Trauma Flashcards
Trimodal distrubution of death for trauma
Death from traumatic injuries is distributed in one of three time periods:
Immediate (50% of cases)
- Occurs within seconds or minutes
- Causes: spinal cord/ severe brain injuries, lesions to great vessels
Early (30-35%)
- within hours
- Thoracic trauma
- Liver/ spleen trauma
- Multiple pelvic fractures
Later (15-20%)
- Occurs within 203 weeks
- Causes: sepsis, multi-organ failure
Golden hour in surgery
Following a traumatic injury, the time where prompt medical treatment has the highest likelihood to prevent death.
Primary survey and resuscitation of vital functions
Team approach to trauma patient in resus.
- Trauma team has been assembled, leader has been allocated
After resus, revaluation. then secondary survey
- Then reevaulated before giving definitive care.
Airway
C-spine proteciton
- Until cervical spine injury is excluded
Is airway patent?
Maneuvers to open airway
- Jaw thrust
- Chin lift
Adjunct devices
- Nasopharyngeal/ oropharyngeal airway
- They can fail, so advance to definitive airway: orotracheal, nasotracheal/ cricothyroidotomy
Breathing and ventilation
Assess oxygenation and ventilation
Check for
- Resp rate
- Chest movement: expansion and symmetry
- Percussion and auscultation of chest
- Tracheal deviation
- Air entry
- O2 sats: high flow O2, non-rebreathe
Reassess to see if it’s airway or breathing issue if patient does not improve
Circulation with haemorrhage control
Assessing organ perfusion: look for signs of shock
LoC: poor perfusion to brain
Skin colour and temperature
BP: if low, think about source of blood loss (chest, abdomen, retroperitoneum, muscles, open fracture)
- Control external bleeding with pressure
HR and character
- ECG
Urinary catheter
IV access with two 12G cannulae
- Get blood for crossmatch
- FBC, clotting, U+Es
- Restore blood if blood loss significant
- Ringer’s lactate solution bolus
Consider CXR, CT, US, pelvic scan
Disability
Neurological status
GCS
- Pupils
- Drugs/ intoxication/ medication
Exposure/ environmental control
Prevent hypothermia
- Warm IV fluids
- Blankets, warming device.
Checking for missed injuries
Examples of traumatic pulmonary injuries
Rib fractures/ flail segment (more than one fracture in 1 rib)
Pulmonary contusions
Pneumothorax
Haemothorax
Triage
The process of prioritizing patients according to treatment
needs and the available resources
- Those with life-threatening
conditions and with the greatest chance of survival are treated first
Thoracic injuries
- Epidemiology
- Open vs closed injuries
Causes 25% of deaths in trauma
- Those died with multiple injuries, 50% had thoracic
- Road traffic accidents the most common cause
Open injury
- caused by penetrating trauma (knives, gunshot)
Close injury
- Blasts
- Blunt trauma
- Deceleration
Tension pneumothorax
- description
- Presentation
- Management
Pneumothorax caused by penetration in pleura tracheobronchial tree where air cannot escape.
- Due to formation of one way valve.
Presentation
- Tachycardia
- Hypotension
- Respiratory distress: cyanosis, diaphoresis
- Tracheal deviation
- Hyperresonant chest, reduced expansion
Management
- Decompression: 12G cannulae in 2nd IC space, mid-clavicular line
- Underwater seal chest drain into 5th IC space
Open pneumothorax
- Description
- Presentation
- Management
Pneumothorax from open chest wound
- Air enters pleural on inspiration and leaks to exterior on expiration
Presentation
- Open chest wound
- Absent breath sounds
- Hyperresonant chest
Management
- Three-sided dressing
- Followed by IC drain
Abdominal trauma
- epidemiology
- Types
Occurs in 7-10% of trauma patients
Types:
Blunt
- Spleen, liver, retroperiotneal bleed
Penetrating
- Stab wounds/ gun shots
- Liver, small bowel, diaphragm, colon
- High velocity shots: small bowel, colon, liver, vessels.
Indications for resus laparatomy
In blunt abdominal trauma where
- Unresponsive and hypotensive despite adequate resus
- No other cause of bleeding found
Indications for urgent laparatomy
Features of peritonitis
Any gunshot wound or serious knife injury
Blunt trauma with CT features of solid organ injury not suitable for conservative management.
Identifying peritoneal cavity as source of significant haemorrhage
Four Ps
Morison’s pouch
- Between liver and right kidney
pouch of Douglas
- Retrovaginal/ retrovesicle pouch
Perisplenic
Pericardium
Indications for abdo CT
In haemodynamically stable patients where no apparent indication for emergency laparotomy
