Trauma Flashcards
Newtons First Law
An object in motion stays in motion
Newtons Second Law
F=ma
Newtons Third Law
For every action, there is an equal and opposite reaction
Circulation in Trauma
MAP >60mmHg
>120 HR is decompensated shock.
Look at peripheral extremities, especially feet for pallor, temperature.
BP is LATE sign. 30-40% loss in volume for hypotension to occur.
Shock index - HR/SBP Concern at >0.9
Class 3 Blood Loss
1500-2000 ml of volume loss
30-40% of blood loss
>120 HR decomensation
BP low
5-15ml/hr of urine output.
Penetrating Trauma
What object?
Serrated?
Length?
Permissive Hypotension >60 MAP
GSW
What caliber?
Entry/Exit wound?
Permissive Hypotension >60 MAP
Beck’s Triad
Cardiac Tamponade
Widened Pulse Pressures
JVD
Muffled Heart Sounds
Widened Mediastinum on Chest X-Ray
Tension Pneumothorax
Respiratory Distress
Decreased Breath Sounds
Subcutaneous Air
Increase Pplat on ventilator
JVD, Tracheal deviation are LATE SIGNS
When to clamp chest tube?
Clamp chest tube after initial 1500cc output to avoid pulmonary edema.
CT Size. ETT x4
Pelvic Trauma
Anterior/Posterior Compression (Crushing Injury)
Lateral Compression - (crushing, side injury)
Vertical Shear - Most ominous, often fatal
Parkland Formula
kgxTBSAx4ml = volume/24hrs
1/2 over 8 hours
1/4 over 8 hours
1/4 over 8 hours
consensus formula
Kg/TBSAx2-4ml = volume/24hrs
adults - 2ml/kg
pediatrics-3ml/kg
electrical -4ml/kg
Fluid Resuscitation
Tracked by urine output
Adults 0.5ml/kg/hr
Pediatrics 1ml/kg/hr
LR is the best initial fluid
Electrolyte Imbalances
Phase 1 - 0-36 hours
Hyponatremia, Hyperkalemia
Phase 2 - 3-7 days
Hypernatremia, hypokalemia, hypophosphotemia, hypomag, hypocalc.
