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
