Trauma Flashcards
What is the first step in the evaluation of trauma?
Airway assessment and protection.
When is an airway considered protected?
If the patient is conscious and speaking in a normal tone of voice.
If unconscious then look and feel (منطلع على الصدر ومتسمع الصوت ومنحس النفس)
When is an airway considered unprotected?
If there is an expanding hematoma, subcutaneous emphysema in the neck, noisy gurgly breathing, or GCS <8.
How can an airway be secured in the field?
Suctioning of secretions and fluid
Simple airway maneuvers ( jaw thrust , OPA ,NPA , chin lift )
Advanced airway maneuvers( cuffed endotracheal tube )
Cricothyroidotomy
What is the preferred method of securing an airway in the emergency department?
Rapid sequence induction and orotracheal intubation with pulse oximetry monitoring.
Can orotracheal intubation be done in the presence of a cervical spine injury?
Yes, as long as the head is secured and in-line stabilization is maintained.
What is another option for airway management in cervical spine injury?
Nasotracheal intubation over a fiberoptic bronchoscope.
What should be done if severe maxillofacial injuries preclude intubation?
Cricothyroidotomy may become necessary.
Why is tracheostomy preferred over cricothyroidotomy in pediatric patients?
Due to the high risk of subglottic stenosis as the cricoid is much smaller than in adults.
What is a common complication of endotracheal intubation?
Right mainstem bronchus intubation.
What are the signs of right mainstem bronchus intubation?
Asymmetric chest expansion and decreased or absent breath sounds on the left side.
What is the ideal location for the distal tip of the endotracheal tube?
2-6 cm above the carina.
Why does an ETT advanced too far preferentially enter the right main bronchus?
Because the right mainstem bronchus diverges from the trachea at a non-acute angle.
How is right mainstem bronchus intubation corrected?
By pulling back the endotracheal tube slightly.
What is the first step in managing cervical spine trauma in the field?
Stabilize the cervical spine with a backboard, rigid cervical collar, and lateral head supports.
Why is early airway assessment important in cervical spine trauma?
Unstable lesions above C3 can cause immediate paralysis, and lower cervical lesions can damage the phrenic nerve.
What is the preferred method of airway management in cervical spine trauma?
Orotracheal intubation with rapid-sequence intubation unless there is significant facial trauma.
What are the key steps in prehospital management of cervical spine trauma?
Spinal immobilization, careful helmet removal, and airway oxygenation.
What are examples of spinal immobilization techniques in prehospital care?
Backboard, rigid cervical collar, and lateral head supports.
How should helmets be handled in cervical spine trauma?
They should be carefully removed (e.g., motorcycle helmet).
What is the preferred method of intubation in cervical spine trauma unless there is significant facial trauma?
Orotracheal intubation.
When is rapid-sequence intubation indicated in cervical spine trauma?
For unconscious patients who are breathing but need ventilatory support.
What precaution should be taken during intubation in cervical spine trauma?
In-line cervical stabilization should be maintained unless it interferes with intubation.
What imaging is recommended for evaluating cervical spine trauma in the emergency department?
CT of the entire cervical spine.
What type of shock should be monitored for in cervical spine trauma?
Neurogenic shock from spinal cord injury.
What is the definition of trauma?
An injury due to energy transfer from an inflicting source.
What are the two main types of trauma?
Blunt trauma and penetrating trauma.
What is the primary goal in trauma assessment?
To assess and respond before irreversible damage or death occurs.
What are the key components of the primary survey in trauma?
cABCDE: Control exsanguinating hemorrhage, Airway, Breathing, Circulation, Disability, Exposure.
Why is the mechanism of injury important in trauma?
It helps predict hidden injuries and guides further assessment.
What is the Advanced Trauma Life Support (ATLS) approach?
A systematic approach to managing trauma patients.
What are the three factors considered in trauma assessment?
Mechanism of injury, pre-existing patient factors, and injuries found.
What is the first priority in trauma resuscitation?
Airway management and cervical spine control.
What is the significance of tension pneumothorax in trauma?
It is a life-threatening condition that requires immediate decompression.
What is the role of a trauma team leader?
To coordinate activities, manage time, interpret findings, and plan treatment.
What is permissive hypotension?
A resuscitation strategy to maintain low but adequate blood pressure to prevent excessive bleeding.
What is the ratio of blood products in massive transfusion?
1:1:1 ratio of packed RBCs, fresh frozen plasma, and platelets.
What is the purpose of tranexamic acid in trauma?
It reduces mortality by preventing excessive fibrinolysis in bleeding patients.
What imaging modality is the gold standard for multiple trauma patients?
Whole-body CT (WBCT) with IV contrast.
What is damage control surgery (DCS)?
A staged surgical approach focusing on rapid hemorrhage control and stabilization before definitive repair.
What are the stages of damage control surgery?
Resuscitation, Hemorrhage control, Decompression, Decontamination, Fracture splintage.
What is the purpose of a pelvic binder in trauma?
To stabilize pelvic fractures and control hemorrhage.
What are the four triage categories in mass casualty incidents?
Immediate (Red), Urgent (Yellow), Delayed (Green), Dead (Black).
What are the key indicators of adequate resuscitation?
Pulse <100 bpm, normal BP, RR, urine output >30 mL/hr, normal lactate and ABG.
What is the ‘triad of death’ in trauma?
Acidosis, coagulopathy, and hypothermia.
What are the clinical signs of shock?
Low BP (<90 mm Hg systolic), tachycardia (>100 bpm), low urine output (<0.5 ml/kg/h), pale, cold, shivering, sweating, thirsty, and apprehensive.
What are the main types of shock in trauma?
Hypovolemic (due to hemorrhage, most common) and cardiogenic (due to pericardial tamponade or tension pneumothorax).
How does hemorrhagic shock differ from cardiogenic shock in terms of CVP?
Hemorrhagic shock causes collapsed neck veins (low CVP), while cardiogenic shock causes jugular venous distension (high CVP).
How to differentiate pericardial tamponade from tension pneumothorax?
Tamponade: no respiratory distress; Tension pneumothorax: severe dyspnea, unilateral breath sounds absent, tracheal deviation.
What is the initial treatment of hemorrhagic shock?
Volume resuscitation with blood products in a 1:1:1 ratio (RBCs, plasma, platelets) and control of bleeding.
What is the preferred route of fluid resuscitation in trauma?
Two large-bore peripheral IV lines; if unavailable, subclavian or femoral vein catheters are used.
What is pericardial tamponade?
Bleeding into a stiff pericardium leading to compression of the heart, elevated JVP, and obstructive shock.
What is Beck’s triad for cardiac tamponade?
Hypotension, muffled heart sounds, and jugular venous distension.
What is the immediate treatment for acute cardiac tamponade?
Pericardiocentesis or surgical pericardiotomy to remove pericardial fluid and lower pressure.
How does chronic pericardial tamponade differ from acute?
Chronic tamponade accumulates fluid slowly (1-2L), allowing pericardium to stretch; acute needs only 100-200mL to cause shock.
What is the immediate management of tension pneumothorax?
Large-bore needle decompression followed by chest tube placement.
What are the common indications for central venous catheter (CVC) placement?
Critical care medications, difficult vascular access, long-term medication administration (e.g., chemotherapy).
What are the preferred sites for CVC placement?
Internal jugular vein (ultrasound-guided) or subclavian vein (anatomic landmark-guided).
What are the complications of CVC placement?
Venous perforation, lung puncture (pneumothorax), myocardial perforation (tamponade), arterial puncture.
Where should a CVC tip be placed for ideal positioning?
Lower superior vena cava, just proximal to the angle between the trachea and right mainstem bronchus.
How does we administer Tranexamic acid in trauma patients ?
1g in first 10 min and 1g in subsequent 8hrs
Should be administered in the first 3 hrs of trauma
To whom do we give Tranexamic acid ?
To all trauma patients suspected to have massive hemorrhage
BP <110 mmHg
HR>110bpm
In massive transfusion blood products must be ———— before transfused
Must be warmed
Hot report and detailed report ??
Hot report with tin minutes from whole body CT to identify immediately life threatening conditions
Detailed report within 30-60 min
In the patient requiring immediate laparotomy do we remove pelvic binder ?
No the correctly positioned pelvic binder at the level of greater trochanter should not obstruct the laparotomy
Disability include?
GCS
Pupils assessment
Core temperature
C spine protection +log roll
WBCT
Why must trauma patients be adequately exposed during the secondary survey?
To allow a thorough and systematic clinical examination for other injuries.
What precaution must be taken when exposing trauma patients?
They must be kept warm to prevent hypothermia.
Why are trauma patients at high risk of hypothermia?
Because of exposure during assessment and shock-related heat loss.
What is the consequence of hypothermia in trauma patients?
It increases the risk of coagulopathy, impairing blood clotting.
How can normal body temperature be maintained in trauma patients?
By minimizing unnecessary exposure and using warmed blankets, trolleys, and warmed fluids during resuscitation.
Breathing include ?? 2 points
Breathing sounds (absent or decreased)
Pulse oximetry for saturation
What effect does positive pressure mechanical ventilation have on intrathoracic pressure?
It causes an acute increase in intrathoracic pressure.
How can increased intrathoracic pressure affect venous return in hypovolemic patients?
It can collapse venous capacitance vessels, such as the inferior vena cava, reducing venous return to the heart.
What is the impact of sedatives used prior to intubation on venous capacitance vessels?
Sedatives cause relaxation of venous capacitance vessels, which can further decrease venous return.
Why is decreased venous return a concern in severely hypovolemic patients?
It can lead to decreased cardiac output and worsen hemodynamic stability.
