Trauma/ABCs Flashcards
Indications for Intubation
5Ps - protect airway, positive pressure ventilation (failure to ventilate/oxygenate), pulmonary toileting, anticipatory (trauma, OD, inhalation, COPD, CHF), patency
Difficult to ventilate
“BOOTS” - beard, obese, no teeth, older, snores
Difficult to intubate
LEMON- look for signs, evaluate 3-3-2 rule, mallampati, obstruction/obesity, neck mobility (ankylosing spondylitis, RA)
Measures to improve airway
chin-lift jaw thrust, BVM, suctioning, nasal airway, oral airway, LMA
Definitive airway
endotracheal tube (orotracheal or nasotracheal), surgical airway
Airway methods
RSI, blind nasotracheal intubation, oral intubation without agents “crash airway”
Rapid Sequence Intubation
6Ps: preparation, preoxygenation (100% O2 x 3 mins or pt taking deep breaths on 100% O2), Pretreatment (optional - lidocaine 1.5 mg/kg for reactive, fentanyl 3 mcg/kg for CVD or increased ICP), paralysis (sedative followed by muscle relaxant if indicated, place tube with proof, post-intubation (CXR, ongoing analgesia and sedation, resuscitation)
Definition of Acute Respiratory Failure
pO2 < 50 mmHg or pCO2 > 45 mmHg
Types of Respiratory Failure
Type 1 (respiratory failure without hypercapnia), Type 2a (respiratory failure with hypercapnia normal lungs), Type 2b (respiratory failure with hypercapnia abnormal lungs)
Type 1 Respiratory Failure
no hypercapnia (< 45 mmHg): diffusion problem (pneumonia, ARDs), V/Q mismatch (PE), shunting, low FiO2 (high altitudes), alveolar hypoventilation
Type 2a Respiratory Failure
hypercapnia and normal lungs: disorder of respiratory control - OD, brainstem lesion, CNS, disease, NM disorder (muscular dystrophy, GBS, MG, ALS), trauma, AnkSp
Type 2b Respiratory Failure
hypercapnia abnormal lungs: COPDae, Asthma exacerbation, scarring, IPF
Assessment of Breathing
Look: mental status, colour, chest wall movement, accessory muscle use; Listen: auscultate for breath sounds, signs of obstruction, air entering or escaping, Feel: tracheal devation, crepitus, flail segments, chest wounds
MGMT of breathing
Spontaneous: NP, face mask, non-rebreather face mask; Inadequate Ventilation: BVM, nasal airway, high-flow nasal oxygenation, CPAP/BiPAP (CHF, COPD, asthma)
Causes of Shock
Hypovolemic shock (bleeding, GI losses, third spacing), Obstructive shock (PE, cardiac tamponade, TPTX, valvular dysfunction, air embolism), Distributive shock (Septic, anaphylactic, neurogenic, drug overdose, adrenal), Cardiogenic shock (ACS, cardiomyopathy, cardiac structural damage, dysrhythmia)
Rosen’s Empirical Criteria for Circulatory Shock
Ill appearance or altered LOC, RR > 20 or PaCO2 < 32, UO < 0.5 ml?kg/hr, HR > 100 BMP, base deficit < -4 or lactate > 4, arterial hypotension > 30 mins continuous treatment
Initial Investigations for Shock
CBC, lytes, BUN, Cr, LFT, coag, VBG, lactate
Hemorrhagic hypovolemic shock MGMT
control hemorrhage, aggressive fluids, blood productions (1:1:1 - pRBC platelets, FFP)
Obstructive shock MGMT
TPTX: needle decompression, chest tube; Cardiac Tamponade: IV crystalloids, pericardiocentesis, PE: IV crystalloids, inotropes, thrombolysis
Anaphylaxis Shock MGMT
epi IM, IV crystalloids, antihistamines, corticosteroids
Septic Shock
broad-spec Abx, IV crystalloids, norepi; Goals: UO > 0.5, CVP 8 - 12 mmHgs, MAP > 65 mmHg, ScvO2 > 70%, lactate clearance
Cardiogenic Shock MGMT
MAP > 65 with fluid bolus to optimize preload, norepi 5 mcg/min, dobutamine 2.5 mcg/kg/min, treat underlying cause (Cath lab, ECMO)
PRIMARY SURVEY
Airway (patency, obstruction, C-spine, RSI), Breathing (expose chest, assess breathing, auscultate for breath sounds, r/o TPTX), Circulation (assess LOC, signs of shock, degree of hemorrhagic shock), Disability (GCS assessment, neurological evaluation), Exposure (expose patient, logroll to inspect for injuries, spine tenderness, rectal exam for high-riding prostate and tone), Keep patient warm and dry to prevent hypothermia
Secondary Survey
full physical exam (Head and neck, chest, abdomen, MSK, neuro, SAMPLE, collateral), FAST exam (pericardial window, perisplenic, hepatorenal, pelvic)
Investigations for Trauma
CBC, lytes, BUN, Cr, glucose, lactate, INR/PTT, firbinogen, BHCG, tox screening, UA; CXR, pelvis XR spine XR, CT if stable
Deadly Triad
coagulopathy, hypothermia, acidosis
MGMT of Trauma patient
- Resuscitation: blood products, Transexamic acid (1g IV q 10 mins, then 1g q8 hours)
MGMT of head trauma
seizure MGMT, treat suspected cause of raised ICP, neurosurgical intervention for severe head injury or bleed
spinal cord trauma MGMT
immobilize, treat neurogenic shock, consult spine service
chest trauma MGMT
airway MGMT, thoracotomy for blunt vs. penetrating trauma, surgical intervention for life threatening injuries
abdominal trauma MGMt
laparatomy for hemodynamically unstable and hollow organ injuries
orthopedic injury MGMT
reduce, immobilize when possible, analgesia, consult ortho
