Trauma Flashcards
What is a handover tool used by paramedics to tell A+E about an incoming patient?
ATMIST
A: age T: time of incident, ETA M: mechanism of injury I: injuries expected S: signs, vital obs T: treatment given
Who is in the trauma team?
A+E doctors Anaesthetist Orthopaedic surgeon General surgeon Nurses ODP Radiographer Porter
How would you assess the patient?
ABCDE
During A assess C spine
How would you assess C spine?
Palpate for tenderness over cervical vertebrae
Use head immobilisation if suspected fracture
What can cause tachycardia in a patient?
Pain Anxiety Shock (all types except neurogenic which would cause brady) Drugs (salbutamol) Arrhythmia
What blood tests would you ask for in a trauma patient?
FBC U+E Group and save or crossmatch if need blood now Coagulation Glucose
What are the types of pneumothorax and what causes them?
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
What are the symptoms of a pneumothorax?
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
What are some signs OE of a pneumothorax?
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
In pneumothorax…
Tracheal deviation goes to which side?
Which side is chest expansion reduced on?
Which side is hyper-resonant?
Tracheal deviation away from collapsed side
On the side of the collapse
The side of the collapse
What causes PSPs?
Bullae
Which are dilated air spaces in the lung parenchyma
They can burst, causing pneumothorax
What is the mechanism of a tension pneumothorax and how it can cause death?
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.
How do you treat a tension pneumothorax?
Needle thoracocentesis
Use a large bore needle, stab in mid-clavicular line in the first decent inter-costal space (usually 2nd)
In trauma cases, why is it not advised to over-resuscitate with fluids?
What should you do?
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
What happens to clotting in major trauma?
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
What is the lethal triad?
What’s the significance of it?
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
What could abdominal tenderness mean in trauma?
Internal organ damage
Peritonitic: one of the peritoneal organs
Non-peritonitic: likely the spleen
Splenic rupture causes peritonism. True or false?
False, its a retroperitoneal organ so will bleed into retroperitoneal space
What is a FAST scan? When should it be done?
Focused assessment with sonography for trauma
At presentation
What is a log roll?
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
There are many life-threatening chest injuries. Classify which ones occur immediately after trauma and which occur later.
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
What is scanned in a whole body CT scan?
Also what are the indications for one?
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
What are the benefits of splinting a femoral fracture?
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
