Trauma Flashcards
The following conditions should be managed as soon as they are discovered
- M-Massive hemorrhage
- A-Airway control
- R-Respiratory support
- C-Circulation
- H-Head injury/hypothermia
IV fluids should be given for a SBP
< 90
GSC Eye Opening
- Spontaneously 4
- To speech 3
- To pain 2
- None 1
GSC Verbal Response
- Oriented 5
- Confused 4
- Inappropriate 3
- Incomprehensive 2
- None 1
GSC Motor Response
- Obeys commands 6
- Localize Pain 5
- Withdraws from pain 4
- Flexion to pain 3
- Extension to pain 2
- None 1
Determination of death: Resuscitation should NOT be attempted for trauma patients that have ALL 3
- Apneic
- Asystole
- Fixed and dilated pupils
OR - Injuries incompatible with life (e.g., decapitation, massive crush injury, incineration, etc.)
Special consideration: PEA
Defined as an organized rhythm greater than 20 bpm. Anything less is considered asystole
Special consideration: Penetrating trauma
- Attempt bilateral needle decompression in an attempt to achieve ROSC
- Do not resuscitate if pulses were not obtain after needle decompression
Special consideration: Transport
- If Trauma Hawk is not available and ground transport is greater than 40 minutes, it is
acceptable to transport to the nearest ED
Triage: Green
Walking wounded
Triage: Black
Dead
Triage: Red (R.P.M)
- Respirations: > 30
- Perfusion: No radial pulse
- Cap refill > 2 sec
- Mental status: Unable to follow commands
Triage: Yellow
Delayed
Pediatric 1- 8 years old considered immediate triage (RED)
- Respirations: <15 or > 45
- Pulse: No
AVPU: Inappropriate/posturing
Trauma score Criteria Adults: RED
AIRWAY
* Respiratory rate <10 or >29
* Airway assistance
CIRCULATION
* Lack of radial pulse
* Rate >120
* BP < 90
DISABILITY
* GSC <13 Presence of paralysis,
* Spinal core injury or loss of sensation
SOFT TISSUE
* 2nd or 3rd degree burn to 10% TBSA
* Amputation or GSW above the wrist or ankle
* Any penetration to the head, neck, or torso
* Penetrating injury above the elbow or knee
* Fail chest
* Crushed mangled, degloved or pulseless extremity
LONG BONE FRACTURE
* Unstable pelvic fracture
* Fracture of two or more long bone fracture
MECHANIMS OF INJURY
* Facial injury with airway compromise
* Electrocution or lightning injury with LOC or visible signs of injury
* Blunt abdominal or chest trauma in pts with history of paralysis
* Pregnancy >20 weeks with abdominal pain after blunt trauma
Trauma Criteria Adults: BLUE
AIRWAY
* None
CIRCULATION
* Sustained HR >120
DISABILITY
* Head injury with LOC
* Amnesia
* AMS
SOFT TISSUE
* Soft tissue loss
* GSW distal to the elbow or knee
LONG BONE FRACTURE
* Single long bone fracture due to MVC
* Single long bone fracture in pts with bleeding disorder or taking blood thinners
AGE
* 55 years old
MECHANIMS OF INJURY
* Ejection from automobile, motorcycle, or golf car
* Ejection from a horse with anatomical injury
* Death in the same passenger compartment
* Intrusion including roof
_> 12 inch occupant site
_ > 18 inch any site into the passenger compartment
* Vehicle telemetry data consistent with high risk of injury
* Fall of 10ft or more
* Auto vs pedestrian/bicyclist, run over with impact and signs of anatomical injury
* Motorcycle Golf card, ATV crash with signs of anatomical injury
Trauma Criteria Pediatrics: RED
AIRWAY
* Airway assistance
* Infant resp < 20 under 1 year old
* Children resp < 10 1-15 years old
CIRCULATION
* Non palpable femoral or carotid pulse
* BP < 50
DISABILITY
* AMS
* Presence of paralysis
* Suspicion of spinal cord injury
* Loss of sensation
SOFT TISSUE
* Major tissue disruption
* 2nd or 3rd burns to 10% TBSA
* GSC at or above wrist or ankle
* Amputation at or above wrist or ankle
* Penetration or GSW to neck, head, or torso
* Major degloving injury
LONG BONE FRACTURE
* Open long bone fracture
* Multiple fractures
* Pelvic fracture
MECHANIMS OF INJURY
* Facial injury with airway compromise
* Electrocution or lightning injury with LOC or visible signs of injury
* Blunt abdominal or chest trauma in pts with history of paralysis
* Auto vs pedestrian/bicyclist, run over with impact and signs of anatomical injury
* Motorcycle Golf card, ATV crash with signs of anatomical injury
Trauma Criteria Pediatrics: BLUE
SIZE
* Weight < 20kg
AIRWAY
* None
CIRCULATION
* Carotid or femoral pulses, no radial
* < 90
DISABILITY
* Amnesia
* Loss of consciousness
SOFT TISSUE
* Penetrating injuries to the extremities distal to the elbow
LONG BONE FRACTURE
* Single long bone fracture or dislocation due to a MVC
* Pelvic fracture in pts with bleeding disorders
MECHANIMS OF INJURY
* Ejection from automobile
* Death in the same passenger compartment
* Intrusion including roof
- >12 inch occupant site
_ > 18 inch any site into the passenger compartment
* Vehicle telemetry data consistent with high risk of injury
* Fall of 10ft or 2-3 times the high of the child
First degree burn
Red painful
Second degree burn
Blistering
Third degree
Deep tissue damage and will appear as thick, dry, white, leathery burns (regardless of skin color)
Burn treatment adult and pediatric
- Irritate skin with NS for 2 mins
- Determinate TBSA
- Do not remove cloth if adhered to burn skin
- Remove Jewelry
- Considered pain management protocols
- Do not use IM for meds
- Consider carbon monoxide and cyanide exposure
1st and 2nd degree < 15 or 3rd degree burns < 5
Apply sterile dressing
1st and 2nd degree > 15 or 3rd degree burns > 5
- Apply sterile burn sheet
- Normal saline
- Adult 500mL
- Pediatric 10mL/kg max 250mL
Electrical burns
Treat as indicated
Chemical Burns
- Liquid burns: Irritate with NS
- Dry burns: Brush off prior to irritation
- Remove clothing prior to irritation
Private part, palm and fingers burns %
1%
Infant Burns %
- Head 18%
- Torso 18%
- Arms 9%
- Legs 14%
Child burns %
- Head 18%
- Torso 18%
- Arms 9%
- Leg 13.5%
Adult Burns %
- Head 9%
- Torso 18%
- Arms 9%
- Legs 9%
Chest Trauma
Occurs to 2 or more adjacent ribs are fractured
Open Pneumothorax (Sucking chest wound)
Air enters the pleural space, causing the lung to collapse
Tension Pneumothorax
- When air continues to enter the pleural space without an exit or release, causing an increase in intrathoracic pressure
- Intrathoracic pressure decreases cardiac output and gas exchange
Penetrating Objects
Stabilize
Fail Chest
Stabilize
Tension Pneumothorax (Sucking chest wound) treatment
- Apply a vented chest seal or occlusive dressing to all open chest wounds and monitor for signs & symptoms of a tension pneumothorax
- Apply on expiration if possible
Needle decompression should be performed when ALL of the following findings are present
- Respiratory distress or difficulty ventilating with a BVM
- Decreased or absent breath sounds to the affected side
- Decompensated shock
- ADULT: SBP <90 mmHg
- PEDIATRIC: Age-appropriate hypotension
- Primary site:
- 5th intercostal space midaxillary line
- Secondary site:
- 2nd or 3rd intercostal space, midclavicular line
Crush Injury
- Prolonged continuous pressure on large muscles, which results in muscle damage and cell death.
- Injury is associated with release of lactic acid.
- Treatment is directed at replacing fluid loss, establishing high urine flow rates to protect the kidneys and reversal of the
metabolic acidosis. Injury duration and the amount of muscle involvement are significant determinants of outcome.
Crush Injury adult treatment
- 2 large bore IV’s
- Appropriate transport
- For crush injuries lasting longer than 30 minutes
- Sodium bicarbonate 8.4%:1mEg/kg mixed
with the first liter of NS
Crush Injury pediatric treatment
- 2 large bore IV’s
- Appropriate transport
- For crush injuries lasting longer than 30 minutes
- Call for orders
Eye Injury chemical exposure
- Remove contact lens if present
- Irrigate the affected eye(s) with MORGAN LENS and NS
- Do not contaminate the unaffected eye with runoff
- Consider pain management using TETRACAINE
1-2 gtts in affected eye
Eye Injury penetrating eye injuries
- Stabilize
- Cover both eyes
- Consider pain management
Head Injuries: Consider airway management specially for pts with a GSC
< 9
Intracranial pressure/herniation signs
- Sluggish or nonreactive pupil
- Decline in the GCS of 2 or more points
- Paralysis or weakness on 1 side of the body
Cushing’s Triad
- A widening pulse pressure (increasing systolic, decreasing diastolic)
- Change in respiratory pattern (irregular respirations)
- Bradycardia
All head injuries
- 15 LPM NB unless ventilation its required
NS only enough to maintain BP of 110-120 - Pediatric NS only enough to maintain age appropriate BP
Pressure dressings should not be applied to depressed or open skull fractures because it can cause
ICP
ICP/Herniation head positioning
30 degree
ICP/Herniation maintain ETCO2 and SPO2
30-35, > 90%
Hypotension or hypoxia may increase mortality in pts with ICP by
150%
Open Fractures treatment
- Gross contamination, shoukd be remove
- Cover open fractures with a moist sterile dressing
- Fractures should be splinted in the position found
- Exception: No pulse present or the pt cannot be transported due to the extremity’s unusual position
- 2 attempts can be made to place the injured extremity in a normal anatomical position
- Discontinue attempts if the patient complains of severe pain or if there is resistance to
movement felt - Reassess neurovascular status before and after repositioning the patient’s extremity
Compensated Shock
- Anxiety
- Agitation
- Restlessness
- Normotensive
- Capillary refill normal to delayed
- Tachycardia
Decompensated Shock
- Decreased LOC
- Hypotension
- Peripheral cyanosis
- Delayed capillary refill
- Inequality of central/distal pulses
- Tachycardia
Schock treatment adult and pediatric
- Maintain body temperature with blankets and consider increasing the temperature in the patient compartment
- Control all major external bleeding
- Establish IV, utilizing largest catheter size possible
- NS (only enough to maintain peripheral pulses)
Neurogenic shock signs and symptoms
- Warm/dry skin (especially below the area of the injury)
- Hypotension with a heart rate within normal limits
- Paralysis
Neurogenic shock treatment adult and pediatric
- NS
If pt is hypotensive - Push dose Epi
Physiological changes during pregnancy
- Mother’s heart rate increases
- By the third trimester, the HR can be 15-20 beats per minute above normal
- Both the systolic and diastolic blood pressures drop 5-15 mmHg during the second trimester
- The mother’s cardiac output and blood volume increase
- Therefore, the pregnant patient may lose 30-35% of her blood volume before the signs
& symptoms of shock become apparent - Supine hypotension usually occurs in the third trimester
Pregnancy positioning
Left side, if unable add padding to the pts right side 4-6 inches
All third trimester pregnancy
O2 15LPM
If pregnant and pt its hypotensive
NS only enough to maintain peripheral pulses
