trauma Flashcards
how to assess airway and common indications for compromised airway? and how to stabilize?
assess by talking to the patient. Evaluate for respiratory distress, burns
common indications:
-respiratory failure
-airway obstruction (stridor, SOB)
-GCS<8
-inhalational injury
-severe trauma (disrupted anatomy)
-shock/cardiac arrest
management:
-intubate
-suction any fluids, remove foreign body
-stabilize C-spine (immobilize)
-jaw thrust
-in less severe cases (not above), consider nasal cannula -> bag mask -> definitive airway -> cricothyrotomy
how to assess breathing? management? adjunct?
-vitals (RR, SpO2)
-inspect for
*penetrating chest wounds
*paradoxic chest movement
*tracheal deviation
*auscultate (absent/reduced breath sounds)
pathologies: tension/spontaneous pneumothorax, hemothorax, flail chest (2 fractured ribs -> opposite chest movements at fracture site like indrawing during inspiration)
management:
needle decompression/chest tube insertion, oxygen supplement, mechanical ventilation for resp failure
chest xray: confirm pathology, chest tube placement
how to assess circulation? management for early intervention then definitive?
vitals: BP, pulse, capillary refill, lactate, base excess
early intervention:
-two large bore IV cannulas, intraosseous if peripheral is difficult then central (internal jugular, subclavian, femoral)
-start with crystalloid and 1L as bolus
-consider tranexamic acid
-if fluid unsuccessful, switch to blood transfusion with O- then cross matched, 1:1:1 ratio of plasma, pRBC, platelets
definitive: find and stop the bleed
common places: chest, pelvis, femur, abdomen, external (scalp)
use FAST to localize in unstable patients, CT/ chest or pelvic xray for stable patients
use torniquet, pelvic binder, chest tubes, exploratory laparotomy, splint, angioembolization
monitoring and diagnostic adjuncts?
vitals
ABG, VBG (lactate, base excess)
capnography (ETT placement)
ECG (new arrythmia indicates blunt cardiac trauma)
foley catheter for urine output (relative contraindication: blood at urethra, pubic fx, high riding prostate, perineal ecchymosis)
NGT for gastric decompression (orally if base skull fx)
diagnostic: FAST (checks for fluid in the abdomen and pelvis, hepatorenal, splenorenal, pericardial, cardiac tamponade), chest, pelvic xray
disability?
pupil reactivity, calculate GCS, assess motor and sensory function
secondary survey?
begins once patient is stable after primary survey is complete
review primary survey
take AMPLE hx
head to toe exam for lacerations, bruises, foreign body, deformity, edema, bleeding
-consider tetanus and antibiotics
do chest and pelvic xray are needed for confirmation before managing?
causes of obstructive shock?
symptoms and management of tension pneumothorax, hemothorax?
chest and pelvic xrays shouldn’t delay management
-cardiac tamponade, tension pneumothorax, hemothorax
TP-tracheal deviation. absent breath sounds, hyperresonant percussion, needle decompression in 2nd intercostal space midclavicular line, then chest tube in 5th intercostal space mid axillary line connect to underwater seal
H: penetrating chest injury, absent breath sounds, chest tube placement, do thoracotomy if the output is >1.5L
cardiac tamponade clinical features, dx, tx?
uncontrolled bleeding sites and tx?
hypotension, tachycardia, muffled heart sounds, distended JVP
use FAST to dx
tx by pericardiocentesis
-chest,abdomen,pelvis,femur, external like scalp
use FAST to localize (or xray/CT)
tx by pelvic binder, immobilize limb and realign and splint, torniquet and suture, laparotomy, angioembolization
