Trauma Flashcards
What key features comprise the rapid history taken in trauma situations? - SAMPLE
SAMPLE
- signs & sx
- allergies
- medicines & drugs
- past medical hx
- last oral intake/bowel movement
- events leading to accident
What is the primary survey in trauma situations?
ABCDE from ATLS
What is the secondary survey in trauma situations?
Full systemic examination
Examination of peripheries
What makes up a trauma series of X-rays?
C-spine XRs (often not done immediately)
CXR
Pelvic XR
What is a FAST scan?
Focused abdominal sonography for trauma
- performed for suspected abdo injury/bleeding
- can detect organ lacerations/haematomas/free fluid
- can detect pericardial effusion
Perihepatic Perisplenic Pelvic Pleural Pericardial
When should CT scanning occur?
Once pt is stable
What sort of injuries are present in pelvic trauma?
Visceral & vascular injuries, high energy trauma
- bladder, urethral & rectal trauma
- iliac arteries/retroperitoneal vv injuries (massive haemorrhage)
How can pelvic trauma be diagnosed?
History
Examination - bimanual compression of iliac wings produces pain, legs may bow
AP XR (90%)
How should pelvic trauma be managed?
Pelvic splint if pt unstable
Arteriography to determine site of bleed
Surgical management often required
What are the immediate life threatening injuries that may occur in chest trauma?
ATOM FC
- airway obstruction
- tension pneumothorax
- open pneumothorax
- massive haemothorax
- flail chest
- cardiac tamponade
What features suggest airway obstruction?
Stridor
Noisy breathing
s.c. emphysema
How should airway obstruction be managed?
Jaw thrust
Examination/suction
Temp airway
Definitive airway management (int/vent)
How should tension pneumothorax be managed?
Emergency needle thoracocentesis
-grey cannula into 2nd ics, mid-clavicular line
What is an open pneumothorax?
Direct communication b/w pleural cavity & external environment
What features suggest an open pneumothorax?
Obvious on examination w/ bubbling wound
-tension pneumothorax may develop
How should an open pneumothorax be managed?
Asherman valve -sterile dressing sealed on 3 sides Chest drain -situated away from wound itself Surgical closure
What is a massive haemothorax?
> 1500ml of blood w/i pleural cavity OR
>200ml/hr for 4hrs (blood entering pleural cavity)
What is the most common cause of a massive haemothorax?
Rib fracture causing venous injury
What features suggest a massive haemothorax?
Shock
Lung dull to percussion
No breath signs
How should a massive haemothorax be managed?
Large chest drain in 6th ics, mid-clavicular line
Admit for obs
Thoracotomy (if >200ml for 4 consecutive hrs)
What is a flail chest?
Multiple rib fractures causing a mobile segment that in-draws on inspiration
-underlying pulmonary contusion
What features suggest a flail chest?
V. painful
Respiratory depression
-rapid, shallow
How should a flail chest be managed?
Intercostal block/anaesthesia
Mechanical ventilation if in resp failure/exhausted
What is cardiac tamponade?
Bleeding into pericardial cavity, preventing ventricular filling and causing a fall in cardiac output
What causes cardiac tamponade?
Penetrating trauma
Pericarditis
-slower, heart able to adapt
What features suggest cardiac tamponade?
Beck's triad -raised JVP -low SBP -muffled heart sounds DIAGNOSTIC ECHO
How should cardiac tamponade be managed?
Immediate pericardiocentesis
Thoracotomy
What are the common, non-immediate life threatening injuries resulting from chest trauma?
Pulmonary contusion
Aortic disruption
Myocardial contusion
What is a pulmonary contusion?
Blood in alveolar space
-usually due to blunt trauma
What features suggest a pulmonary contusion?
Worsening hypoxia over 24hrs
Alveolar shadowing on CXR
What causes an aortic disruption?
Severe acc-decc injury
What features suggest an aortic disruption?
Presents as aortic dissection
-tearing chest pain, radiating to back
What is the prognosis of an aortic disruption?
Fatal unless false aneurysm develops in mediastinum
If not immediately fatal then have several hrs to manage
What is a myocardial contusion?
Bruising of myocardium
- occurs w/ steering wheel injuries/sternal fractures
- appears similar to MI on ECG
- manage conservatively
When should a tetanus booster be given for open wounds?
Clean minor wounds
-if uncertain vacc hx/>10yrs since last dose
All other wounds
-give unless tetanus booster given <5yrs
What key features comprise the rapid history taken in trauma situations? - CHAMPS
CHAMPS
- chief complaint
- history
- allergies
- medicines
- prev activity
- signs/sx
What is the preferred mode of venous access in children in trauma?
Interosseseus
What are the indications for Groshong and Hickman lines?
long term therapeutic requirements e.g. chemotherapy
What is a PICC?
peripherally inserted central cannula
central venous access
What are the complications of long term ventilation?
tracheo-oesophageal fistula formation
