trauma Flashcards
Adult
Vital signs (adult)
- HR <60 >120
- RR <10 >30
- BP < 90
- GCS if > = to 16 is < 13; < or = 15 - <15
- SpO2 < 90
co-morbidities of trauma MOI (8)
• Systemic illness limiting normal activity / systemic illness constant threat to life. Examples include: - Poorly controlled hypertension - Obesity - Controlled or uncontrolled CCF - Symptomatic COPD - Ischaemic heart disease - Chronic renal failure or liver disease • Pregnancy • Age < 12 or > 55
major trauma - what 3 things increase mortality:?
hypothermia, acidosis, coagulopathy
what pt’s does the hemorhagic hypovolaemic guideline apply to? (3)
Suspected hypovolemia from a haemorrhagic
cause – e.g. GI, AAA, trauma
This guideline applies to patients with suspected
ruptured AAA, massive GIT haemorrhage, and pregnant trauma patients.
what pt’s does the hemorhagic hypovolaemic guideline NOT apply to? (3)
This guideline DOES NOT apply to patients with TBI,
isolated SCI or PPH. Manage as per the relevant CPG
SBP < ?? fluid mx? in hemorhagic hypovolaemia
• Normal Saline 250 mL IV
- Repeat 250 mL (max. 2000 mL) as required
- Titrate to SBP ≥ 70 mmHg
ARS: Once inserted, if air escapes, or air and blood bubble through the cannula, or no air/blood
detected.. should it be removed or left in?
leave in situ.
ARS: If copious blood flows out, what should you do ?
remove the cannula and cover the insertion site
with an occlusive dressing.
indications for quick clot (4)
• Uncontrolled haemorrhage from a non-compressible wound site
• Any traumatic haemorrhage that is not controlled by basic haemorrhage control measures such as direct
pressure with a pad and bandage
• Severe limb wounds not controlled by two Combat Application Tourniquets
• Multiple casualty scenes where patient numbers dictate that simple haemorrhage control measures cannot
be individually applied
CI for Quick Clot (3)
- Bleeding that can be controlled using basic first aid measures
- Ocular trauma
- Haemostatic dressings are not to be used for haemorrhages where they are unlikely to contact the point of bleeding such as PV or PR haemorrhage, or posterior epistaxis
what area must the quick clot come into contact with?
- into direct contact with the point of bleeding.
how long should a quick clot be held in place, before removing direct pressure?
2 - 3 minutes; if it bleeds through remove and apply new pad
CT6 indication
Indications
- Middle third femur fractures
- Upper two third tibia fractures
indications for PIB
- All Australian Snake Species (including Sea)
- Funnel Web spider
- Blue Ringed Octopus
- Cone fish
CI for PIB
- Any other spider bite
- Jelly fish stings
- Stone fish and other fish stings
- Scorpion, centipede and beetle bites
Pneumothorax SS (ULS)
- Unequal breath sounds in spontaneously ventilating pt
- Low spO2 on RA (< 92%)
- Subcutaneous emphysema
TPT SS (CLEPT-PJR)
- < conscious state
- Low SPO2 on O2 (< 92%)
- < EtCO2
- > peak inspiratory pressure (stiff bag)
- tracheal shift
- Poor perfusion (shock)
- > JVP
- > respiratory distress in awake pt
if GCS is < ??? and BP < ??? in TPT what is the mx?
< 10; < 70; immediately decompress (Cardiac Arrest Imminent)
perfusion mx in THI?? what is the BP to aim for??
• Normal Saline IV (max. 40 mL/kg) titrated to patient response (unless in the setting of penetrating truncal
trauma or uncontrolled overt bleeding)
• Aim for SBP > 120 mmHg If SBP < 100 mmHg after 40 mL/kg:
- Consult with appropriate trauma service
- If consult is unavailable, Normal Saline 20 mL/kg IV
isoloated SCI: BP < ??? fluid mx?
If BP < 90 mmHg:
• Normal saline 10 mL/kg IV
SS of airway burns (B-FRESSH)
- Evidence of burns to upper torso, neck and face
- Facial and upper airway oedema
- Sooty sputum
- Burns that occurred in an enclosed space
- Singed facial hair (nasal hair, eyebrows, eyelashes, beards)
- Respiratory distress (dyspnoea +/- wheeze and associated
tachycardia, stridor) - Hypoxia (restlessness, irritability, cyanosis, decreased GCS)
how long should chemical burns be irrigated for?
for as long as pain persists (being mindful of hypothermia)
partial or full thickness burns mx? include pt age and burn %
• Patients > 15 years with TBSA >15%
Normal Saline - % TBSA x Pt wt (kg) = vol (mL)
administered over 2 hours from time of the burn
• If Pt 12 – 15 years with TBSA >10%
Normal Saline IV fluid replacement 3 x %TBSA x Pt
weight (kg) = vol fluid (mL)
- Given over 24 hours from time of burn
- Administer half of the 24 hour fluid volume over
the first 8 hours
if > than ??? from an ED consult with recieving hospital for advice regarding scene relocation
15 minutes
DRE: pts with a temp < ??? should be warmed to what temperature to avoid arrythmias?
32; 32
DRE: what is the concern with warming a pt with suspected dysbarism?
warming a pt will cause undissolved N2 to dissolve –> gas embolism
DRE: perfusion mx if adequately perfused
• If adequately perfused and chest clear administer Normal Saline 1000 mL over 15 - 20 minutes to rehydrate Pt. Continue Normal Saline at 1000 mL
every 4 hr
DRE: perfusion mx if pt NOT adequately perfused?
- Less than adequate perfusion: administer ambient temperature Normal Saline IV (max. 40 mL /kg) titrated to patient response.
- Consult Alfred Hospital ED for further advice and fluid. If consult unavailable repeat Normal Saline 20 mL / kg IV
