Trauma Flashcards
Level 2 trauma care
Same as level one except does not participate in education and research
Level 3 trauma care
Stabilize and transfer
Level 4 trauma care
Resuscitate and stabilize and arrange for transfer
First peak of death
Instantaneous death on the spot
Only help is prevention and teaching
Second peak of death
The golden hour
What happens in trauma bay to rapidly determine injuries that could cause death
First hour of emergent care
Rapid fluid resuscitation important
Third peak of death
Death due to SIRS, sepsis, ARDS, ICP, MODS
Fluid resuscitation in trauma
60-80ml/kg/hr massive 20-30ml/kg/hr normal Make sure you get weight immediately Base off if BP and map Changes in hgb, k+, and Na+ Third spacing
Intraosseous access
Infiltration risk look for signs and symptoms of infection
Infiltration fluid dependently below needle
Minor trauma
Single system injury
No threat to life or limb
Major trauma
Multiple system injuries
Blunt trauma- most common mechanism of injury
Shearing and crush injuries
MVCs, falls, sports related injuries, fragmentation and rupture
Level one trauma care
Regional resource center Providers immediately available Participate on research and education Trauma bay and at least 2 ORs Comprehensive trauma care
Penetrating trauma
Implement of foreign objects
Exit wounds can be bigger and more severe than entrance wounds
Blast trauma
Primarily associated with burn More difficult to manage More systemic response More end organ damage Compartment syndrome
Primary survey- emergency care phases
Very quick 1-2 mins ABCDE Airway Breathing Circulation Disability Expose patient
Secondary survey- emergency care phase
Full assessment
History and full head to toe assessment
Give comfort measures
Resuscitation phase
Begins prehospital to stabilization Key component fluid resuscitation Establish airway patency Maintain effective breathing Maintain circulation Diagnostic testing Assessment of neurological disabilities Exposure and environment considerations
Establish airway patency
Open airway Jaw thrust/ chin lift Suction Oro/nasopharyngeal airway Endotracheal intubation Laryngeal mask airway Cricothyrotomy
Maintain effective breathing
Effective positioning
Frequent/ongoing assesment, impaired gas exchange?
Paradoxical movement of the chest?
Tracheal shift?
Maintain circulation
Hypolvolenia most common cause of circulatory collapse Apply pressure Replace circulatory volume Early rapid surgical intervention Assesment?
Diagnostic testing
X ray FAST- focus assesment with sonography for trauma CT scan 12 lead ECG Continuous ECG
Adequacy of resuscitation
Sublingual capnometry- partial pressure of CO2
Near infrared spectroscopy- tiny needle in Palm of thumb that measures oxygen saturation state of tissue
Fluid resuscitation
2 large bore IV rapid
IO line or central venous line
Pulmonary artery catheter?
Ongoing assesment
Fluid resuscitation complications
Dilation all coagulopathy
Third spacing
Assesment of neurological disabilities
TBI
Primary head injuries/ blunt trauma to head
Spinal cord injuries
Assess LOC complete sensory and neurological exam, spinal immobilization
Passive external rewarming strategy
Remove wet clothes
Normal blankets
Active external rewarming strategy
Warming blankets
Convection blankets
Warming lights
Active internal rewarming strategies
Warmed IV fluids
Thoracic injuries/lung
Decreased or uneven breath sounds
Dullness on percussion
Possible chest tube
Rib fractures most common- give morphine to help breathe better
Flail chest- paradoxical chest movement
Open pneumothorax- apply dressing right away and tape on 3 sides
Abdominal injury
Liver most commonly injured after blunt or penetrating trauma
Greys turner sign- ecchymosis in flank area=bleeding in abdominal cavity, splenic injuries
Cullen sign- bruising in c shape around umbilicus
Disruption of pelvic structure
Pelvic stabilization
Bruising in perineum
High mortality rate
