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
