Trauma Flashcards
When initially receiving a trauma patient the trauma team begins with a primary survey. What does the primary survey include?
ABCDE
Primary Survey =
A - Airway
B - Breathing
C - Circulation
D - Disability (Glasgow coma scale & pupillary response)
E - Exposure
When initially receiving a trauma patient the trauma team begins with a primary survey. What does A in the primary survey stand for and what should be done?
ABCDE
A in the primary survey stands for Airway and the following should be completed:
1. Assess airway patency
2. Clear foreign bodies
3. Insert oral / nasal airway if necessary
*Unconscious patients should be intubated.
When initially receiving a trauma patient the trauma team begins with a primary survey. What does A in the primary survey stand for and what should be done?
A in the primary survey stands for Airway and the following should be completed:
1. Assess airway patency
2. Clear foreign bodies
3. Insert oral / nasal airway if necessary
*Unconscious patients should be intubated.
When initially receiving a trauma patient the trauma team begins with a primary survey. What does B in the primary survey stand for and what should be done?
B in the primary survey stands for Breathing and the following should be completed:
1. Respiratory Rate
2. Adequacy of the respiratory effort.
3. Pattern of respiration (normal breath sounds? Abnormal ie paradoxical breathing or flail chest?)
3. Is the trachea deviated?
4. Auscultate lungs for breath sounds in all lobes. Is there crepitus / reduced sounds, hyper-resonance?
5. Pulse oximetry readings.
6. Is there any wounds to the chest?
When initially receiving a trauma patient the trauma team begins with a primary survey. What does C in the primary survey stand for and what should be done?
C in the primary survey stands for Circulation and the following should be done / assessed.
1. Control haemorrhage
2. Assess circulatory status (BP + Pulse rate; capillary refill <2seconds).
3. Attach pt to ECG
4. Insert IV canulars (2 x large gauge ie 14G or 16G.
5. Take blood - suitable tests or group and hold in case of infusion.
When initially receiving a trauma patient the trauma team begins with a primary survey. What does E in the primary survey stand for and what should be done?
E in the primary survey stands for Exposure and the following should be done / assessed:
1. Completely disrobe pt.
2. Logroll pt and check back
3. Rectal exam.
What action should be immediately taken if a patient has a high pulse rate and a low blood pressure following trauma?
The patient is likely in hypovolaemic shock and requires urgent fluid resuscitation via a pump.
Blood transfusion is preferred however 10-20ml/kg of colloid or isotonic crystalloid can be given.
In the case of haemorrhagic shock 20-30mg/kg of colloid or isotonic crystalloid is required.
What does D stand for in the primary survey commenced by the trauma team when a patient is first received.
D stands for disability and involves a Glasgow Coma Scale assessment and assessment of pupils.
What are the three components of the Glasgow Coma Scale?
The Glasgow Coma Scale analyses an individuals response to commands that require a response via:
Opening their Eyes
Speaking / Verbal response
Following / performing a Motor command
There are 4 points possible for GCS eye component of the assessment. What do each of these points stand for?
- No response
- Eyes open to pain
- Eyes open to verbal commands
- Eyes open spontaneously
There are 5 points possible for the GCS verbal component of the assessment. What do each of these 5 points stand for?
- No respons (non verbal)
- Incomprehensible sounds
- Inappropriate words
- Confused
- Oriented and talking.
There are 6 points possible for the GSC motor component of the assessment. What do each of these 6 stand for?
- No response.
- Extensor (decerebrate posture).
- Abnormal flexion (decorticate posture).
- Flexion withdrawl to pain.
- Localises pain to painful stimuli.
- Obeys commands.
When working through the primary survey. If you find a problem at any of the stages what do you do?
Stop the survey, address the problem, then continue the primary survey.
What kinds of imaging form part of the primary survey?
- FAST exam (bedside ultrasound looks at the abdomen for free fluid).
- Chest / Pelvis Xray
When the primary survey is completed and any issues address what is in a secondary survey?
A secondary survey in trauma managment involves a head to toe complete survey of the patient looking for injuries etc.
Trauma work up management of blunt head trauma includes?
Neurological examination
Pupillary response
CSF leak ? increased risk of meningitis > provide prophylactic Abs.
What are the primary goals of trauma management of blunt head trauma?
Primary goals include:
1. Maintain cerebral perfusion (MAP >90mmHg)
2. Optimize intravascular volume (fluids / blood transfusion if req).
3. Optimise ventilation (pulse ox monitoring; oxygen; intubation as req).
4. Prevent / control seizures.
5. Treated elevated ICP (mannitol / hypertonic saline).
- Neurosurge consult for ICP monitoring, intracranial mass etc).
What are the secondary goals of trauma management of blunt head trauma?
Preventing:
1. Hypoglycemia
2. Hyperglycemia
3. Hypoxia goal >Sp02 90%
4. Hypercapnia
5. Hyperthermia
6. Hypoperfusion
