trauma Flashcards
what is the leading cause of death in the developed world for 1-44yo?
trauma and injury
why is a systematic approach important when dealing with trauma?
- allows pts to be sent to correct centres after triage and stabilisation
- higher quality care and improved outcomes
what is the “golden hour”?
concept that pts suffering critical injuries should start receiving care in the first hour following injury to reduce mortality and morbidity
what is the general structure for managing a patient with trauma?
1 primary survey
2 resuscitation
3 secondary survey
4 initiation of definitive care
5 reassessment of pt at regular intervals
describe the primary survey for a pt with trauma
1 Airway with spine protection (prevent further harm to neck/spinal cord) = cervical in-line stabilisation or positioning upright and forwards
2 Breathing
3 Circulation
4 Disability = AVPU, GCS (≤8 significant)
+/- some assessment of injury at this stage
what is the Glasgow Coma Scale and what is assessed?
- objectively assesses extent of impaired consciousness
- rated 3-15 with ≤8 indicating significant deficit (should be intubated)
- eyes /4
- motor /6
- voice /5
describe what is assessed in the secondary survey for a pt with trauma (9)
- full history, also mechanism and time of injury, esp head injury, safeguarding, alcohol or drugs
- inspection of H&N = injuries, symmetry, Battle’s sign, etc
- palpation for tenderness, step deformities, swelling
- eyes = pupil reflex, visual acuity, range of movement, diplopia, haemorrhage, swelling, exophthalmos
- ears = gross abnormalities, tympanic membrane, fluid leakage
- nose = bridge (nas-ethmoidal complex), airflow, bleeding, fluid leakage
- full CN examination (short = 3/4/5/6/7)
- mouth opening
- IO = occlusion, dental trauma and fragments, bleeding, lacerations, haematoma, fractures
what is Battle’s sign?
bruising seen behind the ear (over mastoid process) which may indicate a skull base fracture
if a patient has clear fluid leakage from ear/nose, what should you test for and what does this confirm?
- beta 2 transferrin
- only found in CSF
for visual acuity, should you test the injured or uninjured eye first?
- injured first
- to prevent memory bias
what types of haemorrhage may affect the eye post-trauma? (2)
- subconjunctival haemorrhage
- retrobulbar haemorrhage
what is exophthalmos?
abnormal protrusion of the eyeball(s)
(AKA proptosis)
describe retrobulbar haemorrhage (what, s/s, immediate and definitive management)
- seen with some orbital fractures
- bleeding –> compartment syndrome, increased orbital pressure
- impaired vision + 4 Ps = pain, paralysis, poor visual acuity, proptosis
- urgent surgical management to prevent blindness = lateral canthotomy and inferior cantholysis
- +/- medical management = eye drops (timolol, mannitol), diuretics, carbonic anhydrase inhibitors, corticosteroids
- definitive management = remove any haematoma, decompression if needed
4Ps of retrobulbar haemorrhage
consider retrobulbar haemorrhage if impaired vision with any of the following:
- Pain
- Paralysis of ocular movement
- Poor visual acuity
- Proptosis
septal haematoma management
urgent aspiration and nasal packing (prevent reaccumulation)
what IO feature indicates mandibular fracture?
sublingual haematoma
describe epidemiology of mandible fractures (demographic, cause, location)
- 20-30yo, males
- mostly interpersonal violence
- most commonly angle and ramus, parasymphysis, condylar region
