Trauma Flashcards
What are the aims of the primary and secondary surveys?
Primary survey = identify and correct any immediately life threatening conditions
Secondary survey= once patient stable identify all injuries no matter how minor
What is C ABCDE?
used in trauma where before the normal ABCDE assessment you need to address catastrophic external haemorrhage
History needed in a trauma?
mechanism of the injury, energy and transfer
then AMPLE history
Order of interventions in airway?
look for obvious obstructions and remove, suction if appropriate
then head tilt chin lift/ jaw thrust
if that does not work or patient obstructs again when you let go of manoeuvre you need an airway adjunct
- guedel
- nasopharyngeal
- LMA
definitive airway management would be with ET tube
If patient cannot be intubated or ventilated they need a surgical airway
When are guedel/ oropharyngeal airways not well tolerated?
when a patient is not unconscious
Who should you not use a NP airway in?
people with base of skull fractures
signs of base of skull fractures include: battle sign (bruising behind ear), raccoon eyes, clear fluid (CSF) or blood running from ears or nose
Explain what paradoxical breathing is and what it may be a sign of?
when the chest moves in on inspiration and out on expiration (opposite to what it usually does)
may be a sign of flail chest where two or more ribs become detached from the rib cage
Explain 4 types of shock?
hypovolaemic - loss of blood or fluid in burns
Obstructive - physical obstructive to flow e.g. tamponade or tension pneumothorax
distributive - massive vasodilation e.g. neurogenic, septic or anaphylactic shock
Cardiogenic - pump failure
Neurogenic vs spinal shock?
neurogenic shock is when you get loss of sympathetic outflow in trauma and massive vasodilation- clue in a question - people with neurogenic shock appear flushed
spinal shock is the initial flacid paralysis and arreflexia you get in spinal injury - eventually these people if spinal injury complete will then get paralysis with UMN signs
Aim when resuscitation of someone with massive haemorrhage?
presence of radial pulse (systolic 80-90)
NOT normotension
What is sent in massive haemorrhage?
4 packed red cells and 4 frozen plasma plus a pool of platelets
red cells are universal o neg
given in ratio of 1 RCC: 1 FFP
List GCS scoring?
Eyes:
spontaneous - 4
verbal - 3
pain - 2
none - 1
Verbal:
oriented - 5
confused - 4
inappropriate words - 3
incomprehensible sounds- 2
none - 1
Motor:
obeys - 6
localises to pain - 5
withdraws from pain - 4
decorticate - 3
decerebrate -2
none - 1
Decorticate vs decerebrate posturing?
decorticate posturing you have abnormally bent arms
decerebrate it is abnormal extension of whole body
During initial assessment of the airway all major trauma patients should receive?
high flow oxygen 15l/ min through a non-rebreather mask
Gold standard investigation for patients with thoracic trauma?
CT
CXR can be done initially to pick up life threatening trauma and check tube placement though
Signs of a tension pneumothorax?
patient likely to be shocked
tracheal deviation away from side of injury - late sign
hyper resonance to percussion
bony crepitus
surgical emphysema - air in the chest wall (seen as abnormal black spaces in subcutaneous layer on CXR)
flail chest
Emergency and definitive management of a tension pneumothorax?
emergency management - large bore cannula in 2nd intercostal space mid clavicular line - go just above the rib below to avoid the neurovascular bundle which runs on the underside of each rib
definitive management = insertion of a chest drain
5th intercostal space mid axillary line - lateral border of the pectoralis major, anterior border or latissimus dorsi and axial border just superior to the nipple
Management of an open pneumothorax?
cover the defect but only three sides so there is still a small space for air to escape but the space is not as big meaning air will start going in and out again through the trachea
What is the most commonly injured organ in blunt abdominal trauma?
spleen
What is a deceleration injury?
occurs when you get difference in movement between fixed and non fixed body parts
What is the most commonly injured organ in penetrating trauma?
the liver
If a patient with abdominal trauma is too unstable for a CT scan?
send them straight to theatre for emergency laparotomy
3 types of major pelvic fractures?
vertical shear - fall from height - one part moves up so leg shorter than other
anterior posterior compression - open book fracture
lateral compression fracture - force from side
If in major trauma there are concerns of a pelvic fracture?
should stabilise early on with a pelvic binder
What is the definitive management for patients with ongoing haemorrhage related to a pelvic fracture?
angiographic embolisation by the interventional radiologists
A dilated pupil on the context of severe head trauma?
suggests rapidly rising ICP due to pressure on the third nerve
Investigation of choice for head injuries?
CT scan (skull XR plays no role)
use NICE/ SIGN guidelines to decide if needed
What is the cushing response?
terminal phase of raised ICP and suggests herniation is imminent
causes bradycardia, hypertension and respiratory depression - essentially you raise your BP to try and perfuse the brain but the baroreceptor reflex drops the HR because you dont need increased vascular resistance
Usual cause of extradural haematoma?
arterial bleed
rupture of the middle meningeal artery secondary to trauma of the pterion
Classic presentation of extradural haematoma?
brief loss of consciousness followed by a lucid interval then a deterioration
Appearance of EDH on CT?
lens shaped appearance as bounded by sutures
Usual cause of subdural haematoma?
venous bleed
rupture of the bridging veins
more common in elderly or alcoholics as there is cerebral atrophy meaning the bridging veins are more stretched so more likely to rupture
Appearance of SDH on CT?
semilunar appearance as not bounded by sutures
What is a cerebral contusion?
bleeding into the brain parenchyma from direct impact
Cerebral contusion vs haemorrhage?
no distinct cut off but contusions generally smaller
What is diffuse axonal injury?
Brain injury with damage in the form of extensive lesions to white matter tracts occurring over a widespread area
The result of shearing forces from rapid acceleration/deceleration of the head for example, in high speed RTCs
One of the most devastating head injuries and a major cause of unconsciousness/ persistent vegetative state post head trauma
Initial CT scan may be normal
What is secondary brain injury?
this does not occur at the time of the trauma but afterwards due to hypoperfusion or increased ICP - it is important to try and prevent this !
Initial management of burns?
cool the burn (beware of hypothermia, only attempt cooling if burns < 10% total body area)
cover the burn - helps with pain and keeps it clean
Rule of 9s for burns?
Body surface area can be estimated on an adult using multiples of nines
Anterior head = 4.5%
Posterior head = 4.5%
Anterior arm = 4.5%
Posterior arm = 4.5%
Anterior torso = 18%
Posterior torso = 18%
Anterior leg = 9%
Posterior leg = 9%
Giving fluids in burns?
Parkland formula: 4ml x %burn x Weight(kg)
This calculates the total volume of fluid required over a 24 hour period. 50% of this total should be administered over the first 8 hours of treatment from the time of the thermal insult. The remaining 50% should be administered over the next 16 hours.
What is a CT pan-scan?
A whole body CT done in major trauma
