Trauma

Question 1

The need for trauma care

Answer 1

-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.

Question 2

Trimodial Death Distribution

Answer 2

-Immediate deaths
-Early deaths (1-3 hours, our biggest concern)
-Late deaths (2-5 weeks)

Question 3

Standard Concepts

Answer 3

● 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

Question 4

ATLS Concept

Answer 4

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

Question 5

Regular medical assessment

Answer 5

Injury, history, physical, differential diagnosis, investigations, diffrential diagnosis, treatment

Question 6

Trauma medical assessment

Answer 6

injury, primary survey, resuscitation, reevaluation, detailed secondary survey, reevaluation, optimize patient status, transfer

Question 7

Quick simple way to asses a patient in 10 seconds for trauma

Answer 7

-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

Question 8

Trauma in the elderly

Answer 8

-Fragility: Same injury, differentoutcome
-Pre-existing disease
-Medications
-anticoagulation
-Lack of functional reserve

Question 9

Pediatric Trauma

Answer 9

-Different mechanisms of injury
-Cannot alway scommunicate
-Treatments mustbe scaled
-Broselow tape

Question 10

Trauma in Pregnancy

Answer 10

-Two patients tomonitor
-Medications
-Different normal values, eg. Hb
-Preterm labour

Question 11

What is the magic intubaiton number

Answer 11

8… below 8, intubate

Question 12

Breathing, immediate life threatening injuries

Answer 12

● Laryngeotracheal injury / Airway obstruction
● Tension pneumothorax
● Open pneumothorax
● Flail chest and pulmonary contusion
● Massive hemothorax
● Cardiac tamponade

Question 13

Tension pneumothorax patho

Answer 13

-Air enters pleural space
-Tension pneumothorax: air cant leave
-Preassure on lungs, trachea, heart, other structures

Question 14

Tension Pneumothorax s&s

Answer 14

-SOB
-Acute Chest pain
-Low BP
-Low spo2
-High hr
-Distended neck veins
-Rennocence

Question 15

Tension pneumothorax Tx

Answer 15

Needle decompression (second intercostal space, midclivicualr line, followed by insertion of chest tube)

Question 16

Open Phenumothorax

Answer 16

-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

Question 17

Open pneumothorax s & s

Answer 17

-Sudden chest pain
-Shortness of breath
-Rapid and shallow breathing
-Fast heart rate
-Hypoxia

Question 18

open pneumothorax causes

Answer 18

-Blunt or penatrating trauma
-Lung biopsy
-Tube Thoracostomy

Question 19

open pneumothorax treatment

Answer 19

-Three way dressing
-Chest tube
-Surgical repair

Question 20

Flail chest

Answer 20

-A fractue in 2-3 consecutive ribs in at least 2 places

Question 21

Flail chest CM

Answer 21

-Paradoxical chest movement
-Pain with breathing
-Coughing
-decreased Breath sounds
-Crepitus
-SOB
-cyanosis
-Refractory hypoxia
-Hemodynamic instability

Question 22

Massive hemothroax patho

Question 23

Massive hemothroax dx

Answer 23

-CXR
-Tube thoracostomy reveals blood

Question 24

Massive hemothorax treatment

Answer 24

-Tube thoracotomy
-Autotransfusion
-Thoracotomy: Greater than 1500 cc or 20 cc/hr over 4 hrs

Question 25

Cardiac Tamponade

Answer 25

-Build up of fluid, blood, or air in the the pericardium
-Considered a medical emergency (can progress to circulatory shock and cardiac arrest)

Question 26

Cardiac tamponade becks triad

Answer 26

-Distension of jugular veins
-Muffled heart sounds
-Low blood preassure

Question 27

Cardiac Tamponade: pericardial effusion

Answer 27

-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

Question 28

Acute Pericardial Tamponade

Answer 28

-Sudden fluid accumulation
-Pericardium cannot adjust (dramatic increase in preassure inside pericardial sac)

Question 29

IV Access

Answer 29

-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

Question 30

IV Access in order (in unable try…)

Answer 30

-Periphreal Veins (preferably antecubital fossa)
-Intraosseous access
-Percutaneous central venous access femoral vein
-Venous cutdown
-Percutaneous (external jugular/Subclavian/Internal jugular)

Question 31

Crystalloids

Answer 31

-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

Question 32

Restore Volume (theoretical distrubution of IV fluids on infusion

Answer 32

Refer to chart

Question 33

Isotonic saline (normal saline/NS)

Answer 33

-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.

Question 34

When to give normal saline (6)

Answer 34

1. To treat low extracellular fluid from (Hemmorhage, severe vomiting or diarrhea, heavy drainige from GI suction)
2. Shock
3. Mild Hyponatremia
4. Metabolic acidosis (Such as DKA)
5. It’s the only fluid used with administraiton of blood products

Question 35

disadvantage of normal saline

Answer 35

-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

Question 36

Ringers Lactate (Hartmann’s Soloution)