Trauma Flashcards
What does AMPLE stand for?
A - Allergies M - Meds + drugs P - PMH L - Last meal E - events leading to an accident
Primary Survery (3)
Full systems exam
Trauma Series Xray
FAST scan
Trauma xray series (3)
C-spine
CXR
Pelvic XR
What is a FAST scan
Focused abdominal sonography for trauma
What type of injuries are pelvic disurptions usually associated with?
Visceral - bladder, urethral, rectal
Vascular - iliac aa/retroperitoneal vv
Ix pelvic disruptions
Pelvic XR
Mx pelvic disruptions (3)
Initially - pelvic splint
Arteriography
Surgery
Haemorrhagic shock - blood loss (1-4)
1- <750/ 15%
2 - 750-1500/15-30%
3 - 1500-2000/30-40%
4 - >2000/>40%
Haemorrhagic shock - HR (1-4)
1 - <100
2 - 100-20
3 - 120-40
4 - >140
Haemorrhagic shock - BP (1-4)
1 - no change
2- no change
3 - decr
4 - decr
Haemorrhagic shock - Pulse pressure (1-4)
1 - incr/no change
2- decr
3 - decr
4 - decr
Haemorrhagic shock - RR (1-4)
1 - 14-20
2 - 20-30
3 - 30-40
4 - >35
Haemorrhagic shock - Urine output (1-4)
1 - 30ml/hr
2 - 20-30mls/hr
3 - 5-15ml/hr
4- negligible
Haemorrhagic shock - CNS (1-4)
1 - slightly anxious
2 - mildly anxious
3 - anxious/confused
4 - confused/lethargy
What does ATOM FC stand for
Indicates common causes of life threatening chest injury A = Airway T = Tension pneumothorax O = Open pneumothorax M = Massive haemothorax F = Flail chest C = cardiac tamponade
Indications of airway compromise (3)
Stridor
Noisy breathing
Surgical emphysema
Mx Airway
Head tilt/chin lift
Suction
temporary airway
ETT = definitive Mx
Indications of tension pneumothorax (3)
Absent breathsounds
hyperresonant lung 1 side
Tracheal shift to NORM side
Which way does the trachea shift in tension pneumothorax?
Towards the normal side
Mx tension pneumothorax
Needle decompression 2 ICS MCL
What is an open pneumothorax
A direct communication betw pleural cavity and environment
Mx open pnuemothorax (3)
Asherman valve
Chest drain
Surgical closure
What is a massive haemothorax
> 1500ml of blood
Cause of massive haemothorax
Rib fracture –> vv injury
PS Massive haemothorax (3)
Shock
Dull percussion
No breath sounds
Mx massive haemothorax
Large chest drain - 6ICS MCL
Admit
Thoractomy
What is flail chest
When chest wall disconnects from thoracic cage
Cause of flail chest
> 2 rib fractures in >2 places
PS Flail chest (3)
Pain
Withdrawal of chest on inspiration
Rapid shallow breathing
Mx Flail chest
Intercostal anaesthesia
Aggressive pulmonary toilet
CPAP
Causes cardiac tamponade (2)
Penetrating trauma
Pericarditis
What is Beck’s triad
Distended neck vv
Distant heart sounds
Decr BP
How is cardiac tamponade diagnosed
Echo
Mx cardiac tamponade (2)
Pericardiocentesis
Thoractomy
What is pulmonary contrusion
Blood is alveolar space
Cause of pulmonary contrusion
Blunt trauma
XR appearance pulmonary contrusion
Diffuse alveolar shadowing
What causees aortic disruption?
Acceleration-deceleration injury –> laceration by ligamentum arteriosum
PS aortic disruption (3)
Incr BP
Tearing pain towards back
Widened mediastinum
Mx aortic disruption
Fatal
Hence needs instant repair
What is Tracheobronchial or Oesophageal Disruption
Damage to bronchial tree
What Sx suggest Tracheobronchial or Oesophageal Disruption
Haemopytsis
Surgical emphysema
Mx Tracheobronchial or Oesophageal Disruption
Intubate and ventilate
Cause diaphragmatic disruption
Blunt/penetrating trauma
Mx diaphragmatic disruption
Laparotomy
What is myocardial contrusion
bruising of myocardium
Cause of myocardial contrusion
Steering wheels/sternal fracture
Ix myocardial contrusion
ECG
ECHO - rule out tamponade
Mx myocardial contrusion
Supportative
Most common abdo organ damaged: blunt trauma
Spleen
Most common abdo organ damaged: stab wound
Liver
Most common abdo organ damaged: Gun shot
Small bowel
What does a FAST scan do?
Detects free fl/organ haematomas and lacerations
-ve FAST
Less reliable than CT
+ve FAST
Can be done on less stable pt’s
What 5 areas does the FAST scan focus on? (5 Ps)
Perihepatic Perisplenic Pelvic Pleural Pericardial
What are focal head injuries due to?
Mechanical force
What is cerebral contrusion?
Bruising of brain
Cause of cerebral contrusion ?
Countercoup injury
Cause of epidural haemorrhage?
Damage to middle meningeal aa q
Cause of subdural haemorrhage?
Damage to bridging of vv
What is Cushings reflex
Incr BR and decr HR in a brain injury
Late and terminal sign :(
Criteria for CT head (<8hrs) (5)
On warfarin LOC/Amnesia since injury + > +65 > Hx bleeding/clotting disorder > Dangerous injury mechanism > >30mins retrograde amnesia
Criteria for immediate CT head (<1h) (7)
GCS <13 initial assessment GCS <15 @ 2hrs admission Suspected skull fracture Basal skull fracture Post traumatic seizure Focal neuro defecit >1 ep vomiting
Battle’s sign
Bruise located behind ear
Indicates basal skull fracture
Cerebral perfusion eq
= MAP - ICP
What value must MAP not fall below in ITU
65
How can you incr MAP
Fluids
Inotropes - Noradrenaline/vasopressin/ADH
How can you decr ICP
Avoid XS fl
Elevating head @ 30’
Ix - head injury patient
Beside: BM, ABG, GCS
Lab: ETOL, FBC, U+E, clotting, G+S
Image: CT brain+ spine
What are the 4 outcomes for neurosurgery patients
Urgent neurosurgery
ICU
Ward care
Catastrophic - no chance of survival
GCS - eyes
4 - spontaneous
3 - to speech
2 - to pain
1 - no response
GCS - verbal
5 - oriented to time, person + place 4 - confused 3 - inapprop words 2 - incomprehensible sound 1 - no response
GCS - motor
6 - obey command 5 - moves to localised pain 4 - flexes away from pain 3 - abnormal flexion 2 - abnormal extension 1 - no response
PS Incr ICP (5)
Nocturnal headache, worse on movement Changes in mental state Vomiting NO nausea Pupil changes Papilloedenma
Causes Incr ICP (8)
Localised mass Neoplasm Abscess Foecal oedema Diffuse swelling 2' to infection/SAH, Reye's syndrome Disruption in CSF flow Obstructed venous sinus Idiopathic HTN
Mx incr ICP (7)
Avoid pyrexia Mx seizures CSF drainage Elevate head Analgesia + sedation Mannitol Hyperventilation
How do you drain CSF
Intraventricular catheter
