Trauma Flashcards
Steps involved in maintaining airway
Protect cervical spine.
Inspect for any foreign bodies Burns, injuries.
Jaw, thrust, or chin lift if C spine is stable.
Oropharyngeal airway if patient is unconscious.
Can also use Laryngeal mask airway
Definitive is with intubation or with cricothyroidotomy
to assess: look, evaluate three, three, two rule, mallampatti, obstruction, neck mobility
Step involved in maintaining breathing
Physical exam
Pulse oximeter
Oxygen via nasal prongs or facemask?
Needle deCompression or thoracostomy tube if pneumothorax
Chest tube if hemothorax
Temporary 3 sided occlusive dressing if open pneumothorax
Steps in involved in circulation
Physical exam.
Large bore to IVs or I/O(proximal tibia, distal, tibia, distal, femur in kids, proximal, tibia, head of humerus, in adults)
1 to 2 L of IV normal saline bolus, followed by blood products as needed (warmed)
Stop active haemorrhage prior to blood products with pelvic binder, direct manual pressure, torniquet, artery clamping, pericardial, decompression, extremity splits, surgery.
Patient should be on monitors 
Consider TXA
What are the steps after ABC in primary survey
Disability: quick neuro exam, level of consciousness, lateralizing signs. If suspecting traumatic brain injury elevate the head of the bed consider mannitol or hypertonic saline. Hypertonic saline is preferred if patient is hypotensive.
Don’t ever forget glucose.
Consider intoxication, carbon monoxide exposure.
Environment and exposure: remove all clothing. Prevent hypothermia.
What are the components of secondary survey
AMPLE (allergies, medication, past medical history, last week, events) history.
Full exposure with head to two exam including vaginal and rectal exam and log roll.
Setting bones, dislocations
NG or oral gastric tube if no signs of basal skull fracture
Fully catheter, if no blood at meatus, pelvic bruising, high riding prostate.
Use fast scan, x-ray, other imaging and bloodwork. Delay imaging until pt is stable.
Repeat ABC DE with everychange in patient status
Analgesia, antibiotics, tetanus as needed.
Specialty consults as needed
Signs and treatment of tension pneumothorax
Presence of respiratory distress, tracheal deviation away from side of pneumothorax, decrease breath, sounds, or absent breath sounds on ipsilateral side, hypoxia
Treat with needle decompression in the second intercostal space the midclavicular line or the fifth cost of space at the anterior or mid auxiliary line, followed by chest tube insert in the fifth of coastal space in the anterior axillary line
Signs and treatment of cardiac tamponade
Beck’s triad : hypertension, muffled heart sounds, elevated JVP.
Kussmaul sign
Pulsus paradoxus
Confirm with echocardiogram, carry out, guided pericardiocentesis
Diagnosis of shock requires
Systolic BP less than 110 (isolated, or persistent)
Shock index greater than one that is heart rate to systolic BP ratio is greater than 1
Shock index from field to arrival greater than 0.1
Hemorrhage with a flat IVC
Loss of central pulses or signs of poor peripheral perfusion
Types of shock
Hypovolemic.
Distributive.
Obstructive.
Cardiogenic.
Endocrine.
Metabolic 
Categorization of hypothermia
Temperature less than 35°C
Mild is 32 to 35 (tachypnea, tachycardia,, shivering, dysarthria)
Moderate is 28 to 31.9 (loss of ability to shiver, decreased level of consciousness, muscle rigidity, dilated pupils, combative)
Severe is less than 28 ( Hypotension, VF, acidosis, asystole, apnea,coma)
What is massive transfusion protocol and when are patients likely need it?
Massive transfusion protocol is transfusion of four units of blood in one hour or 10 units of blood in 24 hours.
Risk of leading massive transfusion can calculated if two or more of the following are present
Positive fast.
Penetrating trauma.
Heart rate greater than 120
Systolic BP less than 90
