Trauma

Question 1

What is a handover tool used by paramedics to tell A+E about an incoming patient?

Answer 1

ATMIST

A: age
T: time of incident, ETA
M: mechanism of injury
I: injuries expected
S: signs, vital obs
T: treatment given

Question 2

Who is in the trauma team?

Answer 2

A+E doctors
Anaesthetist
Orthopaedic surgeon
General surgeon
Nurses
ODP
Radiographer
Porter

Question 3

How would you assess the patient?

Answer 3

ABCDE

During A assess C spine

Question 4

How would you assess C spine?

Answer 4

Palpate for tenderness over cervical vertebrae

Use head immobilisation if suspected fracture

Question 5

What can cause tachycardia in a patient?

Answer 5

Pain
Anxiety
Shock (all types except neurogenic which would cause brady)
Drugs (salbutamol)
Arrhythmia

Question 6

What blood tests would you ask for in a trauma patient?

Answer 6

FBC
U+E
Group and save or crossmatch if need blood now
Coagulation
Glucose

Question 7

What are the types of pneumothorax and what causes them?

Answer 7

Primary spontaneous pneumothorax (PSP)
Occur in people without underlying lung disease

Secondary spontaneous pneumothorax.
These occur in people with underlying lung disease

Traumatic pneumothorax, can be open or closed

Sometimes a pneumothorax can become tension pneumothorax

Question 8

What are the symptoms of a pneumothorax?

Answer 8

Chest pain
SOB
Hypoxia
Hypercapnia

Worse symptoms are seen in SSPs compared to PSPs

Tension pneumothorax: respiratory distress, chest pain, tachycardia, tachypnoea, hypoxia, much more severe

Question 9

What are some signs OE of a pneumothorax?

Answer 9

Tracheal deviation
Tachycardia, tachypnoea
Low BP
Cyanosis
Displaced apex beat
Hyper-resonance over collapse
Reduced or absent breath sounds in affected area
Reduced chest expansion of affected side

Question 10

In pneumothorax…

Tracheal deviation goes to which side?

Which side is chest expansion reduced on?

Which side is hyper-resonant?

Answer 10

Tracheal deviation away from collapsed side

On the side of the collapse

The side of the collapse

Question 11

What causes PSPs?

Answer 11

Bullae

Which are dilated air spaces in the lung parenchyma
They can burst, causing pneumothorax

Question 12

What is the mechanism of a tension pneumothorax and how it can cause death?

Answer 12

Progressive build up of air in the pleural space

Usually due to lung laceration that allows air to escape into the pleural space but not back into the lung

Pressure build up in the pleural space causes mediastinal shift, this compresses the IVC which means the RA can’t fill with blood, leading to circulatory instability and arrest.

Question 13

How do you treat a tension pneumothorax?

Answer 13

Needle thoracocentesis

Use a large bore needle, stab in mid-clavicular line in the first decent inter-costal space (usually 2nd)

Question 14

In trauma cases, why is it not advised to over-resuscitate with fluids?

What should you do?

Answer 14

Fluid dilutes coagulation factors, platelets

Creating too high a BP could mean they bleed out

Higher BP could dislodge a clot that has sealed a wound.

Permissive hypotensive resuscitation: get systolic to about 80

Question 15

What happens to clotting in major trauma?

Answer 15

Trauma induced coagulopathy

Consumption + dilution of coagulation factors and platelets
AND
an imbalance of dynamic equilibrium between pro-coagulant factors, anti-coagulant factors, platelets etc.

Poor clotting ability

Question 16

What is the lethal triad?

What’s the significance of it?

Answer 16

Acidosis
Coagulopathy
Hypothermia

Each factor can compound the other resulting in high risk of mortality

Severe hemorrhage leads to hypothermia
Hypothermia can halt the coagulation cascade

Severe haemorrhage also leads to to poorly perfused tissues, resulting in anaerobic respiration, producing lactic acid, ketones etc. This causes acidosis

Question 17

What could abdominal tenderness mean in trauma?

Answer 17

Internal organ damage

Peritonitic: one of the peritoneal organs

Non-peritonitic: likely the spleen

Question 18

Splenic rupture causes peritonism. True or false?

Answer 18

False, its a retroperitoneal organ so will bleed into retroperitoneal space

Question 19

What is a FAST scan? When should it be done?

Answer 19

Focused assessment with sonography for trauma

At presentation

Question 20

What is a log roll?

Answer 20

To move a patient without flexing the spinal column

Patient’s head is held to immobilize the neck and they’re rolled to one side.

Allows doctor to palpate the spine and see if there’s any tenderness

Question 21

There are many life-threatening chest injuries. Classify which ones occur immediately after trauma and which occur later.

Answer 21

ATOM FC: immediately

Airway obstruction
Tension pneumothorax
Open pneumothorax
Massive haemothorax
Flail chest
Cardiac tamponade

ATOM PD: delayed

Aortic disruption
Tracheo-bronchial disruption
Oesophageal rupture
Myocardial contusion
Pulmonary contusion
Diaphragmatic rupture

Question 22

What is scanned in a whole body CT scan?

Also what are the indications for one?

Answer 22

Vertex (top of head) to mid thigh

Haemodynamic instability
FAST scan has shown abnormalities
Suspected long bone or pelvic fractures
Low GCS
Mechanism of injury: ejection, entrapment
Fatality at scene

Question 23

What are the benefits of splinting a femoral fracture?

Answer 23

Prevents further damage to bone and surrounding structures

Reduces pain as periosteum is not being stretched and moved

Pulls the femur into a more anatomical position

Reduces blood loss because of compression effect