Trauma Flashcards
Trimodal distribution of death?
Death at scene (immediate)
Early in hospital due to hemorrhage (<4 hours)
Late in hospital due to organ failure (>4 hours)
What is the golden hour?
This is the time after the trauma where the likelihood that prompt medical and or surgical treatment will improve survival
Why is mechanism of injury important?
Can help to ID the likely injuries/ concerns - patterns of occult injury
Parts of the Primary Survey?
Airway - is it clear, do they need a tube?
Breathing - ventilate with O2, is there a tension pneumothorax
Circulation - arguably the most important - start IV, give fluids, prepare for transfusion
Disability - pupils and quick mental status, GCS
Exposure - completely disrobe and log roll
Parts of the secondary survey?
Complete a head to toe exam, check all orifaces for bleeds, pelvic stability, fractures and perfusion
Can ask AMPLE
Imaging and bloodwork for trauma patient?
FAST U/S for patients that are not good candidates for a top to tail CT, can also go for a CXR. Will need CT or X-ray of c-spine for patients in collars to clear
Type and screen, Hbg, urine dip for blood, tox, bHCG, CBG, ECG, consider troops
Estimating blood loss?
ATLS guidelines
- Class 1 - HR >100 normal BP, RR, pulse = <750mls
- Class 2 - HR 100-120, normal BP, elevated RR, decreased pulse = 750-1500
- Class 3 - HR 120-140, decreased BP, elevated RR, decreased pulse = 1500-2000
YOUR BODY CAN KEEP NORMAL BP TO 1500mls lost
- Class 4 - HR >140, decreased BP, increased RR, decreased pulse = >2000
Determining GCS
Do they open eyes?
Do they respond verbally (LOAx3)?
Are they able to obey a motor command (do they respond to painful stimuli)?
When to give charcoal?
If they are totally conscious - and ingested within an hour - charcoal aspiration is DEVASTATING
Signs of a tension pneumothorax?
Asymmetric breath sounds, deviated trachea, decompensating SOB
Possible head trauma DDX?
Skull fracture - basilar or external, epidermal hematoma, subdural hematoma. SAH, concussion
Important points on a trauma Hx
Specific mechanism, LOC, blood thinners.
6 key facial trauma injuries to know?
Frontal (internal frontal sinus)
Eyes and orbits (blow out and entrapment)
Nose (septal hematoma)
Zygomatic (tripod)
Upper jaw (Le Fort)
Mandible (open fractures - intraoral lac)
NEXUS criteria for C-Spine injury
Spinal midline tenderness Painful distracting injury Intoxication Neurological deficit Encephalopathy
If positive need a Cervical CT
How to clear c-spine?
Have pt turn head 45 degrees, no limitation/ parasthesias or deficit - take off collar
Becks triad?
Cardiac tamponade- hypotension, muffled heart sounds, JVD
Cardiac traumas - 3 main
Cardiac tamponade, aortic dissection (at lig art), blunt injury (worry about vfib/ follow trops)
Locations to look for FAST scan?
Right upper quad (Morrison’s pouch)
Left upper - spleen
Suprapubic - bladder rupture
Subxiphoid- cardiac tamp
Signs of genitourinary injury?
Look for hematuria - gross, bruising of the area, hip/ pelvic instability
2 types of urethral injuries
Posterior - with pelvic fractures
Anterior - straddle
Concerning signs for inhalation?
Singing or soot around the nose and mouth, hoarse voice/ cough, take a CO level, get on O2
Times when you might need to intubate early?
Children, neck trauma, inhalation injury, transport (and make sure it does not get dislodged)
Triangle of Death
Hypothermia, acidosis, coagulopathy
Labs for Trauma
Coags, type and cross, glucose, bHCG, (All the other routine stuff is fine but not as important in the moment)
Imaging for trauma?
CXR, C-Spine x-ray, pelvic X-ray , FAST US.
TXA in trauma?
Sure, as long as occurred within 3 hours
