Trauma Flashcards
7 steps in hospital trauma care (think before during and after)
Robust pre-hospital care
Preparation
Primary Survey
Resuscitation/adjuncts
Secondary survey - head to toe
Cont monitoring and reevaluation - Vitals, ABGs, UO
Definitive care - necessary specialists, safe transfer etc.
What are the features of the primary survey?
c Ac BCDE
Control of massive haemorrhage
Airwaywith C-spine stabilisation
Breathing
Circulation
Disability - AVPU, GCS, Pupils, care with BP, CT head
Exposure + everything else; cover because cold can inhibit clotting
How handover in trauma situation?
(MIST)
Mechanism of injury
Injuries identified
Signs/Vital signs
Treatment so far
How control massive haemorrhage?
Not really relevant to civilian life…
Direct pressure
Elevation
Tourniquet
How stabilise C-spine?
How move patient?
Collar, blocks and tape
Log roll
Fastest way to assess breathing?
Inspection ***RR***
Auscultate
Percuss
Palpate
What are 5 potential life-threatening situations when assessing B?
TOMFC
Tension pneumothorax
Open Pneumothorac
Massive haemothorax
Flail segment
Cardiac tamponade
What is Tension PT?
How present?
Immediate action?
What next?
Pneumothorax with one-way valve resulting in shifting of mediastinum
Very, very agitated, SOB, “air hunger”
If awake and not intubated –> thoracocentesis
If intubated - thoracostomy
What is Open PT?
Immediate action?
Once 2/3 size of month, preferntial air-entry leading to inefficient respiration
Haemlich valve (flutter valve) - put on out of hospital
In hospital - cover, chest drain in alternative site
What is Massive haemothorax?
Managment?
>1.5L or >200ml/h for 4h or shocked
Chest drain and blood
What is flail chest?
How manage?
Main worry?
≥2 ribs # in 2 places
IV morphine, intercostal block; chest drain if PT
Large amount of force needed to produce –> underlying contusion?
When suspect cardiac tamponade?
What is best Ix?
How can it be managed?
Resistant hypotension in absence of bleeding
Echo; diagnosis of exclusion in blunt trauma
If about to arrest - theatre or open chest in A+E
Pericardiocentesis will relieve symptoms temporarily, but won’t have stopped bleed, so will recur
Circulation
Where can blood go?!
How control the haemorrhage?
What investiagions?
On the floor and four more (CLAP)
Chest, Long bones, Abdomen, Pelvis
Pressure; pelvic binder; traction for long bones
CXR, PXR, FAST scan, CT
What is most important fluid to use if possible?
How can resuscitation be balanced?
Blood if poss - O neg
Mentation, radial pulse, ? BP
Why is early analgesia important?
Never forget to prescribe…?
Patient more comfortable, therefore easier assessment, less stress
Anti-emetic
