Trauma

Question 1

Discuss the components of the primary survey

Answer 1

A: Airway
- obstructions of airway from secretions (blood, vomit), distortion of anatomy, decreased level of consciousness
- intervention through jaw thrust, suctioning, nasopharyngeal, oropharyneal or endotracheal airway
B: Breathing
- inspection, palpation and auscultation
C: Circulation
- should always have 2 large bore IVs
- blood pressure, HR, level of consciousness
- control of source bleeding: hemothorax, intra-abdominal bleeding, pelvic fracture, fracture of long bone, or open wound
- compression to stop bleeding and replace volume with 2L and if refractory consider transfusion
- MAP (2*DP+SP)/3) >65
D: Disability
- GCS
- Eyes open (1: no, 2: to pain, 3: to voice, 4: spontaneously)
- Best verbal response (1: no, 2: incomprehensible, 3: inappropriate, 4: confused, disorientated, 5: answers appropriately)
- Best motor response (1: no, 2: decerebrate, 3: decorticate, 4: withdraws from pain, 5: localizes pain, 6: obeys commands)
E: Exposure
- remove clothing and do total assessment
- Spine exam and DRE

Question 2

Discuss trauma proximal airway obstruction

Answer 2

Cause:
- secretions in upper airway
- foreign body
- distortion of upper airway
- decreased level of consciousness
Presentation
- hoarseness
- apnea, cyanosis
- stridor
Management
- intubation

Question 3

Discuss trauam tracheobronchial injury

Answer 3

Pathophysiology
- trauma to neck or chest leading to damage and opening of tracheobronchial tree
Presentation
- hemoptysis
- dysphonia
- respiratory distress
- subcutaneous emphysema
Investigations
- bronchoscopy is gold standard
Management
- intubation
- cardiopulmonary bypass
- surgical repair

Question 4

Discuss trauma aortic tear

Answer 4

Pathophysiology
- result from high speed deceleration resulting in partial thickness tear of aorta leading to pseudoaneurysm
Presentation
- die at scene
- decreased femoral pulses and difference in BP between arms
Investigations
- X-ray: depressed left bronchus with wide mediastinum
Management
- urgent vascular surgery

Question 5

Discuss trauma intra-abdominal hemorrhage

Answer 5

Presentation
- abdominal pain with change in vitals
- peritoneal signs
Investigations
- FAST show free fluid in Morrison's pouch, splenic-renal recess, and space posterior to bladder
- CT with contrast if stable
Management
- laparotomy for source control

Question 6

Discuss trauma pelvic hemorrhage

Answer 6

Pathophysiology
- high energy injury lead to pelvic injury and associated disruption of surrounding arteries and veins
Presentation
- abdominal pain
- pelvic instability
Investigations
- X-ray
- CT with contrast
Management
- pelvic binder
- resuscitation
- source control