trauma and surgical skills Flashcards
what are the ABCDEs of trauma management
Airway/c spine protection
Breathing/life threatening chest injury
Circulation/stop the bleeding
Disability/intracranial mass lesion
Exposure/Environment/body temp
what is the leading cause of death in the first four decades of life
trauma
other causes of rapid death:
- major CV injury
- major neuro injurt
- -we cant do much with causes of rapid deaths, so we approach with prevention
list some causes of early death (2-4 hours post injury)
bleeding from organs (liver, spleen, kidney)
bleeding into the skull/CNS injury
orthopedic injury (long bones, pelvis)
airway compromise and pneumo/hemothoraces
**therapeutic interventions can somewhat prevent deaths from these injuries
what causes late deaths (2-3 week post injury)
infectious mechanisms
multiple organ dysfunction
what does TEAM stand for
Trauma Evaluation And Management
what are the precepts of TEAM approach
**Treat the greatest threat to life first
Definitive diagnosis is less important
Physiologic approach
**Time is of the essence
Do no further harm
what is the TEAM sequence
- rapid primary survey/resuscitation of vital functions simultaneously
- -ABCDEs
- -adjuncts - detailed secondary survey/re-evaluations of vital functions simultaneously
- -head to toe
- -adjuncts - safe transfer
- definitive care
how do you perform a primary survey generally
- assess airway patency
- assess breathing adequacy
- assess organ perfusion
- assess neuro disability/responsiveness
- assess exposures/environment
how do you assess airway patency in a primary survey
listen/look for gurgling, stridor, ventilation and oxygenation
how do you assess breathing adequacy in a primary survey
chest rise–synchronous, equal?
breath sounds and air entry
rate/effort
color/sensorium
adjunct–> CXR (great screening test for airway compromise)
example of problem–> tension pneumothorax will show decreased breath sounds, hypotension, hyperresonance, JVP change, tracheal deviation
how do you assess organ perfusion in a primary survey
loss of consciousness (brain)
skin color and temp
pulse rate and character
heart sounds and ECG
tachy? –> seen at 15% of blood loss
vasoconstriction?
hypotension? –> seen at 30% blood loss
how do you assess neuro disability/responsiveness in a primary survey
GCS (EVM-456)
seizure activity or abnormal movements
how do you assess exposures/environment in a primary survey
observe the entire patient
keep then adequately warm
list some adjuncts to a primary survey
- monitoring
- vital signs
- ABCs
- ECG
- pulse ox
- end tidal CO2 - diagnostic tools
- chest/pelvis xray
- c spine xray when appropriate
- DPL
- FAST
what are the main points of trauma resuscitation
- if in doubt, establish a definitive airway
- oxygen for all trauma patients
- chest tube may be definitive for chest trauma
- stop the bleeding!
- two large calibre IVs
- prevent hypothermia
how should you manage bleeding in a trauma patient thats causing shock?
stop it
use direct pressure or operation but avoid blind clamping
- -assess breath sounds and use CXR for thoracic bleed
- -pelvic xray for pelvic bleed (most bleeds in this area are from a pelvic fracture)
- -peritoneal U/S for abdo bleeding (FAST)
what are the components of a secondary survey
AMPLE history
head to toe physical exam (including complete neuro exam)
special diagnostic tests
re-evaluation
what is an AMPLE history
Allergies Meds Past illnesses/surgery Last meal Events/environment
on your head to toe physical exam in your secondary survey, what should you focus on in the:
head
GCS
neuro
on your head to toe physical exam in your secondary survey, what should you focus on in the:
cspine
tenderness, motor/sensory exam
xray
on your head to toe physical exam in your secondary survey, what should you focus on in the:
neck
airway injury (stridor, hoarseness, crepitus)
blunt (usually occult) or penetrating injury
on your head to toe physical exam in your secondary survey, what should you focus on in the:
chest
CXR
inspect, auscultate, palpate etc
re evaluate frequently
on your head to toe physical exam in your secondary survey, what should you focus on in the:
abdomen
hard to physically and radiologically examine but still do it
re eval frequently (can take a lot of blood before there are signs)
special tests–> DPL and FAST, CT if hemodynamucally stable
on your head to toe physical exam in your secondary survey, what should you focus on in the:
CNS
motor and sensory exam with imaging as indicated
record this well, often over time to see if improvement or worsening and how fast
