscle weakening disease/injury
Difficult patient assessment
- ACS
- Intoxication
- Significant distracting injury
Actual evience of structural injury
- Midline pain/tenderness on palpation of the vertebrae
Neck range of motion
- patient unable to actively rotate neck 45 degees left and right without pain
Define tension pneumothorax
- Ongoing escape of air into the pleural space through a one way flap or valve. Air enters the pleural space during inhalation but cannot escape during exhalation.
- The increasing pressure in the pleural space leads to collapse of the lung on the affected side, with associated hypoxia as the lung’s gaseous exchange is compromised.
- This creates a tension on the internal structures, eventually compressing them and impeding their ability to function
- This pressure also tends to push the mediastinum in the opposite direction (evidenced by tracheal deviation AWAY from the affected side).
- Intrathoracic pressure also increases as a result which overcomes the pressure of venous return. This leads to reduced cardiac output and poor perfusion.
What are the signs and symptoms of a TPT
- Increased PIPs (ventilator)/stiff bag
- Decreased ETCO2 (Capnography to be standard issue)
- Poor perfusion or increased HR +/- decreased BP
- Increased JVP
- Decreased conscious state in the awake pt
- Tracheal shift (late sign)
- Low Spo2 on supplemental O2 (late sign)
How many bones does the skull have?
8
What is a primary head injury
- Initial insult
- Coup/contra - coup injury
What is a secondary head injury
- delayed (minutes to days)
- Oedema/vasodilation/increased ICP
- Decreased Na+/K+ pump
How do you calculate CPP?
- CPP = MAP - ICP
What are two major influences of ICP
- hypoxia + hypercapnia
increased CO2 will reduce blood flow (vasodilation)
Decreased CO2 will increase blood flow
How do you decrease the risk of secondary HI
Correct
- hypoxia
- hypercapnia
- hypotension
- hypovolaemia
What are some neuroprotective measures?
- Aim SBP >120
- SpO2 >94%
- ETCO2 35-40
- HOB 30 degrees
What does 5HEDS stand for?
Blunt head trauma with a GCS 13-15 either with or without LOC/amnesia with ANY
5 - any LOC > 5 mins
H - skull # (depressed, open or BOS)
E - vomiting more than once
D - neurological deficit
S - seizure
What are 3 different types of SCI
- direct mechanical injury
- tissue degeneration (within hours sof the injury)
- complete spinal cord transection
What nerve controls the diaphragm and where is it located
- the phrenic nerve
- C3, C4, C5
Injury about what vertebrae will lose sympathetic response
T2
Where does the vagus nerve exit?
- BOS
- AKA parasympathetic nerve
Define neurogenic shock
caused by sudden loss of the autonomic nervous system signals to the smooth muscle in in vessel walls.
This can result from severe Central Nervous System (brain and spinal cord) damage.
With the sudden loss of background sympathetic stimulation, the vessels suddenly become relaxed, resulting in sudden decrease in peripheral vascular resistance (vasodilation) and decreased blood pressure.
The vagus nerve remains intact (exits the BOS) and so becomes the Dominant nerve.
What are some S&S of spinal trauma
- HYPOTENSION- due to venous pooling and decreased venous return
- BRADYCARDIA – due to unopposed parasympathetic response
- PARALYSIS – damage to motor nerves
- PRIAPRISM – neurological and vascular causes
- PARADOXICAL RESPIRATIONS – loss of innervation to the thoracic musculature
- PARATHESIA – damage to sensory nerves.
How much blood can you loose from the ribs, radius/ulna, humerus, tib/fib, femur, pelvis
- ribs = 100-150mls
- radius/ulna = 150-250
- humerus - 250 mls
- tib/fib = 500mls
- femur = 1000mls
- pelvis = 1.5-3L
What are the aims of fracture/dislocation management
- Control External haemorrhage
- Apply good splinting practises
- resolve neurological or vascular compromise (where possible)
- Use judicious analgesia
