Trauma Flashcards
What is ATLS protocol?
Advanced Trauma Life Support
- Airway
- Breathing
- Circulation
- Neurologic deficit
- Exposure
How do you assess airway?
Is there evidence of a partial or complete obstruction?
Is there risk of anticipated airway obstruction?
Is there a risk of aspiration from failure to protect their airway?
What are life threatening chest injuries?
Tension pneumothorax
Open Pneumothorax
Flail chest
Massive hemothorax
Cardiac tamponade
What is the pathophysiology of a tension pneumothorax?
Progressive entry of air into pleural space and the collapse of ipsilateral lung. Causes shifting of mediastinal structures and compromised venous return
How does a tension pneumothorax present?
Hypotensive and tachycardic
Cardiovascular collapse
WONT HEAR BREATH SOUNDS on that side
What is an open pneumothorax
Air accumulates between the chest wall and the lung as the result of an open chest wound or other physical defect
What is a flail chest?
> 3 ribs fractured in 2 places. Paradoxical breathing. They can’t expand chest to get air in
How is flail chest managed?
With a ventilator and internally splint patients
What is and how do you diagnose cardiac tamponade?
Injury to the pericardial sac ex knife stuck in someone’s chest. Pt will be tachycardic, hypotensive, hypovolemic, and you will STILL HEAR BREATH SOUNDS
WATCH OUT FOR PHRENIC NERVE
Shock is
Inadequate delivery of oxygen and nutrients necessary for normal tissue and cellular function
What can cause obstructive shock
Tension pneumothorax
Pericardial tamponade
What can cause cardiogenic shock
Heart attack
What can cause neurogenic shock
High spinal cord injury
What are s/sx of shock
Narrowing of pulse pressure
Tachycardia
Tachypnea
Hypotension
Oliguria/anuria
Mental status changes
What is the clinical intervention for hemorrhagic shock
Large bore peripheral IV
—Bolus 2 liters of warm fluid
—blood and or coag factors
—Frequently monitor vital signs/UOP for response
Hemorrhagic shock— where has the blood gone?
The scene Extremity fractures Thorax— can lose 60% of blood to chest Peritoneum Retroperitoneum
How do you workup the cause of hemorrhagic shock blood loss?
CXR/Pelvic X ray
Physical exam
DPL/US peritoneal vs retroperitoneal
Rules of abdominal packing
Pack to generate opposing vectors of force
Pack early
Too much can be bad
Be paranoid about your packs
Trauma Laparotomy
- Initial assessment and temporary bleeding control
- Systematic abdominal exploration
—assess liver and spleen
—check root of mesentery
—assess stomach, small intestine, colon
—Assess retroperitoneum: kidneys, lesser sac, Kocher
—assess diaphragm - Strategic decision— limit operative time— damage control vs definitive repair
Triangle of death
Coagulopathy
Hypothermia
Acidosis
Pt cold, coag enzymes dont work as well, bad perfusion—> acidosis
What’s the first priority in hepatic trauma?
Stop the hemorrhage
—Manual compression
—temporary packing
—Pringle maneuver
Conduct thorough exploration
Always ___ the liver
Drain
What’s the operative management for a splenic injury?
You must mobilize the spleen to the midline for an adequate inspection Remove vs repair? —What is overall trauma burden? —Pts age —how bad is injury —what’s your experience with repair
Completing the Splenectomy
Clamp and divide vessels
Stay close to spleen and avoid pancreas and greater curve of stomach
Suture ligate the hilar vessels individually
Inspect the greater curve closely
Avoid leaving a drain
Assess hemostasis
Do most renal injuries require surgical intervention?
No, most times the bleeding will stop on its own— sx needed if hematoma is enlarging
Best imaging modality for duodenal injuries?
CT with IV and oral contrast
Warnings signs in duodenal injuries
—Zone 1 hematoma
—Bile staining in field
—Retroperitoneal crepitus
—Retroperitoneal edema, fat necrosis, phlegmon
If observed, must identify cause
What do you do about a near complete transaction of the 1st, 3rd, or 4th part of the duodenum?
Debridement
End to end anastomoses— start on pancreatic side d/t limited mobility
What do you do about a near complete transaction of the 2nd part of the duodenum?
Consider roux en y jejunum
—time consuming and relevant only in stable pts
For unstable pts best option is to approximate edges around an exteriorized drain which creates a controlled fistula and come back on a better day
Pancreatic injuries operative management?
Adequate exploration is essential
Kocher maneuver
Drain all— even if duct is disrupted, the drain establishes a controlled fistula
Laceration of body and or tail? Distal pancreatectomy with splenectomy
T/F: Avoid pancreaticojejunostomies for trauma?
True
