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Emergency Medicine > Trauma > Flashcards

Trauma Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Trimodal distribution of death

A

Three major times death occurs after an accident/trauma
Instant - 1hr –> laceration or trauma to the brain/brainstem, aorta, spinal cord, heart
3 - 5hrs –> Epidural, subdural, haemopneumothorax, open-book pelvic #, long bone #, abdominal trauma, blood loss and shock
2 - 4wks –> Sepsis or MOF

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2
Q

Golden Hour

A

The first hour following a trauma - need to recognise threats to life and treat them - massive influence on later mortality and morbidity

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3
Q

Principles of early trauma care

A

Do no harm - Cervical spine control
Adequate oxygen delivery to organs - Patent airway
- Functioning lung
- Additional high flow oxygen
- Organ perfusion - preserve and replace blood volume

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4
Q

Primary Survey

A 
A - Airway + C spine control
B - Breathing & ventilation + oxygen
C - Circulation + Haemorrhage control (consider analgesia)
D - Disability + CNS
E - Exposure + Environment
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5
Q

Timeline of trauma care

A

Primary survey –> Resuscitation (re-evaluate) –> secondary survey (Re-evaluate primary survey) –> Definitive Care

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6
Q

Principles of Pre-hospital care

A

Safety first –> yourself, others and patient
Make the best use of the ‘Golden Hour’
Swoop and scoop Vs Stay and play
Treat immediate threats to life and transport to nearest appropriate facility

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7
Q

Way to protect the patient during transport

A

Spinal board
Cervical collar/blocks and straps
Limb splints and pelvic binder
Pressure on external haemorrhages

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8
Q

Preparations while awaiting the patient

A

Anticipate injuries and assemble team members
Define the roles and prepare the kit
Universal safety precautions

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9
Q

Roles of the trauma team

A

Simultaneous ABCDE management
Rapid critical and definitive interventions
Rapid test results allow for directed management
Senior multidisciplinary input immediately avaliable

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10
Q

C-spine control

A

Collar and blocks & straps for in-line immobilisation
Can be done manually
Use Jaw thrust to open the airway but not head tilt

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11
Q

Airway protection

A

Clear airway with suction (vomit, teeth, blood, FB etc)
Airway adjunct - Nasopharyngeal / Oropharyngeal airway
Definitive airways - an endotracheal tube - required if GCS is below 8

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12
Q

Guedel

A

An Oropharyngeal airway adjunct - not a definitive airway
Measure by incisors to the angle of the jaw
Insert upside down and once in the mouth rotate and fully insert - use a tongue depressor and no turn with children

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13
Q

Definitive airway

A

Cuffed Oro-endotracheal tube (COETT) - Oro/nasal tracheal airways or combitube
Surgical airways - Cricothyroidotomy & Tracheostomy
Others - LMA or jet insufflation (Not definitive)

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14
Q

Emergency respiratory assessment

A

Rapid exam - RR & inspect, palpate, percuss, auscultate
Investigate with X-ray if concern of trauma
Pulse oximetry, ABG

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15
Q

Thoracic Trauma

A

Major cause of mortality
Blunt: less than 10% require operation
Penetrating: 15-30% require surgical treatment
Can be life threatening and should be identified in primary survey – most require only simple procedures

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16
Q

Traumatic injuries which may impair breathing

A

Airway obstruction or Tracheobronchial tree injury
Tension, open or haem- pneumothorax
Flail chest

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17
Q

Laryngeal injuries causing airway obstruction

A

Rare but serious and will cause hoarseness
May be signs of subcutaneous emphysema
Treat with cautious intubation and possible tracheostomy

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18
Q

Tension pneumothorax

A

Respiratory distress with distended neck veins and unilaterally absent breath sounds –> BP drops. Tracheal deviation is a later sign
Needle aspiration through the 2nd intercostal space, mid-clavicular line

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19
Q

Flail chest

A

Where multiple rib fractures have produced a flail segment which will move paradoxically with breathing
Tx - re-expand lung and give oxygen. cautious use of intubation, analgesia and fluids

20
Q

Cardiac Tamponade

A

Often found after penetrating chest injury - Drop in arterial pressure, distended neck veins and muffled heart sounds - May develop PEA

21
Q

Potentially lethal cardiac injuries

A

Cardiac tamponade
Blunt cardiac injury
Traumatic aortic disruption
Mediastinal traversing wound

22
Q

Circulation and haemorrhagic control

A

Identify site of bleeding - open wounds or internal (thorax, abdomen, pelvis, retroperitoneal, long bones)
Control haemorrhage –> Direct pressure, splint/realign long bones, emergency surgery, reduce pelvic/3rd space volume
Replace volume and RBCs (warmed crystalloid or blood)

23
Q

Assessing Disability in the primary survey

A

Checking CNS function (5 P’s) - monitor for deterioration
Pernicketiness - GCS
Pupils - responsive? size and papilloedema
Planatars - normal reflexes
Power - Any focal weakness
Protruded tongue

24
Q

Preventing secondary Brain injury

A

ABC is most important because it keeps blood going to the brain - MABP should be >60mmHg to maintain CPP
If a concern about ICP raise head 30 degrees - if there is a bleed refer for surgery if cerebral oedema - head up, diuretics, ventilate

25
Q

Exposure and environment

A

Expose for primary and secondary survey but keep warm (warmed environment, fluids, blankets etc)
May be hypothermic on arrival and so will need warming

26
Q

Additional monitoring after primary survey

A

Obs - RR, Stats, BP, ECG
ABG + bloods
Catheters and NG tube
Imaging - CT, CXR, Pelvic X-ray, C-spine X-ray, abdo USS

27
Q

Secondary Survey

A

AMPLE history
Check for injuries - head to toe body check
Systems reveiw - neurological, musculoskeletal

28
Q

AMPPLEE history

A 
Allergies
Medications
Past medical History and Pregnancy
Last Meal 
Events leading up and including the injury
29
Q

Use of emergency C-spine X rays

A

An X-ray will not totally exclude a C-spine injury so it is not considered useful to have early in management - thus it is not an emergency measure

30
Q

Easy and quick first assessment?

A

Ask the patient their name/get them to talk to you
Indicates they have a patent airway, enough air to speak and enough cerebral perfusion to think and enough senses to hear

31
Q

Dangers when securing the airway

A

Occult airway injury
Progressive loss of airway patency - keep re-evaluating
Equipment failure
Inability to intubate

32
Q

Dangers when securing breathing

A

Lower airway problems verses ventilation problems
Risks of iatrogenic pneumothorax
Ventilation/perfusion mismatching

33
Q

Dangers when securing the circulation

A

Assess organ perfusion - level of consciousness - skin colour and temp and pulse rate and character
Beware of children, the elderly and athletes as they have weird CV systems anyway

34
Q

When performing a secondary survey on the head

A

External exam - scalp palpation for skull fractures or lacerations - Check eyes and ears
Red Flags - continued unconsciousness, periorbital oedema (panda eyes) and occluded auditory canal

35
Q

When performing a secondary survey on the face

A

Feel for bony crepitus, deformity or malocclusion (fucked up teeth)
Red Flags – Potential airway obstruction, Cribiform plate fractures, skull base fractures

36
Q

When performing a secondary survey on the neck

A

Consider was the injury blunt or penetrating
Check for hoarseness or airway obstruction
Signs - crepitus, haematoma, stidor,
Red Flags –> delayed onset symptoms, occult injuries, airway obstructions

37
Q

When performing a secondary survey on the pelvis

A

Possible injury if there is: pain on palpation, leg length inequalities, bony instability, leg/foot rotation – x-ray if needed
Be cautious about excessive pelvic manipulation or underestimating pelvic blood loss (its alot)

38
Q

When performing a secondary survey on the limbs

A

Check for contusions and deformity - always check peripheral perfusion and neurological status
Red flags – missed fractures, ligamentous injury, compartment syndrome

39
Q

When performing a secondary survey on the spine

A

Check the whole spine for tenderness and swelling
Complete motor and sensory exams with reflexes
Consider imaging if there is altered sensorium or inability to perform exam properly - refer or perform further investigations

40
Q

Accidents in children

A

15-20% of children attending AnE are due to accidents. cause 1/3 of all childhood deaths and are the single commonest cause of death in children 1-15yrs old. Boys and lower social class children are at a higher risk and RTAs are the most common cause of fatal accidents

41
Q

Primary Prevention

A

Preventing an accident from happening - stair guards, speed limits, teaching road safety, window safety catches

42
Q

Secondary Prevention

A

Preventing or reducing injury from the accident - wearing seat belts, cycling helmets, smoke alarms, laminated safety glass

43
Q

Tertiary Prevention

A

Limiting the impact of the injury - eg teaching parents first aid.

44
Q

Disaster Triage

A

Can they walk? - if yes priority 3
Are they breathing? - if no dead
Is there RR abnormal or cap refill prolonged - yes priority 1
- if not priority 2

45
Q

Process of Decontamination

A

Remove clothes - rinse - wash - rinse - dry.

Emergency Medicine (9 decks)

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