Trauma Flashcards
The need for trauma care
-The leading cause of death in the first fourdecades of life.
- More than 5 million trauma-related deaths eachyear worldwide.
-Motor vehicle crashes cause over 1 million deathsper year.
- Injury accounts for 12% of the world’s burden ofdisease.
Trimodial Death Distribution
-Immediate deaths
-Early deaths (1-3 hours, our biggest concern)
-Late deaths (2-5 weeks)
Standard Concepts
● ABCDE approach to evaluation and treatment
● Treat greatest threat to life first
● Definitive diagnosis not immediately important
● Time is of the essence
● Do no further harm
ATLS Concept
The priorities are the same for all patients:
-Airway with c-spine protection
-Breathing / ventilation / oxygenation
-Circulation: stop the bleeding!
-Disability / neurological statusExpose /
-Environment / body temperature
Regular medical assessment
Injury, history, physical, differential diagnosis, investigations, diffrential diagnosis, treatment
Trauma medical assessment
injury, primary survey, resuscitation, reevaluation, detailed secondary survey, reevaluation, optimize patient status, transfer
Quick simple way to asses a patient in 10 seconds for trauma
-Whats my name
-Whats your name
-What happend
This confirms:
1. Patent airway
2. Sufficient air reserve topermit speech
3. Sufficient perfusion to permitcerebration
4. Clear sensorium
Trauma in the elderly
-Fragility: Same injury, differentoutcome
-Pre-existing disease
-Medications
-anticoagulation
-Lack of functional reserve
Pediatric Trauma
-Different mechanisms of injury
-Cannot alway scommunicate
-Treatments mustbe scaled
-Broselow tape
Trauma in Pregnancy
-Two patients tomonitor
-Medications
-Different normal values, eg. Hb
-Preterm labour
What is the magic intubaiton number
8… below 8, intubate
Breathing, immediate life threatening injuries
● Laryngeotracheal injury / Airway obstruction
● Tension pneumothorax
● Open pneumothorax
● Flail chest and pulmonary contusion
● Massive hemothorax
● Cardiac tamponade
Tension pneumothorax patho
-Air enters pleural space
-Tension pneumothorax: air cant leave
-Preassure on lungs, trachea, heart, other structures
Tension Pneumothorax s&s
-SOB
-Acute Chest pain
-Low BP
-Low spo2
-High hr
-Distended neck veins
-Rennocence
Tension pneumothorax Tx
Needle decompression (second intercostal space, midclivicualr line, followed by insertion of chest tube)
Open Phenumothorax
-Air builds up in the pleural cavity (caused by a hole in the chest wall)
-Puts preassure on the lung, can lead to lung collapse
Open pneumothorax s & s
-Sudden chest pain
-Shortness of breath
-Rapid and shallow breathing
-Fast heart rate
-Hypoxia
open pneumothorax causes
-Blunt or penatrating trauma
-Lung biopsy
-Tube Thoracostomy
open pneumothorax treatment
-Three way dressing
-Chest tube
-Surgical repair
Flail chest
-A fractue in 2-3 consecutive ribs in at least 2 places
Flail chest CM
-Paradoxical chest movement
-Pain with breathing
-Coughing
-decreased Breath sounds
-Crepitus
-SOB
-cyanosis
-Refractory hypoxia
-Hemodynamic instability
Massive hemothroax patho
Massive hemothroax dx
-CXR
-Tube thoracostomy reveals blood
Massive hemothorax treatment
-Tube thoracotomy
-Autotransfusion
-Thoracotomy: Greater than 1500 cc or 20 cc/hr over 4 hrs
Cardiac Tamponade
-Build up of fluid, blood, or air in the the pericardium
-Considered a medical emergency (can progress to circulatory shock and cardiac arrest)
Cardiac tamponade becks triad
-Distension of jugular veins
-Muffled heart sounds
-Low blood preassure
Cardiac Tamponade: pericardial effusion
-Pericardial fluid builds up slowly over time (allows pericardium to stretch out to accomadate bigger volumes of fluid with out compressing heart)
-Symptoms: Chest pain, SOB, Compression of near structures
Acute Pericardial Tamponade
-Sudden fluid accumulation
-Pericardium cannot adjust (dramatic increase in preassure inside pericardial sac)
IV Access
-Start at the most peripheral point and work your way distal, so if you miss you wont have leakeage from the vessel.
-In the ER, the prefered vein is the median cubital vein because it can accomadate a large bore IV and is fairly easy to catheterize
IV Access in order (in unable try…)
-Periphreal Veins (preferably antecubital fossa)
-Intraosseous access
-Percutaneous central venous access femoral vein
-Venous cutdown
-Percutaneous (external jugular/Subclavian/Internal jugular)
Crystalloids
-Includes hypotonic, hypertonic, and isotonic solutions
-Small molocules that dont stay too long in intravascular space
-High amount of fluids needed to equal amount lost
-No allergic reaction or coagulaiton problems
-Cost less and easier to access
Restore Volume (theoretical distrubution of IV fluids on infusion
Refer to chart
Isotonic saline (normal saline/NS)
-Prototype crystalloid fluid is 0.9% NaCl
-9grams of NaCl per litre
-Called normal saline because the percentage of NaCl in the soloution is aproximate to the concentraiton in the intravascualr space.
When to give normal saline (6)
- To treat low extracellular fluid from (Hemmorhage, severe vomiting or diarrhea, heavy drainige from GI suction)
- Shock
- Mild Hyponatremia
- Metabolic acidosis (Such as DKA)
- It’s the only fluid used with administraiton of blood products
disadvantage of normal saline
-Metabolic acidosis - due to high chloride concentration (Hyperchloremic acidosis)
-Intraoperative infusion of isotonic saline at the rate of 30ml/kg/h causes a drop in serum PH from 7.41 to 7.28 after 2 hours
Ringers Lactate (Hartmann’s Soloution)
