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Emergency Medicine > Trauma > Flashcards

Trauma Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

what is the prognosis of the majority of trauma patients?

A

*Immediate Within Minutes (50%)– trauma due to widespread brain damage and/or rupture of heart or great vessels
* Within Hours (30%)– “The Golden Hour” – An injured person has about 60 minutes in which traumatic care can improve survival rate.
* Within Days (20%)– Sepsis and multi-organ failure

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2
Q

when do the majority of trauma deaths occur?

A

at the scene or within 1st hr

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3
Q

Levels of Trauma

A
  • Level 1 – Provides total care for every aspect of injury; research leader
  • Level 2 – Provides definitive care for a wide range of traumatic complexities (pts needing Cardiac Sx, hemodialysis and microvascular Sx are stabilized in level 2 and then passed to level 1)
  • Level 3 – Provides initial stabilization and treatment; care of uncomplicated patients
  • Level 4 – Provides initial stabilization; transfers all trauma patients for definitive care
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4
Q

Parkview and Lutheran handle level ___ trauma

A

2

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5
Q

Should primary and secondary surverys be conducted before or after the pt reaches the hospital?

A

After they get IN the hospital

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6
Q

What is the Primary Survey?

A

ABCDE
Airway
Breathing
Circulation
Disability
Exposure/Environment

2 goals: Identify life threatening injury quickly, provide stabilization when identified.

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7
Q

ABCDE

Airway

A

talking = patent airway
Unconscious -> Intubation (GCS<8)
Conscious + CANT talk -> check airway (FB rmvl, suction, identify frx)
Assess face/neck injuries
C-spine collar immobilization

Swelling (hematoma/edema) -> compress airway.
Bleeding, nasopharygngeal blood -> aspiration
Crepitus = direct laryngeal or tracheal injury
Burns -> airway edema
Inhalation injury -> hypoxia

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8
Q

youre thinking about intubating but arent sure, wdyd?

A

INTUBATE

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9
Q

ABCDE

are airway or chest/pulm (breathing) traumatic injuries MC?

A

Chest/pulm (breathing) injuries are more common

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10
Q

ABCDE

Breathing

A
  1. listen to breath sounds
  2. assess resp effort (rate, muscle use)
  3. assess O2 Sat
  4. r/o tension pneumo, flail chest, open pneumotheroax, hemothorax
  5. give O2 (SpO2 >95%)
  6. Stabile -> CXR
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11
Q

ABCDE - Breathing

Indications for Mechanical Ventilation
RR >___ or <____
O2 <____% despite supp O2

A
  • Respiratory Rate >35 or <6
  • Oxygen desaturation to <90% despite supplemental O2
  • Cardiopulmonary arrest
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12
Q

Why can’t you give Succhinycholine to a pt who has crush injuries and burns?

A

Natural Hyperkalemia after trauma + Succhinycholine induced Hyperkalemia = cardiac arrest

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13
Q

How to do rapid sequence intubation (RSI)

A

Induction agent (eg. Ketamine or Etomidate) followed by a paralytic agent (eg. Rocuronium or Succinylcholine).
OOA: 1 min

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14
Q

What is this? Trmnt?
tracheal deviation, uneven chest, absent breath sounds, hemodynamic compromise.

A

Tension Pneumothorax
Immediately perform needle decompression in 2nd intercostal space along midclavicular line. Followed by tube thoracostomy

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15
Q

Trmnt for flail chest

A

Often associated with underlying pulmonary contusion.
Trmnt: supportive +/- mechanical ventilation

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16
Q

Trmnt for open pneumo due to stab wound

A

Rapid equilibration of atmospheric and intrathoracic pressure
for impaired oxygenation and ventilation

17
Q

Trmnt for hemothorax

A

LARGE tube thoracostomy and replacement of blood products

18
Q

you start to do a needle decompression and blood is coming out. wdyd?

A

get a large tube
the blood will clot in the small needle diameter

19
Q

ABCDE

Circulation

A
  1. asses color, mental state, cap refill
  2. feel peripheral pulses and check vitals on monitor
  3. r/o MC places to bleed out -> hemorrhagic shock (chest, abd, retroperitoneum, hip, femur, cranium (small kids)
  4. r/o obstructive shock (cardiac tamponade, tension pneumo)
  5. direct pressure on external bleeds
  6. IV access (2 large bore peripheral IVs 18g or larger, Intraosseous line, or central line)
  7. Start with isotonic crystalloid (consider blood transfusion)
  8. emergent trmnt based on underlying injury

Peripheral pulses SBP
Carotid >60 mmHg
Femoral >70 mmHg
Radial >80 mmHg
Dorsalis pedis >90 mmHg

20
Q

ABCDE

Circulation FAST Exam
(Which regions do you US to check for ascites?)

A
  • RUQ (Morrison’s pouch) - in b/w liver & kidney
  • Subxiphoid
  • LUQ
  • Suprapubic (pouch of Douglas) - below the bladder
21
Q

ABCDE

Disability

A
  1. Assess Level of consciousness using AVPU (alert, voic, pain, unresponsive), or Glasgow Coma Scale (GCS)
  2. Pupillary Fn
  3. Four extremity Movement (brain/spinal cord injury)
  4. External signs of head/neck trauma
  5. If patient is in any way altered -> check blood glucose (Pts with medical illness can have trauma precipitated by the medical problem)
  6. Assess for life threatening neurological injury

Penetrating cranial injury
Intracranial hemorrhage (Subdural hematoma, epidural hematoma, traumatic sub-arachnoid hemorrhage, intraparenchymal hemorrhage, or intraventricular bleed)
Diffuse axonal injury
High spinal cord injury

22
Q

Glasgow Coma Scale (GCS)

A

“4 eyes”
“Jackson 5”
“V6 motor”

Scoring
3 = unresponsive (Dead)
8 = Intubate
15 = Gucci (fully responding)

23
Q

If GCS is <_____ = INTUBATE

A

8

24
Q

Order a STAT ____ for a low GCS score

A

Cranial image

doesnt say which study specifically

25
Q

ABCDE - Disability

How to r/o a cervical spine injury

A
26
Q

ABCDE

Environment/Exposure

A
  • Remove clothing/covering.
  • Look at the patient’s skin
  • Avoid hypothermia (use a warm trauma bay, warm with fluids or blankets, transfuse blood if needed)
  • Perform a complete head to toe exam (esp axilla, back, back of head, neck)
  • Cover them up again
27
Q

Primary Survery Points

A
  • Do the Primary survey first
  • Do it the same way every time
  • Identify specific life threatening issues and treat simultaneously
  • Know the differential diagnoses of the ABCDEs
  • Following the survey, know if you need to transfer
  • If something changes during exam, return to A, and redo the survey
28
Q

Special Population Considerations:
Children
Pregnancy
Elderly

A
  • Children: Different anatomic variables. They will have more anterior airways. They may not have as many fractured bones given flexible nature.
  • Pregnancy: Higher circulating volumes, gravid uterus
  • Eldery: comorbidities, may be on blood thinners, have less physiologic reserve.
29
Q

Secondary Survery

A

Does not begin until primary survey is finished
Use AMPLEM history
* Allergies
* Medication
* Past surgical/medical history
* Medication
* Last meal
* Events
* Mechanism (blunt, penetrating, burn/inhalation)

30
Q

Secondary Survery
Look for what on PE?

A

Spine (check cervical, thoracic, lumbar spine for deformities, step-offs, areas of tenderness)
Head and scalp (depressed skull fractures)
Maxillofacial
C-spine/neck
Chest
Abdomen (Bruising/distension, penetration)
Perineum/genitalia
Extremities
Neurologic

Flank discoloration = grey turners (think retroperitoneal bleed)

31
Q

This flank discoloration found during Secondary Survery is a concern for _____

A

Flank discoloration = grey turners (think retroperitoneal bleed)

32
Q

Following Survey

following is a verb in this “PA is to follow or FU”

A
  • Consider Pan-Scan (CT it ALL -> Head, C-spine, Chest, Abd/Pelvis)
  • Obtain specific imaging (spine, extremity)
  • Stabilize and transfer to definitive care center if needed
  • Trauma patients must be evaluated continuously
  • Patients should improve as they go
  • Sudden decompensation -> go back to A again and do primary survey all over again (double it and give it to the next person)
  • Tertiary survey refers to rounding on the patient

Emergency Medicine (11 decks)

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