Trauma Assessment and Managment Flashcards
Priorities in Scene Assessment
- Danger
- How many patients there are
- Backup/additional recourses needed
- Kinematics
- Triage (dead dead or not)
Things that Effect Scene Safety
- Chemicals/gas
- Fire
- Sharps on ground
- Weapons/hostiles
- Electricity
- Traffic and weather conditions
Primary Survey
d anger
r esponse - AVPU
c atosrophic haemorrhage
A irway (c) - patent? open airway, maintain?, c spine considerations
B reathing - rate, effort, sound, colour, sats
C irculation - colour, other bleeding, pulses, CRT, BP
D isability - pupils and GCS
E xpose - completely expose for inuries, prevent hypothermia
Motor Response of GCS
- Obeys Command
- Localises to pain
- Withdraws from pain
- Flexion to pain
- Extension to pain
- No motor response
Verbal Response GCS
- Orientated
- Confused
- Inappropriate words
- Nonsensible sounds
- No verbal response
Eyes GCS
- Eyes open spontaneously
- Eyes open to speech
- Eyes open to pain
- Eyes not opening
Methods of External Haemmorhage Control (7)
- Direct Pressure - pressure onto the bleeding site eg digital pressure
- Indirect Pressure - not on site (needs to be practised with good A&P knowledge)
- Wound Packing
- Tourniquets
- Haemostatic Dressing (celox) - prompts clotting (must be put into wound bed, don’t put into cavities as need definitive end point)
- Elevation
- Traction
Where are the 4 Spaces for Interal Haemorrhage?
- Thoracic cavity
- Abdomen
- Pelvis - binding
- Long bones - splinting
Secondary Survey (In Order)
- ‘Smurf test’
- Full set of obs
- Access
- Drugs/Fluids
- History taking (AMPLE)
- Pain management
What is an AMPLE History?
A llergies
M edications
P ast Medical history
L ast meal
E vents preceding injury
IPPA Assessment
Inspection - evaluate each region, observe for soft tissue injuries, deformities
Palpate - distension, pulses, crepitus, surgical emphysema, tenderness/pain
Percuss - chest injuries, hypo/hyperresonance
Auscultation - noisy breathing, equal air entry, adventitious sounds
List of Critical Patients
- Inadequate or threatened airway
- Impaired ventilation
- Significant haemorrhage (external or suspected internal)
- Abnormal neurological status
- Penetrating trauma to the head, neck or torso
- Amputation/near amputation
- Trauma in presence of other significant findings
General Treatment Principles in Trauma
- ‘treat as you go’ philosophy
- Focus on life-threatening issues then rapid transfer
- Limited on scene time to 10 minutes (if possible)
Fluid Resuscitation Procedure
- Sodium chloride solution (with caution)
- Two large bore cannulas (14-16 gauge)
- En route procedures
When to give Fluids and When not to
- if 90 or over NO fluids
- If talking then NO fluids
- Too much fluids being given will reduce clotting capabilities
- Think permissible hypotension
Pain Releif Options and Cautions
- Only done after primary survey
- Use pain management ladder
- IVP
- Morphine - be cautious as it will cause vasodilation (drop of up to 10 systolic)
- Entonox - careful of head/chest injuries
- Penthrox
- Ketamine (CCP)
- Positional Relief eg splinting a mid shaft-femur fracture
ATMIST Handover
- A ge
- T ime of incident/of arrival
- M echanism of Injury
- I njuries suspected/seen
- S igns (obs)
- T reatment given
COMA
A good acronym for the second crew or second crewmate as useful tasks to do while another clinician is doing primary survey
C - clothes off
O - oxygen on (high flow)
M - monitoring
A - access
What Looking for In Top to Toe: Scalp
- Lacs to scalp can bleed a lot and will require a dressing
- Boggy mass indicates head trauma and possible head injury
What Looking for In Top to Toe: Face
- Look for facial fractures
- Battle sign and raccoon eyes are characteristic of facial fractures
- Each classification creates different airway problems, sometimes due to haemorrhage where blood enters the airways or a fragment collapsing backwards into the pharynx
- Look for any CSF leaking out of the ears (TBI)
What Looking for In Top to Toe: Neck
- Feel down bony structures of neck
- Any penetrating trauma
- Deviated trachea
What Looking for In Top to Toe: Abdomen
- See if distended/hard
- Look for bruising and wounds
What Looking for In Top to Toe: Pelvis
- Does the pelvis shift and have little structure
- Is it equal on both sides? can tell by positioning of iliac crest
What Looking for In Top to Toe: Limbs
- Feel for open or closed fractures
- Any other bleeding wounds
- Check gloves for blood systematically
- Do pay attention to hands and feet to note any potential life changing injuries
