Trauma Flashcards
what is included in the primary survey?
airway & c-spine, breathing, circulation, disability, exposure
external bleeding interventions
direct pressure, elevate, tourniquet if on extremity
tourniquet considerations
2h time limit or necrotic limb, will be painful
what is involved in the D in primary survey
disability - quick focused neuro check - pupils, LOC, GCS, s/s of high ICP
what is included in the secondary survey
full set of vitals, pain meds, inspect posterior surface, history & head to toe
tertiary survey
ICU level head to toe
fluid resuscitation
1-2L NS or LR as rapidly as possible, then blood if still unstable
MTP
1:1:1 ratio of pRBCs, FFP, & plt
risks of MTP
DIC, ARDS, hypoCa, hyperK
s/s that MTP was successful
increased MAP, CVP, UO, LOC, decreased HR & cap refill
what to monitor w MTP
CBC, TEG, PT/INR, PTT, plt
trauma triad of death
hypothermia, coagulopathy, acidosis
laryngeal trauma s/s
hoarseness, loss of adams apple, painful swallow/cough
laryngeal trauma treatment
emergent cric or trach
mgmt of rib fracture
pain control, pulmonary hygiene
pulmonary hygiene
incentive, flutter valve, chest PT, coughing & deep breathing
flail chest mgmt
secure airway, pain control, give O2, early ambulation, pulm. hygiene, splint chest when coughing
s/s of pneumothorax
respiratory distress
common causes of pneumothorax
fall, MVC, contact sports, assault
pneumothorax treatment
secure airway, chest tube
chest tube mgmt
check output hourly, notify MD of any big changes
massive hemothorax
often arrive alr dead or in hem. shock; may get MTP, thoracotomy, REBOA
s/s of pulmonary contusion
rales, dyspnea, may mimic ARDS if severe
pulmonary contusion tx
ABGs, pulm. hygiene, vent w PEEP if severe, strict I&Os
FAST exam
checks abd for free fluid
if positive FAST & unstable - patient goes
straight to OR for ex-lap
DPL
quick test for intra-abdominal bleeding
s/s of liver trauma
RUQ pain, cullen’s sign
cullen’s sign
bruising around belly button
mgmt of liver trauma
monitor coags, LFTs, & CBC
spleen trauma s/s
hemorrhagic shock, kehr sign, high WBC, gray turners sign
spleen trauma tx
may need splenectomy
splenectomy pt education
immunocompromised
kehr sign
LUQ pain radiating to left shoulder
gray turners sign
bruising on left flank
s/s of bladder/urethral trauma
supraorbital hematoma, bruised peritoneum, blood @ meatus, gross hematuria, inability to urinate
musculoskeletal trauma assessment
neurovascular checks, spasming, crepitus
limbs should be immobilized if they are
swollen, ecchymotic, or deformed
complications of musculoskeletal trauma
fat embolism, DVT, PE, compartment syndrome
fat embolism triad
petechiae, poor neuro status, hypoxemia
mgmt of minor fractures
RICE, splint care, pain meds, neurovasc checks at home
s/s of pelvic fracture
abrasion lac or contusion, asymmetry in lower extremities, crepitus when rocking pelvis
pelvic fracture tx
control bleed, stabilize w ex-fix or binder, infection prevention, surgery when stabilized
mgmt of crush injury
put on monitor! increase fluids, check myoglobin & CK levels
depressed skull fracture considerations
high risk of meningitis - monitor for infection
basilar skull fracture
fracture at base of skull
basilar skull fracture s/s
Raccoon’s & Battle’s (bruised mastoid process); may have altered EOMs
s/s of concussion
may/may not LOC, photophobia, headache, n/v
secondary brain injuries
cerebral edema, herniation from high ICP, hypoxemia, seizure
when is a SCI suspected
decreased/absent movement or sensation, head injury, or LOC
complications of SCI
pulmonary dysfx, atelectasis, pneumonia, DVT, PE, ileus, stress ulcer
