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CPGs Cass > Trauma > Flashcards

Trauma Flashcards

1
Q

What are the components of the triad of death? (3)

A

Coagulopathy
Acidosis
Hypothermia

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2
Q

What conditions does the haemorrhaging hypovolaemia guideline apply to? (3)

A

Trauma
GI bleed
AAA

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3
Q

What is the management for a pt with haemorrhaging hypovolaemia with a SBP>/=70?

A 
Tolerate hypotension for 2 hours.
Prepare for deterioration. 
Consult with clinician/hospital if:
- long prehospital times
- prolonged extrication
- elderly/frail
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4
Q

What BP do you tolerate without fluids for haemorrhagic hypovoaemia?

A

SBP 70+

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5
Q

What is the management for a haemorrhagic hypovolaemic pt with a BP<70?

A 
Prioritise immediate transport. 
N/Saline 250ml IV bolus. 
Repeat 250ml to max 2L.
Titrate to SBP >/=70
Consider blood products
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6
Q

What adult VSS meet trauma time critical guidelines?

A 
HR<60 or >120
RR<10 or >30
SBP<90
Spo2<90%
GCS <13 (age 16+) or GCS<15 (age 12-15)
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7
Q

Where would you transport a trauma pt with isolated reduction in GCS, age >65 who suffered a fall <1m in Metro?

A

Nearest metro neurosurg facility

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8
Q

List the specific injuries for potential major trauma

A

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

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9
Q

List the mechanism of injury for high risk major trauma (8)

A 
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
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10
Q

List comorbidities for high risk criteria for major trauma

A

Age <12 or >55
Pregnant
Significant underlying medical condition

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11
Q

List significant underlying medical conditions for major trauma comorbidity (6)

A 
Poorly controlled HTN
Obesity
Controlled or uncontrolled CCF
Symptomatic COPD
IHD
Chronic renal failure or liver disease
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12
Q

Chest decompression insertion site (SMART)

A 
Second intercostal space
Mid-clavicular line
Above rib below
Right angles to chest
Towards body of vertebrae
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13
Q

What do you do if you decompress a chest and no blood escapes but copious blood flows?

A

Removed ARS device and cover site

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14
Q

List signs of a simple pneumothorax

A

Unequal breath sounds in spontaneously ventilating pt.
Spo2 <92% on RA.
Subcutaneous emphysema

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15
Q

Lists signs of tension pneumothorax (8)

A

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

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16
Q

Aside from traumatic cardiac arrest, on which pt’s would you perform chest decompression?

A

Patients with TPT, GCS 10 and BP<70 (cardiac arrest imminent)

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17
Q

How do you prepare the pt for CT6?

A

Analgesia
Check pockets
Wound care
Mark pedal pulse, check neurovascular status of the limb

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18
Q

How long should the CT6 pole be?

A

15cm longer than the leg

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19
Q

Steps of CT6 application

A
  1. Manual traction
  2. Ischeal strap
  3. Ankle and heel strap
  4. Initial splint traction
  5. Upper thigh strap
  6. Lower thigh strap
  7. Below knee strap
  8. Above ankle strap
  9. Apply traction
  10. Recheck pulses and neurovascular status
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20
Q

Indications for CT6 (2)

A

Middle 1/3 femur #

Upper 2/3 tibia #

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21
Q

Contraindications for CT6 (2)

A

Pelvic trauma

Knee or ankle/foot trauma

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22
Q

Indication for Sam splint

A

Open book pelvic #

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23
Q

Precautions for Sam splint

A

CT6 causing difficulty closing legs and thus pelvic injury

Adult splints shouldn’t be used for paeds

24
Q

Steps of Sam splint application

A
  1. Towel between knees
  2. Tie bandage above knees
  3. Tie bandage figure 8 around ankles
  4. Towel under knees
  5. Apply sam splint with buckle on L) side over trochanters
  6. Recheck neurovascular status
25
Steps for bite bandaging
1. Remove jewellery and mark bite site 2. Small bandage/dressing over bite 3. Bandage firmly from most distal point of limb 4. Mark approximate location of bite 5. Immobilise limb against the body
26
Indications for bite bandaging/immobilisation (4)
All Australian snakes Funnel web spiders Blue ringed octopus Cone fish
27
Contraindications for bit immobilisation bandage (4)
Any other spider bite Jelly fish stings Stone fish stings Scorpion, centipede and beetle bites
28
Serious blunt head injury criteria (5HEDS)
``` 5 minutes LOC Skull fracture Emesis more than once Neurological deficit Seizure ```
29
Traumatic head injury airway Mx
If patent do not insert NPA or OPA
30
Traumatic head injury ventilation goals
Vt 6-7ml/kg Spo2 >95% ETCO2 30-35 Avoid hypo/hypercapnia
31
What spo2 is the goal for traumatic head injury?
>95%
32
Traumatic head injury perfusion management
N/saline max 40ml/kg titrated to response Aim SBP >120 If SBP <100 after 40ml/kg consult, otherwise give further 20ml/kg
33
What BP is the aim in traumatic head injury?
SBP >120
34
How much fluid can you give a pt with traumatic head injury?
Up to 40ml/kg, and if BP remains <100 and consult unavailable further 20ml/kg
35
Modified nexus criteria
Age 65+ Hx of bone or muscle weakening diseases/injury Altered conscious state Intoxication Significant distracting injury Midline pain/tenderness on palpation Unable to actively rotate neck 45• without pain
36
What is the BP aim for isolated spinal injury
SBP >90
37
What is the management for isolated spinal injury with SBP<90?
N/saline 10ml/kg
38
Who gets a cervical collar?
Major trauma criteria after blunt trauma to head or trunk Neurological changes/defect Meets any of the NEXUS criteria
39
S&S of airway burns (7)
``` Burns to upper torso/neck/face Facial and upper airway oedema Sooty sputum Burns occurring in an enclosed space Angel facial hair Respiratory distress Hypoxia ```
40
At what temperature should you stop cooling burns patients?
35 or less
41
How do you calculate fluids for a burn pt >15 yrs with TBSA >15%?
Volume = %TBSA x pt weight
42
How do you calculate fluids for a burn pt 12-15yrs with TBSA >10%?
Volume = 3x TBSA x pt weight
43
Over what time frame do you give fluids to burn pts >15yrs
Over 2 hours from time of the burn
44
Over what time frame do you give fluids to burn pts 12-15yrs
Over 24 hrs from time of the burn, with half given over the first 8hrs
45
What are the principles of burn Mx? (6)
``` Pain relief Cool the burn Warm the pt IVT Consider need for ETT Appropriate dressing ```
46
Adult burn % rule of 9s
``` Head 9% Torso 18% front and 18% back Arm 9% total circumference Leg 18% total circumference Groin 1% ```
47
What makes someone at higher risk of cerebral arterial gas embolus after diving? (4)
GCS <15 Onset of symptoms <10-15 after surfacing Seizure LOC or altered conscious state
48
S&S of decompression illness (4)
Musculoskeletal pain Itching Neurological changes Respiratory complaint
49
What are the goals of care for decompression illness? (3)
Allow nitrogen to off-gas Increase O2 delivery Rehydration
50
What position should potential CAGE pts be in?
Supine or lateral
51
What medications do you need to consult for in DCI?
Opioids and stemetil as they can mask symptoms
52
What is the O2 for DCI?
10-15L via NRB regardless of spo2
53
What fluid do you give for adequately perfused DCI?
N/Saline 1L over 15-20 minutes to rehydrate | Repeat every 4 hours
54
In what circumstances should you transport an elderly/frail fall? (7)
``` Any injury Anticoagulants Headstrike No full recollection Non-mechanical/environmental Not able to get up by themselves/quickly High risk to have subsequent fall ```
55
What fluid do you give for less than adequate perfusion DCI?
Max 40ml/kg titrated to pt response | If consult unavailable repeat 20ml/kg

CPGs Cass (16 decks)

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