TRAUMA Flashcards
Outline the trimodal death distribution after trauma?
Highest chance of death…
• immediately following the injury as a result of brain or high spinal injuries, cardiac or great vessel damage
• Early hours following injury due to splenic rupture, subdural haematomas and haemopneumothoraces
• Days following - sepsis or multi organ failure
Which simple airway manoeuvre should you not do on trauma patients and why?
Dont do head tilt due to high risk of c-spine injury
What do we use to assess the risk of a c-spine injury following trauma?
The Canadian C-spine rules
What are the Canadian C-spine rules?
Pt is considered high risk if they meet 1 or more of the following criteria…
• ages 65 or older
• Dangerous mechanism of injury
• Paraesthesia in any limbs
Pt is low risk if they meet none of the high risk criteria and 1 or more of the following:
• involved in a minor rear-end motor vehicle collision
• Comfortable sitting
• Ambulatory since the injury
• No midline cervical spine tenderness
• Delayed onset of neck pain
Pt is at no risk if no high risk factors, 1 or more low-risk factors and can rotate their head 45 degrees actively to the L and R
Investigation for c-spine injury?
CT
Interventions for C-spine injury?
Hard board and collar with head blocks
What are the 6 widely recognised life-threatening chest injuries following trauma?
TOM CAT
Tension pneumothorax
Open pneumothorax
Massive Haemothorax
Cardiac tamponade
Airway injury
Tracheobronchial injury
What does “on the floor, and four more” refer to?
Locating a haemorrhage - on the floor refers to the visible blood loss from an external wound and four more refers to 4 potential spaces inside the body where a large volume of blood may be lost: chest, abdomen, pelvis and long bones
Which groups of patients should you be cautious about relying on their observations in trauma?
Young people and athletes can compensate very well
Elderly dont compensate well at all
Imagine in trauma?
Whole body CT scan
FAST US can be done if CT not available or pt not stable enough
What is done in a secondary survey?
Once pt is haemodynamically stable:
AMPLE history
Head, maxillofacial, neck, abdomen, pelvis, perineum, genital, rectum neurological, spine, MSK exam
Pathophysiology of tension pneumothorax?
air enters the pleural space and is unable to escape, creating a one-way valve effect e.g. due to a flap of tissue. The continous accumulation of air leads to increased intrapleural pressure which exceeds atmospheric pressure throughout the resp cycle.
This compresses the affected lung leading to a decrease in functional residual capacity and impaired gas exchange, medistanial shift which can compress the opposing lung and compress the great veins reducing venous return to the heart and the direct pressure on the heart impairs cardiac filling which leads to a lower CO and systemic BP.
Causes of a tension pneumothorax?
Penetrating or blunt chest trauma
Iatrogenic - thoracdentesis, central venous catheter etc
Spontaneous - may have underlying lung disease or lung blebs
Clinical features of tension pneumothorax?
Acute onset dyspnoea
Pleuritic chest pain
Tachypnoea
Hyperresonance on percussion
Diminished breath sounds on affected side
Tracheal deviation away from affected side
Signs of shock
How is tension pneumothorax diagnosed?
Clinically - treatment should not await confirmation on imaging
Portable CXR is recommended if easily available??
Management of a tension pneumothorax?
Finger or needle thoracostomy initially
Placement of a chest drain in the safe triangle of the chest
What are the borders of the triangle of safety
Lateral border of pectoralis major anterior, mid-axillary line posterior, level of nipple inferior
What is a simple pneumothoraces?
The accumulation of air in the pleural space resulting in the partial or complete collapse of the affected lung
What are the types of simple pneurmothoaces?
Spontaneous - primary or secondary to underlying lung disease
Traumatic
Iatrogenic
What is a catamenial pneumothorax?
recurrent spontaneous pneumothorax occurring within 72 hours before or after onset of menstruation
Thought to be caused by endometriosis within the thorax
Features of simple pnuemothoraces?
Dyspnoea
Pleuritic chest pain
Hyperresonant lung percussion
Reduced breath sounds
Reduced lung expansion
Tachypnoea
Tachycardia
Management of a simple pneumothoraces if no significant symptoms or physiological compromise?
Conseervative care regardless of size
If primary it must be reviewed every 2-4 days as an outpatient
If secondary they must be monitored as an inpatient
What are the high risk characteristics of simple pnuemothroaces?
Haemodynamic compromise
Significant hypoxia
Bilateral
Underlying lung disease
>=50
Significant smoking history
Haemotgorax
Management of a traumatic simple pneumothoraces with high-risk characteristics?
Chest drain with inpatient family review
Management of a traumatic simple pneumothoraces but without any high-risk characteristics?
Conservative management or ambulatory or needle aspiration
When must all pmeumothoraces be followed up?
Must have FU 2-4 weeks after as an outpatient
How are recurrent pneumothoraces managed?
Video-assisted thoracoscopic surgery should be considered to allow for pleurodesis and a bullectomy
Discharge advice after a pneumothorax?
• avoid smoking
• Generally you can fly 2 weeks after resolution but normally recommended to =wait for a CXR confirming resolution
• Scuba diving should be permenantly avoided unless pt has undergone bilateral surgical pleurectomy and has normal lung function and chest CT post op
How can you tell a chest drain is lying within the chest cavity?
Look for fogging of the tube and swinging of the chest drain with respiration
What is an open pneumothorax and what usually causes it?
This is a hole on the chest that competes with the normal airway for delivery of air
Very rare and most commonly caused by a shot gun injury
