Trauma Flashcards
1
Q
What is the assessment of a trauma patient?
A
- AMPLE history (allergies, medication, past illness/pregnancy, last meal and events leading to injury)
- A-E assessment and resus
- Secondary survey (log roll to view back)
- Trauma series (chest and pelvic X ray)
- FAST Scan,
- Trauma CT if stable enough,
- Theater or intensive care
2
Q
What are the 6 major areas of blood loss in trauma?
A
- Chest,
- Abdomen
- Long bones,
- Retroperitoneal
- Floor (ambulance floor/ scene)
3
Q
What are the signs of hypovolaemia?
A
- Pallor/grey,
- Cold sweat,
- Rapid, thready pulse,
- Increased resp rate,
- Thirsty/dry mouth,
- Peripherally cold,
- Low BP,
- Reduced urine output
4
Q
What are the investigations for hypovolaemia?
A
- Blood gas (VBG/ABG) to see Hb,
- G&S and crossmatch
- Identify bleeding source
5
Q
What is the initial management for hypovolaemia?
A
- Direct pressure +/- adrenaline soaked gauze,
- Splint long bones and pelvic binder,
- Tourniquet
- Big sutures,
- Tamponade,
- Tie off vessels
- 1L of warmed saline STAT,
- Blood product replacement 2:1:1 (RBCs, Platelets and FFP)
- TXA and coag testing
6
Q
What are some different signs of head trauma?
A
- Racoon eyes and CFS leaking from nose (anterior cranial fossa #)
- Battle sign and CSF leaking from ears/haemotympanum and CN signs ( petrous temporal bone #)
- Blood on head CT (WHITE)
- Reduced GCS,
- Headaches/vomiting,
- Stiff neck,
- Seizures/amnesia,
- Pupil size and reactivity,
- Posturing
- Cushing’s reflex
7
Q
What are the investigations for head trauma?
A
- Full neuro exam,
- GCS every 30-60mins,
- Blood gas,
- CT scan,
- MRI
- EEG
8
Q
Explain the initial management of head trauma
A
- Resus,
- CT scan,
- Stop/ reverse blood thinners,
- Neurology review
- Surgical management = Burr hole decompression or trauma crainectomy
9
Q
What are the complications of head trauma?
A
- Traumatic brain injury,
- CNS infection,
- Disability,
- Herniation,
- Death
10
Q
What are the clinical signs of chest trauma?
A
- Haematoma,
- Respiratory distress,
- Decreased/absent breath sounds,
- Dull/hyper-resonant percussion,
- Hypovolaemia,
- Obstructive shock,
- Surgical emphysema
11
Q
What are the signs of a tension pneumothorax?
A
- Respiratory distress,
- Deviated trachea,
- Distended neck veins (due to compressed SVC),
- Absent breath sounds,
- Hyper-resonant
- Minimal chest movement
12
Q
What is the management of a tension pneumothorax?
A
- Oxygen,
- Decompression with grey venflon in second intercostal space mid-clavicular line
13
Q
What is the management of a haemothorax?
A
Chest drain and trauma CT to localize bleeding
14
Q
Describe features of a cardiac tamponade
A
- It is accumulation of pericardial fluid/ blood/ pus/ air in pericardial space which causes a restriction of cardiac fulling and decreases cardiac output.
- Presents with tachycardia, hypotension, muffled heart sounds, distended neck veins, pulsus paradoxus
- Managed with pericardiocentesis or thoracotomy
15
Q
What are the investigations for chest trauma?
A
- Blood gas,
- ECG,
- Trauma series,
- Monitor blood loss in trauma,
- FAST scan,
- Trauma CT
