Trauma Flashcards
What should be the initial actions you take for a trauma patient (in order)?
assess ABCDEs address problems with the above log roll the patient xray and FAST secondary survey Resuscitation and stabilization
How can you judge if someone’s airway is patent?
have them speak to you if they can and check for voice change and stridor
If they can’t speak, is there any evidence of pooling secretions or cyanosis?
Even if a patient’s airway is currently patent, what are some problems that would make you worried about losing it eventually?
facial injury causing obstruction or bleeding
laryngeal fractures
expanding hematomas
GCS of 9 or less
What are the general strategies if the patient’s airway is NOT patent?
- try jaw thrust
- consider naso or oro-pharyngeal airway with bag-valve mask ventilation
- Rapid sequence intubation
- cricothyroidotomy if that doesn’t work
How do you assess whether a patient is breathing?
inspect: look for cyanosis, JVD, asymmetric movements of the chest, accessory muscle use or open chest wounds
Auscultate
Percuss to feel for hyper-resonance or dullness
Do you get hypertensive or hypotensive with a tension pneumo?
hypotensive because the increased intrathoracic pressure decreases preload
What is the treatment for a tension pneumo?
needle decompression using a 14-16 gauge long angiocath inserted at the midclavicular lin in the second intercostal space, OVER the rib
How can you assess circulation?
Look for any obvious bleeding
feel pulses
(if you can feel the radial - sys BP is at least 80; 60 if you can feel the femoral or carotid
ATLS Class 1 hemorrhagic shock is when you lose what percentage of your blood? What will your vitals be doing?
<15%
may be normal or tachycardic
BP normal
How much blood do you lose for ATLS Class II hemorrhagic shock? Vitals?
15-30%
normal to fast HR
normal to low BP
narrowed pulse pressure
How much blood do you use for ATLS Class III? Vitals?
30-40%
Fast HR
Low BP
Altered mentation
How can you quickly assess the mental status of a patient when checking for disability?
The AVPU scale
alert
responds to voice
responds to pain
unresponsive
What other scale is used to assess neuro status? what are the components?
Glasgow coma scale
Eyes (1-4 points)
Verbal (1-5 points)
Motor (1-6 points)
What are the imaging adjucts to the primary surgery?
standard trauma x-rays like an AP chest and AP pelvis
What are the components of the FAST exam?
sub-xiphoid view, spleno-renal, hepato-renal, and bladder
What does a FAST do for you?
tells you if there is free fluid in the abdomen (rules in an injury, but does not rule it out)
if you see fluid and they are vitally stable - go to CT scanner; if they are not stable - go to OR
What is the secondary survey?
Basically everything else after the primary survey and the patient has stabilized: history and physical
What history should you obtain in the secondary survey from a trauma perspective?
AMPLE:
Allergies Medications Past Illness Last meal Events/Environment (what was the mechanism of injury?)
In order to clear a patient’s c-spine and remove a collar, what criteria must be met?
patient must be alert and not intoxicated absence of neck pain absence of midline neck tenderness abscess of distracting injury absence of sensory or motor complaint
How will a tracheobronchial tree disruption present?
subcutaneous emphysema
you may place a chest tube and the lung refuses to inflate
How will a pulmonary contusion present?
mild hypoxia that worsens after fluid resuscitation due to the resultant pulmonary edema
How will a blunt cardiac injury present?
difficult to diagnose
often the only sign is an abnormal EKG or tracing
echocardiogram will show a hypokinetic heart
How will a traumatic aortic disruption present?
usually they just die right away, but those who survive will have a widened mediastinum on CXR
How will a flail chest present?
It’s 2+ ribs fractures in 2+ contiguous ribs, creating a free-floating segment of chest wall that moves in the opposite direction of the rest of the chest wall during inspiration and expiration
What two signs on abdominal inspection would suggest a retroperitoneal hemorrhage?
Cullen’s sign or Grey-Turner’s sign
What are the 7 life-threatening diagnoses should you have on your differential in a trauma?
airway obstruction tension pneumo open pneumo flail chest cardiac tamponade massive hemothorax traumatic aortic disruption
What is the most important lab in trauma patients?
type and cross
What are the standard trauma x-rays?
AP chest
AP pelvis
Cspine XR
