Trauma Flashcards
Management of shock in trauma APLS algorithm? Doses of fluid and drugs?
10ml/kg blood or warmed fluid
TXA 15mg/kg bolus
+ 2mg/kg/hr infusion
How does primary ABCDE change with trauma
Catastrophic external haemorrhage
A + C-spine
- Jaw thrust
- Suction/removal of foreign body
- Intubation / surgical airway
- Neck collar
B
- Central trachea
- Chest movement
- Obvious chest injuries
- Auscultate
C
- CRT
- Radial pulse and rate
-Fluids
- 2x wide bore IV + Bloods inc Xmatch and lipase
D
- AVPU
- Pupils
E
- Abdo
- Femurs + pelvis
Management of massive haemorrhage in paediatric trauma
Secondary survey includes?
1) Surface (head to toe, front and back)
2) Orifice (mouth, nose, ears, anus, genitalia)
3) Cavity (chest, abdomen, pelvis)
4) Extremity (arms and legs)
Paediatric traumatic cardiac arrest flow chart? What are the considerations for reversible causes
The search for and correction of any of the reversible causes of paediatric TCA should be prioritised. These include:
External exsanguinating haemorrhage should be controlled using direct pressure +/- tourniquets.
Bilateral finger or tube thoracostomy (or needle thoracocentesis) should be considered.
Fluid resuscitation should occur with blood products as soon as available.
Emergency thoracotomy should be considered in paediatric TCA patients with penetrating trauma with or without signs of life on arrival to ED.
C-spine assessment algorithm
When can you clear the C spine
Alert and awake, and not intoxicated
has no neck pain or visible injury to the neck
has no abnormal neurological limb signs
has no major painful distracting injuries
has normal radiology (if indicated
Usual choice for a nerve block
buvipacaine 0.25%
Paracetamol dosing in kids
20 mg/kg followed by doses of 15 mg/kg for a maximum of 4 doses in 24 hours.
Intranasal fentanyl dosage for kids
1.5 microg/kg provides effective and rapid onset (5-10 mins) analgesia
When is N2O contraindicated as pain relief
PTX
Nitrous oxide can diffuse into the pneumothorax airspace and may increase pressure or cause a tension pneumothorax
2 options for raised ICP infusions
IV Mannitol 0.25-0.5 gm/kg
or hypertonic saline (3%) 3 mls/kg
When should you treat a seizure if it occurs following trauma
Immediately
Life threatening Major chest injuries
ATOMFC
A - Major airway compromise
T - Tension pneumothorax
O - Open pneumothorax
M - Massive haemothorax
F - Flail chest
C - Cardiac tamponadee
What can you do in the community if open tension PTX
3 sided dressing
Why do kids get more trauma of liver, pancreas and spleen
More flexible ribs
Horizontal diaphragm
Thinner abdo wall
Spleen also larger
Initial pain relief in burns
Intranasal fentanyl
Cooling
IV morphine if IV
When looking at burns on a limb or digit what are we concerned about
Encircling burns -> damage circulation -> compartment syndrome
[In order to prevent this tissues may need to be surgically divided, allowing tissues to expand without increasing pressures: a procedure known as escharortomy.]
Assessment of burn % rough estimate
Epidermal vs superficial vs mid dermal vs deep dermal vs full thickness
Colour, blisters, CRT, sensation?
Epidermal - no blisters
Superficial - blisters
Mid dermal - slow CRT
Deep - red + reduced sensation
Full - white + no sensation
Painless burn
Full thickness
Mottled, reddend, blistered with slow CRT
Mid dermal burn
Pink blistered with fast CRT
Superficial dermal
What is the parkland formula for burns fluids? How fast should you give it? Which fluid?
Parkland formula - Burn (in %) x Weight (in Kg) x 3 ml - (3mls per kg per % burn)
Half of this daily volume should be given in the first 8 hours and the second half given over the next 16 hours.
A balanced crystalloid such as Hartmann’s solution or Plasmalyte is generally recommended. Other crystalloid solutions such as normal saline can be considered.
What is the correct estimate of fluid requirements due to burns fluid loss for a child with 40% burns (dermal) who weighs 20 kg?
The calculation is 40 (% burn) x 20 (kg) x 3 (mls) = 2400 mls to be given in 24 hours.
Half of this (1200 mls) is to be given in the first 8 hours: that is 150 mls per hour
followed by the second half over the next 16 hours: that is 75 mls per hour.
