Trauma Flashcards
What are the signs a patient with a spinal injury may have?
Diaphragmatic breathing Evidence of neurogenic shock Priapism Responds to pain only above clavicle Flexed posture of upper limbs/flaccid areflexia Complains of loss of sensation/function Spinal tenderness/bruising
How is a spinal injury managed immediately?
Optimise O2 & adequate ventilation Maintain spinal cord perfusion Immobilise Spinal examination Urinary catheter & NG tube Definite imaging Early specialist advice
What are the signs of MSK trauma?
Limb deformity/amputation Localised pain Soft tissue wound Splinting applied pre-hospital Pelvic instability neurovascular compromise
What are complications of MSK trauma?
Nerve compression
Skin necrosis
Compartment syndrome
What makes up the trauma triad of death?
Coagulopathy
Metabolic acidosis
Hypothermia
When is the canadian C-Spine rule applied?
Alert, stable (GCS 15) trauma patients with suspected cervical spine injury
According to the Canadian C-Spine rule what mandates radiography input?
- > 65
- Dangerous mechanism
- Paraesthesias in extremities
- Unable to actively rotate neck 45 degrees L or R
- No low RFs allowing safe assessment of RoM
If low risk rules met no need to scan
What type of injuries are triaged to a MTC?
-Chest injuries
-Traumatic amputation
-Penetrating trauma
-Open/closed head injury
-Time critical burns
-Fall from height >3feet
-Axial lead to head
MVC high speed/ejection
-Bicycle collision/bullseye
What does eFAST look for?
Pneumothorax
Haemothorax
Pericardial effusion
Intraperitoneal haemorrhage
Define shock
Circulatory failure leading to inadequate organ perfusion & tissue oxygenation leading to abnormal metabolic function
What are the types of shock?
Cardiogenic
Hypovolaemic
Obstructive
Distributive: Anaphylactic, Septic, Neurogenic
What are the causes of the different types of shock?
-HypoV: Haemorrhage, dehydration, intravascular
-Obstructive: PE, tension PT
-Cardio: MI, arrhythmia, valvular, obstruction to flow
COOL & PALE
-Distributive: Sepsis, epidural, adrenal insufficiency, drugs & toxins, anaphylaxis, lack of vasomotor tone, neurogenic, liver failure
WARM W/VASOD
What are the consequences of shock & repercussion?
- Intracellular Ca overload leading to dec myocardial contractility, dec ATP & degradation of ion pumps via free radicals
- H+ excess causes dec catecholamine effect & dec myocardial function
- Metabolism becomes glycolysis dependent so inc FFA & lactic acid
Why may a central venous catheter be inserted in a critically ill patient?
- Measure central venous pressure- indicator of fluid status
- Permit the use of drugs that can only be given into a central vein (NorA)
Why may an arterial line be inserted in a critically ill patient?
- Beat-beat measurement of blood pressure
- Regular & repeated arterial blood sample
- Analysis of waveform can indicate adequacy of filling
What equipment is available in a resus kit?
Portable suction All airway devices Stethoscope Bag & mask ventilation laryngoscope syringes Drugs bag oxygen cylinder
What are the initial investigations for an unconscious patient brought into A&E?
CT/MRI head ECG Glucose Bloods & Tox screen ABG Sepsis screen
What is classed as a dangerous mechanism of injury?
Fall from >1m Axial load to head (diving) MVC at high speed, rollover, ejection Bicycle collision Motorized recreational vehicles
If C-Spine rules apply, what type of scanning should be done?
CT
If euro abnormality post-CT: MRI
What factors mean a head CT should be done within 1hour?
GCS <13 GCS <15 at 2hours after the injury Suspected open/depressed skull # Sign of basal skull # (panda eyes, cerebrospinal fluid leakage, Battle's sign) Post-traumatic seizure Focal neuro deficit >1 episode of vomiting Warfarin: ALL get a CT
What factors mean a head CT should be done within 8hours?
> 65years
Hx of bleeding/clotting
Dangerous mechanism
30mins retrograde amnesia
In a head injury, when should a neurosurgeon be involved?
Persisting coma after initial resus Unexplained confusion >4hours Deteriorating GCS after admission Progressive focal neuro signs CSF leak Definite/suspected penetrating injury Seizure without full recovery
What operations require a group and save?
Hysterectomy (simple) Appendicectomy Thyroidectomy Elective LSCS Laparoscopic cholecystectomy
What operations require Cross-match of 2u?
Salpingectomy for ruptured ectopic pregnancy
Total hip replacement
What operations require Cross-match of 4-6u?
Total gastrectomy Oophorectomy Oesophagectomy Elective AAA repair Cystectomy Hepatectomy
What makes up the Primary Survey?
Airway maintenance w/C-Spine protection
Breathing & ventilation w/high flow O2
Circulation w/haemorrhage control
Disability & neurologic status w/prevention of secondary injury
Exposure & environmental control (temp)
What are the potential sites of bleeding?
On the floor & four more: External wounds Chest cavity Abdominal cavity Pelvic cavity Long bone fractures
What is a GCS Score made up of?
- Best eye response: 4) Spontaneous 3) Verbal 2) Pain 1) No eye opening
- Best verbal response: 5) Oriented 4) Confused 3) Inappropriate words 2) Incomprehensible sounds 1) No verbal response
- Best motor response: 6) Obeys command 5) Localizes pain 4) Withdrawal from pain 3) Flexion to pain 2) Extension to pain 1) No motor response
What can cause organ failure?
Consequence of direct injury (toxin, MI, pneumonia)
As a consequence of shock w/tissue ischaemia & dysfunction occurring as a consequence of hypoxia
What are the indicators of specific organ failure?
Resp: Requires O2 +/- ventilation
CV: Low BP, vasopressors/inotropes
Renal: Reduced/no urine output, raised creatinine
NS: Reduced conscious level
Liver: Low sugars, high lactate, encephalopathy, coagulopathy, raised bili
Haem: Low platelets, deranged coag (PTT)
What are the clinical signs of shock?
Inadequate perfusion: -General: BP <90s, lactate >3, BE < -4, reduced CRT -Brain: Lethargy, somnolence -Kidneys: Oliguria/anuria Attempted compensation: -Tachycardia -Tachypnoea
What is a central venous catheter used for?
Similar to assessing JVP clinically:
Indicator of fluid status
Permit the use of drugs that can only be given in a central vein (NorA)
Which vasoactive drugs should be given in:
HypoV
Cardiogenic
Distributive shock
HypoV: Fluids
Cardio: Inotrope (Dobutamine)
Dist: Vasopressor (NorA)
