Trauma Flashcards
facts:
Leading cause of death in the first 4 decades
150,000 deaths annually in the US
Permanent disability 3 times the mortality rate
Trauma related dollar costs exceed $400 billion annually
Level 1 centers:
total care for the pt
Initial injury thru rehab, addresses all problems
24 hr availability of trauma surgeons, neuroSx, orthopedics
Teaching, research, regional trauma leadership
Annual volume (ex Duke – 3000/yr)
Level 2 centers:
24hr in-house surgeons
Prompt access to neuroSx, orthopedics
May refer for cardiac surgery, limb reattachment, sub-specialty reconstruction
Level 3 centers:
- 24 hr emergency med.
- surgeon on call
level 4 centers:
- ATLS certified of ED provider
- open 24 hrs
ACS CoT criteria:
Physiologic Criteria
Ex: SBP < 90
Injury Criteria
Ex: chest wall unstable
Mechanism Criteria
Fall > 2x height
Goal < 5% miss rate
concepts of ATLS:
Focuses on the “second peak” of death
Treat the greatest threat to life first
The lack of a definitive diagnosis should never impede the application of an indicated treatment
A detailed history is not essential to begin the evaluation
“ABCDE” approach
airway assessment:
Airway should be assessed for patency
Is the patient able to communicate verbally?
Inspect for any foreign bodies
Examine for stridor, hoarseness, gurgling, pooled secrecretions or blood
Assume c-spine injury in patients with multisystem trauma
C-spine clearance is both clinical and radiographic
C-collar should remain in place until patient can cooperate with clinical exam
airway interventions:
Supplemental oxygen Suction Chin lift/jaw thrust Oral/nasal airways Definitive airways RSI for agitated patients with c-spine immobilization ETI for comatose patients (GCS<8)
Breathing assessment:
Airway patency alone does not ensure adequate ventilation
Inspect, palpate, and auscultate
Deviated trachea, crepitus, flail chest, sucking chest wound, absence of breath sounds
CXR to evaluate lung fields
breathing interventions:
Ventilate with 100% oxygen
Needle decompression if tension pneumothorax suspected
Chest tubes for pneumothorax / hemothorax
Occlusive dressing to sucking chest wound
If intubated, evaluate ETT position
Circulation assessment:
Hemorrhagic shock should be assumed in any hypotensive trauma patient Rapid assessment of hemodynamic status Level of consciousness Skin color Pulses in four extremities Blood pressure and pulse pressure
circulation interventions:
Cardiac monitor Apply pressure to sites of external hemorrhage Tourniquets! Establish IV access 2 large bore IVs Central lines if indicated Cardiac tamponade decompression if indicated Volume resuscitation Have blood ready if needed Level One infusers available Foley catheter to monitor resuscitation
when to do an ED thoracotomy?
Witness loss of pulses
Generally effective for penetrating trauma only
Ideal patient is penetrating trauma to chest with low velocity weapon
Still only 10% effective
