Trauma - Advance Life support - SHOCK

Question 1

Trauma

Principles of Trauma:

Answer 1

Question 2

Burden of trauma nationally - and TSV

Answer 2

Question 3

Mechanism of injury

Strain applied to tissue - Different mechanisms?

Answer 3

Question 4

Phases of trauma:

Acute: Deaths overwheling, massive haemorrhage

Early: Within 24-72hours of admission, more than half are due to Brain injuries, Also sepsis

Late: Complications:

Answer 4

Question 5

What is ATLS? EMST?

ABCDE

Answer 5

• Very safe simple- can follow in all setting

Question 6

ATLS? WHY?

Question 7

What is the Primary Survey?

Answer 7

Question 8

Primary survey:

Answer 8

Question 9

What are adjunct to the primary survey?

Answer 9

Question 10

AIRWAY

Patency and security of airway -1st

What do you need to assess?

Answer 10

Question 11

Procedure: Cricothyroidotomy

• When is it used?

What do you need to incise?

What are other options?

WHEN should you do this?

Answer 11

Question 12

Cervical Spine immobilisation

• What is it?

How?

Answer 12

Question 13

Major bleeding:

how to manage in short term?

Answer 13

Question 14

B: Breathing:

Oxygen and ventilation

Answer 14

Question 15

What are threats to breathing? (in B) and what do we have to evaluate for?

Answer 15

Tension Pneumothorax: needle decompression immediatley

Tamponade- leave

Haemothorax- drain

Question 16

Procedure: Needle Decompression:

Indications?

Causes?

Signs?

NOT a diagnosis

Answer 16

Question 17

Intercostal catheter insertion: CHEST drain

4-6th intercostal space (avoids being in abdomen)

Incision to pleura superior to the rib- avoids intercostal cessels

Puncture Pleural space and finger sweep

Appropriate size tube into pleural space

Attach to water sealed drainage +/- suction

Answer 17

Question 18

C = Circulation

ALL about SHOCK ; always assume its haemorrhagic shock!

Exclude tamponade

Early control of bleeding and effective resuscitation! = Most important part of management

Once hypotensive they are severely shocked! thus dont rely on BP readings alone `

Answer 18

Question 19

Shock:

Assess VS - pulse, BP,

Assess organ perfusion: Confusion, skin perfusion, pulse oximetry, U/O, Blood gases, lactate.

Assess response over time:

Can maintain their physiology with minimal intervention/resuscitation

(three types of patients)

Answer 19

Question 20

Where is the bleeding?

How to investigate-

Chest, log roll, major external haemorrhage, FAST scan, CT- retroperitoneum, pelvic XR FAST.

Answer 20

Question 21

What is a massive transfusion?

What is a massive transfusion protocol?

What are issues with massive transfusion?

How do you prevent/manage this?

Answer 21

1. Coagulopathy
2. acidosis
3. Hypothermia

Prevention/Management:

• Early control of bleeding
• Goal directed resucitation
• Early use of blood products and clotting factors
• ROTEM guided
• Massive Transfusion Protocols

Question 22

TUH Massive transfusion Adult haemorrhage protocol (MHP)

Answer 22

Question 23

Pelvic Binder: Procedure and application:

What is it used for?

What does it aim to do?

What do you need to do prior removal?

Answer 23

Question 24

Intra osseus cannulation

Answer 24

Question 25

Disbaility: What are we trying to assess?

Answer 25

Question 26

E: Exposure:

What are the two major components of exposure

Answer 26

Question 27

Secondary survey:

What is it entail?

Answer 27

Question 28

What are adjuncts to the secondary survey?

Answer 28

Question 29

Tertiary survey:

What does it entail?

What should you do?

What should you review?

Detects undiagnosed injury in up to 10 % of patients

Answer 29

Question 30

Follow up and rehabilitation post Trauma:

Answer 30

Question 31

Summary of ATLS

: ABCDE

Shock is organ perfusion! not BP!

Answer 31