Trauma Assessment Flashcards
What is ATLS?
approach to injured patients. It emphasizes the greatest threat to life first, and that a lack of a definitive diagnosis should not impede treatment.
ATLS emphasizes that injury kills in a certain reproducible pattern:
- airway first
- breathing next
- loss of circulating blood volume
- intracranial bleed
What is the ABCDE approach?
A: airway (with cervical spine protection)
B: breathing
C: circulation
D: disability–> neuro status
E: exposure (remove clothing) and environment (temp control)
What is the primary survey?
your ABCDEs
Describe the process of trauma management?
- prep
- triage
- primary survey
- resuscitation if needed
- adjuncts to primary survey if needed
- secondary survey (head to toe eval and history)
- adjuncts to secondary surey
- continued post resuscitation monitoring and reevaluation
- definitive care
How are patients treated based on the primary survey? what info is important?
- injuries sustained
- vital signs
- injury mechanism
Describe “a”
airway. must eval while protected cervical spine
describe “B”
breathing and ventilation, maximize oxygenation and c02 elimination.
Describe “c”
circulation with hemorrhage control:
- Blood volume and cardiac output: check level of consciousness, skin color, and pulse.
- bleeding
Describe “D”
• Disability (Neurologic evaluation) • Establish level of consciousness o AVPU method • A Alert • V responds to Vocal stimuli • P responds to Painful stimuli • U Unresponsive to all stimuli o Glasgow Coma Scale • Check pupillary size and reaction
Describe “e”
Exposure/Environment Control
• Completely undress the patient by cutting off garments
• Cover with warm blankets or external warming device
• Warm IV fluids
If resuscitation is needed…describe “a”
Primary Survey – A
• Protect airway and secure when potential exists for compromise
• Jaw thrust or chin lift maneuvers
• Nasopharyngeal airway in conscious patient or oropharyngeal airway in unconscious patient
• Consider need for definitive airway
o Endotracheal tube
o Surgical airway
RESUSCITATION: describe “b”
Definitive control of airway with endotracheal intubation – nasally or orally
• Compromised airway due to mechanical factors
• Ventilatory problems
• Unconsciousness
• Tension pneumothorax, flail chest, etc.
• Supplemental oxygen for every injured patient
RESUSCITATION: describe “c”
Control bleeding
• Direct pressure
• Operative intervention
• Establish two large-caliber IV lines (14 or 16 g)
• Rapid administration of fluids (2 – 3 liters) – Ringer’s lactate is initial crystalloid solution (see “Level 1” machine to the left)
• If unresponsive to initial fluids, give blood (O negative if you don’t know what their blood type is)
What are adjuncts to primary survey: assessment and resuscitation?
Adjuncts to Primary Survey and Resuscitation
• X-rays and Diagnostic Studies
• Use judiciously and do not delay resuscitation
• AP chest x-ray and AP pelvis x-ray
• Lateral cervical spine x-ray
• FAST Ultrasound (Focused Assessment with Sonography for Trauma)
o FAST has essentially replaced Diagnostic Peritoneal Lavage
When can you begin secondary survey?
o Secondary Survey does NOT begin until:
• Primary Survey (ABCDEs) is completed
• Resuscitative efforts are well established
• The patient is demonstrating normalization of vital functions
What is secondary survey?
Secondary survey = Head-to toe evaluation of the trauma patient
• More complete history and physical examination
• Includes reassessment of all vital signs
• Each region of the body is completely examined
Includes a complete neurological exam
• Include Glascow Coma Scale score (if not done in the Primary Survey)
o Additional x-ray studies as indicated
o Special procedures (e.g. specific radiologic evaluations and laboratory studies)
Describe secondary survey: HISTORY:
o Include history of mechanism of injury
• Obtain from: patient, prehospital personnel, family
o AMPLE mnemonic is useful for this purpose
• A Allergies
• M Medications currently used
• P Past illnesses/Pregnancy
• L Last meal
• E Events/Environment related to the injury
o Mechanism of Injury
• Obtain information from prehospital personnel
• Note direction and amount of energy force
• Classify injury into three broad categories
• Blunt – Falls, MVC, Penetrating – GSW, stab wounds, impalement, Other – burns / cold / chemicals /radiation / electrical shock, et
What do you need to be aware of on secondary survey PE?
DISTRACTING INJURIES!
SELF ADMINISTERED ANESTHESIA!
Where does the secondary PE begin?
the HEAD
Patients with___________ or _____ ____ should be presumed to have an unstable cervical spine injury
Patients with maxillofacial or head trauma should be presumed to have an unstable cervical spine injury.
- Immobilize neck until complete evaluation is done and injury has been excluded
- Absence of Neuro deficit does NOT exclude C-spine injury. Treat as if patient has C-spine injury until radiography is complete.
What can distended neck veins indicate?
cardiac tamponade or tension pneumothorax
What are the signs of a tension pneumothorax?
- Signs of tension pneumothorax
- Decreased breath sounds
- Hyperresonance to percussion
- Shock
- Treatment - Immediate chest decompression with chest tube or needle
- Auscultation
- Pneumothorax - listen high in anterior chest wall (air will rise to top)
- Hemothorax – listen at posterior bases (blood will accumulate at bottom)
What is Beck’s triad and what disease is it associated with?
Cardiac Tamponade:
o Low SBP / Narrow pulse pressure
o Distended neck veins
o Muffled heart sounds
What is the key study to use for abdomen exams?
FAST
When should you not put a cath in?
• DO NOT put a urinary catheter in a urethra if there is blood at the urethreal meatus!!! also perform a rectal exam before placing cath.
What does a complete neuro exam include?
Complete neurologic exam includes:
• Motor and sensory evaluation of extremities
• Reevaluation of level of consciousness
• Evaluation of pupillary size and response
• Glasgow coma score (GCS) facilitates detection of early changes and trends in the neurologic status
What do you need to be careful with for secondary adjunctive tests?
They often require that patient gets transferred to an area of the hospital. Personnel may or may not be trained to handle that.
What is appropriate urine output?
Monitoring of urinary output
• Adults – 0.5 mL/kg/hour (35 – 50 ml/hour average)
• Pediatrics over one year – 1 mL/kg/hr
For relief of pain, what drugs should be avoided?
IM–> can take too long to start and could overhwlme the system.
