Trauma Assessment and Management Flashcards
Assessment and Management Priorities? 4
- Rapid Primary Survey
- Resuscitation of vital functions
- Detailed Secondary Survey
- Initiate Definitive Care
PRIMARY SURVEY? 5
A – Airway maintenance and C-spine control B – Breathing and ventilation C – Circulation and hemorrhage control D – Disability: Neurological status E – Exposure: Completely undress patient
Trauma Assessment and Management
PRIMARY SURVEY: Airway/C-Spine
1. Open airway, suction airway, insert mechanical airway; but do not do what?
- Keep neck immobilized
You CANNOT immobilize the neck without what? - Assume IN ANY MULTI-TRAUMA PATIENT AND WITH ANY BLUNT INJURY ABOVE THE CLAVICLE?
- do not hyperextend neck
- complete spinal immobilization
- ASSUME A CERVICAL FRACTURE
Trauma Assessment and Management
PRIMARY SURVEY: Breathing
Expose the patient’s chest
- Need to be able to see what?
- Patent airway does NOT ensure what?
- Oxygen and volume need to be delivered so the what is optimal?
- CANNOT insure adequate oxygen with just what? 2
- Three conditions most often compromise ventilation?
- chest movements
- adequate ventilation
- BMV device
- simple mask or nasal cannula
- Tension pneumothorax
- Open pneumothorax,
- Large flail section with pulmonary contusion
Trauma Assessment and Management
PRIMARY SURVEY: Circulation
- Blood volume and circulation: Hypotension must be assumed to be what until proven otherwise?
- Rapid assessment is based on 3 key factors?
- Bleeding: Obvious external bleeding should be controlled during the primary survey… What is the best method?
- What may be necessary for traumatic amputation?
- hypovolemic
- State of consciousness
- Skin Color
- Pulse
- DIRECT PRESSURE
- Tourniquet
Rapid assessment is based on 3 key factors
1. State of consciousness: How you can assess how much blood has been lost just on primary assessment?
- Which symptoms = no significant hypovolemia? Which do?
- If carotid and femoral pulse are present? If they are not?
- When >50% blood volume is gone everyone is unconscious; therefore if they are awake, the brain is being perfused (less than 50%)
- Pink skin of face and extremities means no significant hypovolemia; ashen, grey skin and white, drained extremities = at least 30% loss
- Carotid or Femoral pulse present less than 50% loss; absent femoral and/or carotid pulse > 50% loss and death is imminent
Trauma Assessment and Management
PRIMARY SURVEY: Disability
1. Brief Neuro Exam? 4
- Eyes?
- Decrease in LOC during serial exams means decreased what?
- if so check? 3 - Secondary survey for neuro includes?
1. “AVPU” is a useful acronym Alert? V responds to Verbal stimuli P responds to painful stimuli Unresponsive
- Check pupillary size and reaction
- Decrease in LOC during serial exams means decreased cerebral perfusion….
- check oxygenation, perfusion, and ventilation status - Glasgow Coma Scale is for secondary survey
Trauma Assessment and Management
PRIMARY SURVEY: Exposure
- What should you do with the patients clothing?
- Field dressings?
- Remember, the ED is generally a cold place. What is the problem with this?
- Following Primary Survey, keep patient covered with what?
- All patients must be completely undressed. Cut awayall clothing, shoes etc
- Remove all field dressings and look underneath
- hypothermia will worsen shock states
- blankets or use Bair Hugger except while doing specific exams or procedures
Trauma Assessment and Management
What is involved in the resuscitation phase?
5
- Airway/Ventilate/Oxygenate
- IV Lines/Warm Fluids
- Shock Management
- Manage life-threatening injuries
- Foley catheter and NG tube may be placed if NOT contraindicated
How do we start shock management? 2
- Control bleeding/Start IV access lines
2. Crystalloids
Trauma Assessment and Management
Resuscitation Phase
- Supplemental O2 on all patients (sats >?)
- Start two (2) large-bore (16g) IV lines
-Draw “rainbow” when starting IV lines
Bolus with what to treat shock while awaiting blood? - Hypovolemic shock is never treated with what?
- Consider what after NS?
- ECG monitoring on all patients; what changes may indicate cardiac contusion? 3
- PEA may indicate what? 3
- Bradycardia may be due to what? 2
- NG tube and foley placement
- NO NG tube with possible what?
- NO Foley in males with what? 3
- 90%
- Bolus with 2-3L NS
- vasopressors
- type specific or O-neg blood
- atrial fibrillation,
- PVCs, and
- ST segment changes
- tamponade,
- tension pneumothorax or
- Class IV Hemorrhage
- hypoperfusion or
- hypothermia
- cribiform plate fractures
- blood at meatus or in scrotum or high-riding prostate
- What must be done before the secondary survey is considered?
- What is involved in this step?
- Primary Survey must be accomplished and resuscitation phase started before any secondary survey is considered
- This is where labs are drawn and diagnostic testing obtained
Secondary survey
1. Eyes? 6
- Maxillofacial trauma: If no Airway obstruction, treatment for these injuries can wait how long?
- Cribiform plate fractures – place NG through?
- Eyes:
- Pupil size and reactivity
- fundi for hemorrhage
- lens for dislocation
- evidence of conjunctival laceration or penetrating trauma.
- Test VA by confrontation.
- Remove contact lenses. - Maxillofacial Trauma: 7-10 days.
- mouth.
Trauma Assessment and Management
SECONDARY SURVEY
Neck/C-Spine
- All blunt injury to maxillofacial area have what until proven otherwise?
- Absence of what does NOT rule-out C-Spine injury?
- Any/all sports or other helmets must be removed while maintaining what?
- Penetrating trauma through the what should NOT be explored in the ED?
- C-Spine injury
- neurological deficit or pain
- C-Spine immobilization
- platysma
Trauma Assessment and Management
SECONDARY SURVEY
Chest
Visually inspect the entire chest (anterior and posterior)
- Palpate the entire chest: such as? 3
Auscultate the chest
2. High on anterior chest for
- Posterior bases for what?
- Distant heart sounds may indicate what?
- Neck veins may not be distended due to what?
- and narrow pulse pressure may be only sign of what?
- Feel each rib and follow its course
- Feel each clavicle
- Palpate the sternum for fracture or tenderness
- pneumothorax
- hemothorax
- tamponade
- hypovolemia
- tamponade