Trauma Flashcards
In trauma Pts presenting with agitation, what should the initial managment focus on?
treating underlying conditions (e.g. pain, hypoxia, tension pneumothorax, hypoglycemia) and providing reassurance to the patient
What route of administration of medication is preferred in trauma Pts?
IV or IO
Critically ill patients may have impaired absorption of medications administered intramuscularly due to reduced perfusion, increased peripheral vascular resistance, tissue hypoxia and acidosis, and altered pharmacokinetics.
What is the preferred analgesic agent and route for trauma Pts presenting with agitation?
fentanyl - IV/IO
What is the 1st line Parenteral Sedation drug for agitated trauma Pts?
Ketamine (ICPs only)
What is the 2nd line Parenteral Sedation drug for agitated trauma Pts?
Midazolam - IV/IO
What type of restraint should be used to facilitate the administration of parenteral sedation?
physical
What type of restraint should be used to facilitate the ongoing management of a sedated Pt?
mechanical
What level of consciousness is the end goal of sedation in the behaviourally disturbed Pt?
drowsy but responsive
What are the sedation contraindications?
Administration of sedation to facilitate advanced airway management
Inability to monitor the patient’s physiological observations post sedation
What must paramedics be prepared to and able to manage post sedation?
- Depression of protective airway reflexes and loss of a patent airway. The risk of aspiration must be anticipated.
- Depression of ventilation.
- Depression of the cardiovascular system (may be due to cardiac dysrhythmias and hypotension).
- Drug interactions or adverse reactions, including dystonia, seizures or more rarely anaphylaxis.
What steps should be undertaken when preparing the Pt for sedation?
- Ensure related conditions (e.g. hypoglycaemia, analgesia) are treated prior to sedation (where possible)
- Explain the procedure and obtain informed consent (where possible) and explain benefits, risks, alternatives and to do nothing (BRAN)
- Prepare and apply (where possible) monitoring equipment: Spo2, EtCO2, NIBP, ECG
- Obtain vascular access (where possible) if not already in situ and appropriate
- Assess the patient’s airway and ventilation for potential difficulties with:
- securing an advanced airway (if not already in situ) post sedation
- ventilation of the patient post sedation
- adequacy of breathing and perfusion
- Determine Pt’s initial SAT score
What is the targeted level of sedation for trauma agitated Pts?
Sedation Assessment Tool Score = 0
Awake and calm/cooperative / speaking normally
What steps should be undertaking during the post procedural care for sedated Pts?
Continuously monitor vital signs (SpO2, EtCO2, NIBP, and ECG)and SAT score.
Document SAT and VSS every 5 minutes post each parenteral sedation for 20 minutes then 30 minutes for two hours or until transfer of care is complete.
Reassessment and management of organic causes of acute behavioural disturbance.
Monitoring should always be supplemented with vigilant clinical observation, as equipment alone may not detect all forms of clinical deterioration
What does MARCHE stand for (used in traumatic cardiac arrest)?
Massive (external) haemorrhage control
Airway management
Respirations (bilateral decompression)
Circulation (pelvic binder, IV/IO access, administer compound sodium lactate (if indicated), chest compressions
Head injury / hypothermia
Everything else – Hyperkalaemia (C9), Burns (T12), Treat per specific protocol.
What is the treatment for traumatic cardiac arrest?
- Check if resuscitation is indicated
- Confirm Code 2 and ICP/Aeromedical backup
- Treat reversible causes:
- Massive (external) haemorrhage control
- Airway management
- Respirations (bilateral decompression)
- Circulation (pelvic binder, IV/IO access, hartmann’s if indicated, chest compressions
- Head injury/hypothermia
- Everything else - hyperkalaemia, burns, etc
- Cease resuscitation if reasons present
- Continue resuscitation and urgent transport with Code #
