Trauma Flashcards
what are the ABCDEs of the primary survey?
Airway
Breathing
Circulation
Disability
Exposure and environment
GCS less than […] is indication for intubation
9
if endotracheal intubation fails, what is the next step?
cricothyroidotomy
if the patient is unable to breathe, establish airway with […] control
c-spine
if patient is […], their airway is controlled
talking
when assessing Airway, you should have a low threshold for […]
intubation
(basically if the patient is not talking –> intubate)
where is a chest tube place?
4th or 5th intercostal space mid-axillary
go above the rib, VAN is below
When assessing Circulation, what labs should you get?
CBC, CMP, type and cross
GCS 3 means the patient is…
probably dead
correcting Circulation with fluids should be achieved by establishing […]
2 large bore peripheral IVs
immediate treatment of cardiac tamponade
IVF bolus and pericardiocentesis
(later– surgical exploration)
what are the three categories of GCS?
eye, motor, verbal
Spontaneous eye opening with blinking at baseline is GCS […]
4
eye opening to verbal command, speech, or shout is GCS […]
3
eye opening to pain is GCS […]
2
no eye opening is GCS […]
1
oriented verbal response is GCS […]
5
confused conversation, but able to answer questions is GCS […]
4
inappropriate responses but discernible words is GCS […]
3
incomprehensible speech is GCS […]
2
no speech/verbal response is GCS […]
1
obeys commands for movements is GCS […]
6
purposeful movement to painful stimulus is GCS […]
5
withdraws from pain is GCS […]
4
abnormal flexion, decorticate posturing is GCS […]
3
extensor response, decerebrate posturing is GCS […]
2
no motor response is GCS […]
1
a blown pupil reflects ipsilateral compression of CN […]
III
what is Beck’s triad and what does it indicate?
hypotension, distant heart sounds, JVD
cardiac tamponade
what areas are assessed via FAST?
pericardium
splenorenal
pouch of Douglas
Morrison’s pouch
lungs
can fast assess the retroperitoneum?
no
next step for a patient with positive FAST that stabilizes with fluid?
CT: chest, abdomen, pelvis
with contrast
next step for a patient with positive FAST that does NOT stabilize with fluid?
ex-lap
have cell saver on hand
what is the goal SBP for fluid resuscitation?
90-100
(overloading can cause tamponade)
if the patient continues to decline after ABCDEs…what should you do?
repeat ABCDEs
(i.e. if BP keeps falling, it is likely to be ABCDE issue)
if the chest tube drains more than […] at time of insertion –> OR
400 ml
if the chest tube drains more than […] ml/hour over 4 hours –> OR
200
mnemonic for secondary survey:
Allergies
Meds
Past illness
Last meal
Events/environment
you’ve taken a hemodynamically unstable patient back for ex-lap:
1. what incision do you make?
2. how do you begin the case?
- midline xiphoid to pubic symphysis
- pack all four quadrants, take down packing 1 at a time to assess for source of bleed
what is the seatbelt sign?
bruising around waist/chest/clavicle for seatbelt
if you need to do a needle decompression for tension pneumo, where would you insert the needle?
2nd intercostal space, midclavicular line
if SBP > […] and HR is normalized, you can get a CT
90
what is Massive Transfusion Protocol?
1:1:1
RBCs
Platelets
FFP
if a patient has midfacial fractures and you want to decompress the stomach, what should you use?
OG tube
[…] fracture can cause NG to coil in intracranial space
cribriform plate
what triad of PE findings indicates urethral injury?
high riding prostate
Ecchymotic scrotum
Blood at meatus
Splenectomy and embolectomy patients require […] prophylaxis
vaccine
S pneumo., N. meningitidis, H. flu
What labs/imaging can be considered during secondary survey?
cervical and lateral spine imaging
AP CXR
AP pelvis
Type and Cross
CBC
CMP
UA, drug screen
ABGs
EKG
lactate
troponin
place pressure on the […] and […] to evaluate for pelvic fracture
iliac crests and greater trochanters
you have a patient with pelvic fracture. you do a DRE and feel bony prominence. What will this patient require?
diverting ileostomy
Patient is hemodynamically stable. On CT you note fluid in the around the spleen…what is the best next step?
consult IR for embolization
when evaluating for Disability, you note your patient has an open femur fracture with pulsatile bleeding and is hemodynamically unstable. What is your next best step?
reduce fracture
when is the tertiary survey completed?
24-48 hrs later once the patient is stabilized and able to interact for H&P
