Trauma Flashcards
A method to eval airway
1- have pt speak- patency and to evaluate for voice change and stridor
2- evidence of pooling secretions or cyanosis
GCS for intubation
GCS of 8 or less requires intubation
Important note for intubation
ALWAYS MAINTAIN C-SPINE IMMOBILIZATION
A patent airway DOES NOT mean adequate ventilation! Ventilation requires:
lung fxn
chest wall
diaphragm
Percussion with hyper-resonance
pneumothorax
Percussion with dullness
hemothorax
subcutaneous emphysema might indicate
airway injury
JVD in trauma may indicate
tension pneumothorax or cardiac tamponade
Tension Pneumothorax presents as
worsening of a simple pneumothorax
formation of a 1-way valve at the point of a rupture in the lung
Hypotension in a Tension Pneumothorax is due to
↑ intrathoracic pressure ↓ preload
Loss of left heart blood flow due to loss of pulmonary vasculature to affected lung
Compression of mediastinum
Tension pneumothorax is a CLINICAL diagnosis and _______ are not appropriate in this setting.
Xrays
If tension pneumothorax is suspected, immediate needle decompression is undertaken
Tension Pneumothorax needle decompression treatment details
- 4-16 gauge long angiocath
- midclavicular line, 2nd intercostal space
- over the rib to avoid neurovasculature
Massive Hemothorax definition
A systemic or pulmonary vessel disruption leads to:
> 1500 mL blood loss initially
400 cc per hour for 2 hours
Consider a massive hemothorax with?
pts in shock w/ no breath sounds and/or percussion dullness.
massive hemothorax treatment
placing a large (36 f) chest tube
possibly a trip to the OR for hemorrhage control.
If a radial pulse is palpable, it suggests a systolic blood pressure of at least?
80 mm Hg
if femoral or carotid are palpable, these suggest a systolic blood pressure of at least?
60 mm Hg
ATLS Classifications of hemorrhagic shock considers?
HR
BP
Blood loss
ATLS Class of hemorrhagic shock that requires blood products
Class 3 and Class 4 (blood loss 30%, >40%)
Reasons in shock–> dont mount a tachycardic response
- Neurogenic shock
- Beta blockade/ Calcium channel blockade
- Elderly
- Children/ young adults
- Conditioned athletes
Assess mental status via the AVPU scale
Alert.
Voice
Pain
Unresponsive
_________ will present as a “blown pupil.” .
Uncal herniation
Paralysis of parasympathetic fibers of CN III
Lowest GCS score
3
Adjuncts to the Primary Survey
Standard Trauma X-rays FAST Exam (Focused Assessment Sonography in Trauma)
FAST Exam four views
subxiphoid cardiac
spleno-renal
hepato-renal
bladder views
Any blood detected during the FAST exam may represent
peritoneal penetration
*negative FAST does not exclude injury
Primary Survey address
- A: Airway Maintenance with CERVICAL SPINE protection
- B: Breathing and Ventilation
- C: Circulation with hemorrhage control / shock assessment
- D: Disability: Neurological
- E: Exposure/Environmental
The 2o Survey not started until all aspects of the 1o survey addressed + vitals addressed
Secondary Survey history
Start with the AMPLE history:
Allergies Medications Past illnesses *Last meal Events / Environment / Mechanism of injury
Secondary Survey physical
head to toe directed assessment
Motor/ Strength Grading
0: Total paralysis
1: Palpable/visible contraction
2: FROM w/gravity eliminated
3: FROM against gravity
4: FROM, less than normal strength
5: Normal strength
A __________ is most important lab in trauma patient
Type and Crossmatch
Type O blood rules
- Type O Negative- women
- Males may receive O Positive blood
Type-specific blood processing time/ details
ABO and Rh only tested
10 minute processing
Standard Trauma X-rays
AP chest + AP pelvis cxr as adjuncts to the 1o survey
C-Spine X Rays: lateral view (detects 80% fractures), AP, open mouth “Odontoid” view, and obliques
EKG is especially important for?
fall, drowning, syncope or single car MVA
_________ imaging if concern for urethral injury.
Retrograde-urethrogram
Diagnositic Peritoneal Lavage
- 98% sensitive for bleeding /detect bowel injury (often missed on CT)
- replaced by US
- performed when intra-abdominal bleeding
Diagnositic Peritoneal Lavage is considered positive if it returns
Gross blood (10 ml) > 100,000 RBCs/mm3 > 500 WBCs/mm3 \+ Gram stain Food fibers Bacteria, bile, feces
To clear the cervical spine/ remove collar, they must have the following:
- Alert, not intoxicated
- Absence of neck pain
- Absence of midline neck tenderness
- Absence of distracting injury
- Absence of sensory /motor complaint
A tracheobronchial tree disruption will present on physical as….
- subcutaneous emphysema.
- may notice that after placing a chest tube, the lung refuses to inflate
A pulmonary contusion may initially present as
- mild hypoxia
- IV fluids–> pulmonary edema and hypoxia worsens
- Rx by proper O2 and ventilation + maintaining normovolemia.
blunt cardiac injury
difficult to ddx.
only sign may be an abnormal ECG
-Echocardiography may show a hypokinetic heart.
-Rx= medicating dysrhythmias that affect hemodynamics
immediately fatal, but those who survive may show a widened mediastinum on CXR.
traumatic aortic disruption caused by rapid acceleration/ deceleration causing a tear
Cullen’s sign / Grey-Turner’s sign are both associated with __________
-retroperitoneal hemorrhage
Cullen’s sign =periumbilical bruising
Grey-Turner’s sign = flank bruising
compartment syndrome presentation
5 P’s:
- Pallor
- Pain
- Paresthesia
- Poikilothermic
- Pulseless (late finding).
Injuries prone to developing compartment syndrome include
- forearm / tibial injuries
- tight dressings with swelling
- prolonged external pressure
- crush injuries
- circumferential burns.
