Trauma Assessment and Management Flashcards
1
Q
Assessment and management priorities?
A
- rapid primary survey
- resuscitation of vital fxns
- detailed secondary survey
- intitiate definitive care
(primary survey and resuscitation of vital fxns are done simultaneously)
2
Q
Primary survey components?
A
- A: airway maint, and C spine control
- B: breathing and ventilation
- C: circulation and hemorrhage control
- D: disability - neuro status
- E: exposure, completely undress pt
3
Q
Primary survey: airway/C-spine?
A
- open airway, suction, insert mechanical airway don’t hyperextend neck:
keep neck immobilized
you can’t immobilize neck w/o complete spinal immobilization - assume a cervical fx in any multi-trauma pt and w/ any blunt injury above the clavicle
- cross-table lateral C-spine film to see all 7 C vertebrae and C7-T1 interspace**
4
Q
Primary survey: breathing? 3 conditions that most often compromise ventilation?
A
- expose pt’s chest:
need to be able to see chest movements, pt airway doesn’t ensure adequate ventilation - O2 and vol need to be delivered so BMV device is optimal - can’t insure adequate O2 w/ simple mask or nasal cannula
- 3 conditions most often compromise ventilation:
tension pneumo
open pneumo
large flail section w/ pulm contusion
5
Q
Primary survey: circulation?
A
- bllod vol and circ: hypotension must be assumed to be hypovolemic until proven otherwise
rapid assessment based on 3 key factors:
-state of consciousness: when more than 50% of blood vol is gone everyone is unconscious - therefore if they are awake - brain is being perfused (less than 50%)
-skin color: pink face ans extremiteis mean no hypovolemia. Ashen, gray skin and white drained extremities - at least 30% loss - pulse: carotid and femoral present less than 50% loss, absent femoral and/or carotid pulse means that more than 50% loss and death is imminent
- obvious eternal bleeding should be controlled during primary survey - direct pressure is the best, tourniquet may be necessary for traumatic amputation
6
Q
Primary survey: disability?
A
Brief neuro exam: AVPU is useful acronym - A - alert? V - responsive to verbal stimuli P - responds to painful stimuli U: unresponsive - check pupil size and rxn - decrease in LOC during serial exams means decreased cerebral perfusion - check 02, perfusion, ventilation status - GCS is used in secondary survey
7
Q
Primary survey: exposure?
A
- all pts must be completely undressed
- cut away all clothing, shoes
- remove all field dressings and look underneath:
remember the ED is generally a cold place and hypothermia will worsen shock states
following primary survey - keep pt covered w/ blankets or use Bair hugger
8
Q
Components of resuscuitation phase?
A
- airway/ventilate/oxygenate
- IV lines/warm fluids
- shock management:
control bleeding/start IV accss lines, crystalloid - manage life-threatenign injuries
- foley cath and NG tube may be placed if not CI
9
Q
Never tx hypovolemic shock w/?
A
- never w/ vasopressors
- bolus of 2-3 L of NS to tx shock while awaiting blood
10
Q
Why should EKG monitoring be done on pt in shock?
A
- bc afib, PVCs, ST seg changes may indicate cardiac contusion
- PEA may indicate tamponade, tension pneumo or class IV hemorrhage
- bradycardia due to hypoperfusion or hypothermia
11
Q
Head exam of the secondary survey?
A
- eyes: pupil size and reactivity, fundi for hemorrhage, lens for dislocation, and evidence of conjunctival laceration or penetrating trauma. Test VA by confrontation, and remove contact lenses
- maxillofacial trauma: if no airway obstruction, tx for these injuries can wait 7-1 days, cribiform plate fxs - place NG tube through mouth
12
Q
Neck/C-spine - secondray survey?
A
- all blunt injury to maxillofacila area have c spine injury until proven otherwise
- absence of neuro deficit or pain doesn’t rule out C spine injury
- any/all sports or other helmets must be removed while maintaining c-spine immobilization
- penetrating trauma through platysma shouldnt’ be explored in the ED
13
Q
Secondary assessment of the chest?
A
- visually inspect the entire chest (ant and post)
- palpate entire chest:
feel each rib, clavicle, palpate sternum for fx or tenderness - auscultate chest:
high on ant chest for pneumo, post base for hemothorax - distant heart sounds may indicate tamponade, neck veins may not be distended due to hypovolemia and narrow PP may be only sign of tamponade
14
Q
Seconary assessment of abdomen?
A
- abd injuries may be occult and potentially dangerous
- specific dx isn’t as impt as recognizing that abdominal injury has occurred
- initial abd exam may be negative, serial abdominal exams over 1-several hours must be done
- call surgeons early and frequently
- FAST has replaced DPL as quick, nonivasive way to detect free fluid (Blood) in abdomen
15
Q
secondary survey - rectal exam?
A
essential part of q secondary survey:
- assess for presence of blood in bowel lumen
- a high riding prostate
- presence of pelvic fx
- integrity of rectal wall
- quality of sphincter tone
