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as surg rt > Trauma > Flashcards

Trauma Flashcards

1
Q

primary survey - brief summary

A

process for dealing with acute trauma patient

  1. secure airway + c-spine
  2. put on high flow oxygen
  3. treat any tension pneumo
  4. close any open sucking 5. chest wounds (dressing)
  5. cannulas x2
  6. cross match, key bloods
  7. assess circulation
  8. examine for sites of haemorrahage
  9. consider fluids, catheter
  10. assess GCS/AVPU, pupil
  11. assess fluid response
  12. fully expose + survey
  13. log roll, PR

and repeat

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2
Q

trauma imaging

A 
c spine 2x views
CXR
x ray pelvis
FAST scan
CT when stable enough
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3
Q

causes of neurogenic shock x 4

A
  • Spinal anaesthesia
  • Hypoglycaemia
  • Cord injury above T5
  • Closed head injuries

presents as:
Hypotension
• Bradycardia
• Warm extremities

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4
Q

treatment neurogenic shock

A

vasopressin, norad

atropine for brady

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5
Q

spinal shock

A 
Acute spinal cord transection
• Loss of all voluntary and reflex activity below the level of injury
Presentation
• Hypotonic paralysis
• Areflexia
• Loss of sensation
• Urinary retention
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6
Q

life-threatening chest injuries

A 
Airway obstruction
• Tension Pneumothorax
• Open pneumothorax (sucking)
• Massive haemothorax
• Intercostal disruption and pulmonary contusion
• Cardiac Tamponade
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7
Q

define massive haemothorax

A

Accumulation of >1.5L of blood in chest cavity

• Usually caused by disruption of hilar vessels

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8
Q

signs and management massive haemothorax

A

reduced breath sounds
vitals off
stony percussion
reduced expansion

x match 6 units
large-bore chest drain (consider autotransfusion)
thoracotomy if 1.5L+, more than 200ml drained/hr

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9
Q

cardiac tamponade signs and management

A

usually penetrating trauma

 Beck’s Triad
§ ↑ JVP / distended neck veins
§ ↓ BP
§ Muffled heart sounds
• Pulsus paradoxus: SBP fall of >10mmHg on inspiration
• Kussmaul’s sign: ↑ JVP on inspiration
• Intensely restless pt.
Ix
• US: FAST or transthoracic echo
• CXR: enlarged pericardium
• ↑CVP >12mmHg
• ECG: low voltage QRS ± electrical alternans
Mx
• Pericardiocentesis: spinal needle in R subxiphoid space
aiming at 45O towards the R tip of left scapula
• Thoracotomy may be needed
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10
Q

define flail chest

A

when adjacent ribs broken in multiple places so you have an independent segment of rib unsupported

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11
Q

rib fractures

A

usually lower ribs
key is good pain relief

consider subcostal block if extreme pain

can cause pneumothorax or organ injury

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12
Q

sternal fracture

A

nearly always driver hitting steering wheel

check troponins for cardiac contusion

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13
Q

what does FAST scan check for?

A

free fluid in the abdominal cavity, checks in multiple locations

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14
Q

indications for laparotomy

A

Unexplained shock
• Peritonism: rigid silent abdomen
• Evisceration: bowel or omentum
• Radiological evidence of intraperitoneal gas
• Radiological evidence of ruptured diaphragm
• Gunshot wounds
• +ve DPL (Iavage) or CT

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15
Q

sign of splenic rupture

A

Kehr’s Sign
§ Shoulder tip pain 2O to blood in the peritoneal
cavity.
§ Left Kehr sign is classic symptom of ruptured
spleen

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16
Q

signs of urethral injury

A

§ Often assoc. pelvic fracture
§ Blood in the urethral meatus or scrotum
§ Perineal bruising
§ High-riding prostate
§ Inability to micturate + palpable bladder

do retrograde urethrogram, suprapubic catheter, surgical repair

17
Q

trauma and urine dip

A

if blood suggests renal injury / ureteric injury

18
Q

Cushing reflex

A

Hypertension
• Bradycardia
• Irregular breathing

means herniation is imminent, very late and bad sign of raised ICP

19
Q

GCS and head injury

A

3-8 = coma
§ 9-12 = moderate head injury
§ 13-15 = mild head injury

20
Q

base of skull fracture signs

A

CSF rhinorrhoea or otorrhoea (Test: halo sign)
• Battle sign: bruised mastoid
• Pando sign: bilateral orbital bruising
• Haemotympanum

21
Q

some indications for CT head

A

(head) trauma +

Basal or other skull fracture
§ Amnesia: > 30min retrograde (before event)
§ Neurological deficit: e.g. seizures
§ GCS: <13 @ scene, <15 2h later
§ Sick: vomiting > 1
22
Q

managing head trauma post CT head

A 
• Neurosurgical consult if +ve CT
• Admit if
§ LOC >5min
§ Abnormalities on imaging
§ Difficult to assess: EtOH, post-ictal
§ Not returned to GCS 15 after imaging
§ CNS signs: persistent vomiting, severe headache
• Neuro obs: half hrly until GCS 15/15
§ GCS, pupils, TPR, BP
• Analgesia: codeine phosphate 30-60mg PO/IM QDS
• Suture scalp lacs
• Abx: if open / base of skull #
23
Q

head injury and when to intubate

A

GCS ≤ 8
• PaO2 <9KPa on air / <13KPa on O2 or PCO2 >6KPa
• Spontaneous hyperventilation: PCO2 <4KPa
• Respiratory irregularity

24
Q

treating raised ICP

A

Elevate bed
• Good sedation, analgesia ± NM block
• Neuroprotective ventilation
• Mannitol or hypertonic saline

25
Q

safety-netting discharging head injury

A 
• Stay with someone for first 48hrs
• Give advice card advising return on:
§ Confusion, drowsiness, LOC, fits
§ Visual problems
§ V. painful headache that won’t go away
§ Vomiting
26
Q

classifying burns

A 
Superficial
• Erythema
• Painful
• E.g. sunburn
Partial Thickness
• Heal w/i 2-3wks if not complicated
• Superficial
§ No loss of dermis
§ Painful
§ Blisters
• Deep
§ Loss of dermis but adnexae remain
§ Healing from adnexae: e.g. follicles
§ V. painful
Full Thickness
• Complete loss of dermis
• Charred, waxy, white, skin
• Anaesthetic
• Heal from the edges → scar
27
Q

early medium late complications of burn

A

Early
• Infection: loss of barrier function, necrotic tissue, SIRS
• Hypovolaemia: loss of fluid in skin + ↑ cap permeability
• Metabolic disturbance: ↑↑K, ↑↑myoglobin, ↑Hb → AKI
• Compartment syndrome: circumferential burns
• Peptic ulcers: Curling’s ulcers
• Pulmonary: laryngeal oedema, CO poisoning, ARDS
• Renal and hepatic impairment
Intermediate
• VTE
• Pressure sores
Late
• Scarring
• Contractures
• Psychological problems

28
Q

Wallace rule of 9s

A 
Wallace Rule of 9s: % body surface area burnt
• Head and neck: 9%
• Arms: 9% each
• Torso: 18% front and back
• Legs: 18% each
• Perineum: 1%
• (Palm: 1%)
NB. may also use Lund and Browder charts
29
Q

key ATLS prinicples in managing severe burns

A

Secure airway
§ Manage fluid loss
§ Prevent infection

30
Q

formulae for replacing fluid lost in burns patients

A

Parkland Formula to guide replacement in 1st 24hrs
• 4 x wt. (kg) x % burn = mL of Hartmann’s in 24h
• Replace fluid from time of burn
• Give half in 1st 8h
• Best guide is UO: 30-50mL/h
Muir and Barclay Formula to guide fluid replacement
• (wt. x % burn)/2 = mL of Colloid per unit time
• Time units: 4, 4, 4, 6, 6, 12 = 36hrs total
• May need to use blood

31
Q

treating burns

A 
grafts
dressings
creams
abx prophylaxis 
tetanus booster
prevent compartment syndrome
32
Q

hypothermia ECG

A

J waves

33
Q

treating hypothermia

A

cardiac monitor
warmed IV fluids
urinary catheter
Abx routinely if <32 and 65+

warm up slowly or they’ll get worse shock!

as surg rt (15 decks)

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