Trauma Flashcards
What are the components of the triad of death? (3)
Coagulopathy
Acidosis
Hypothermia
What conditions does the haemorrhaging hypovolaemia guideline apply to? (3)
Trauma
GI bleed
AAA
What is the management for a pt with haemorrhaging hypovolaemia with a SBP>/=70?
Tolerate hypotension for 2 hours. Prepare for deterioration. Consult with clinician/hospital if: - long prehospital times - prolonged extrication - elderly/frail
What BP do you tolerate without fluids for haemorrhagic hypovoaemia?
SBP 70+
What is the management for a haemorrhagic hypovolaemic pt with a BP<70?
Prioritise immediate transport. N/Saline 250ml IV bolus. Repeat 250ml to max 2L. Titrate to SBP >/=70 Consider blood products
What adult VSS meet trauma time critical guidelines?
HR<60 or >120 RR<10 or >30 SBP<90 Spo2<90% GCS <13 (age 16+) or GCS<15 (age 12-15)
Where would you transport a trauma pt with isolated reduction in GCS, age >65 who suffered a fall <1m in Metro?
Nearest metro neurosurg facility
List the specific injuries for potential major trauma
All penetrating injuries (except isolated superficial limb)
Blunt injuries
- serious to a single body region that requires specialised care or risks life, limb or QOL
- significant to more than one body region
Specific injuries
- limb amputation or threatening injury
- suspected SCI or spinal #
- burns >20% TBSA (>10% age 12-15) or suspected resp tract burns
- high voltage burn injury (>1000V)
- serious crush injury
- major compound # or open dislocation
- # to 2 or more of femur/tibia/humerus
- # pelvis
List the mechanism of injury for high risk major trauma (8)
Motor/cyclist impact >30kph High speed MCA >60kph Pedestrian impact Ejection from vehicle Prolonged extrication Fall from height >3m Struck on head by object falling >3m Explosion
List comorbidities for high risk criteria for major trauma
Age <12 or >55
Pregnant
Significant underlying medical condition
List significant underlying medical conditions for major trauma comorbidity (6)
Poorly controlled HTN Obesity Controlled or uncontrolled CCF Symptomatic COPD IHD Chronic renal failure or liver disease
Chest decompression insertion site (SMART)
Second intercostal space Mid-clavicular line Above rib below Right angles to chest Towards body of vertebrae
What do you do if you decompress a chest and no blood escapes but copious blood flows?
Removed ARS device and cover site
List signs of a simple pneumothorax
Unequal breath sounds in spontaneously ventilating pt.
Spo2 <92% on RA.
Subcutaneous emphysema
Lists signs of tension pneumothorax (8)
Increasing resp distress in the awake pt.
Decreasing spo2 <92% despite O2.
Decreasing conscious state.
Poor perfusion or increasing HR +/- decreasing BP.
Increasing peak inspiratory pressure (ventilator)/stiff bag.
Decreasing ETCO2.
Increasing JVP.
Tracheal shift
Aside from traumatic cardiac arrest, on which pt’s would you perform chest decompression?
Patients with TPT, GCS 10 and BP<70 (cardiac arrest imminent)
How do you prepare the pt for CT6?
Analgesia
Check pockets
Wound care
Mark pedal pulse, check neurovascular status of the limb
How long should the CT6 pole be?
15cm longer than the leg
Steps of CT6 application
- Manual traction
- Ischeal strap
- Ankle and heel strap
- Initial splint traction
- Upper thigh strap
- Lower thigh strap
- Below knee strap
- Above ankle strap
- Apply traction
- Recheck pulses and neurovascular status
Indications for CT6 (2)
Middle 1/3 femur #
Upper 2/3 tibia #
Contraindications for CT6 (2)
Pelvic trauma
Knee or ankle/foot trauma
Indication for Sam splint
Open book pelvic #