Trauma Assessment and Resuscitation Flashcards
What is ATLS?
Training program for medical providers in the management of acute trauma cases/emergencies
- Advanced Trauma Life Support
What is the ATLS Concept?
A - Airway
B - Breathing
C - Circulation
D - Disability/Neurologic status
E - Exposure/Environment
Components of initial assessment/management?
- injury
- primary survey
- resuscitation
- reevaluation
- secondary survey
- reevaluation
- optimize patient status
- transfer
What is initial assessment?
primary survey and resuscitation of vital functions are done simultaneously - a team approach
How do you assess the airway?
- LOOK
- Inspect for any foreign bodies - LISTEN
- Is the patient able to communicate verbally?
- stridor : high pitched whistling sound heard while taking in a breath
- hoarseness : changes in pitch or quality of voice which may sound weak, husky or scratchy
- gurgling : hollow bubbling sound
- pooled secretions or blood - FEEL
- Inspect for any foreign bodies
Airway interventions?
- Supplemental oxygen
- Suction
- Chin lift/jaw thrust
- Oral/nasal airways
- Definitive airways
- RSI for agitated patients with c-spine immobilization
When to do chin lift/jaw thrust?
when the tongue has rolled back into the mouth
Describe an oral airway intervention?
oropharyngeal airway
- a rigid curved device placed in the mouth to prevent the tongue from occluding the airway
Note: to be used on unconscious patients with airway obstruction - no gag reflex
e.g. guedel airway
Describe a nasal airway intervention?
nasopharyngeal airway
- a soft flexible tube inserted through the nares into the nasopharynx to prevent the tongue from occluding the airway
Note: used in patients with current or potential oropharyngeal obstruction and contraindicated in facial fractured, basilar fractures and coagulopathy (nosebleed)
What is a definitive airway?
a tube placed in trachea with cuff inflated below the vocal cords connected to oxygen enriched assisted ventilation and is secured in place
Features of a definitive airway?
- tube connected to oxygen enriched assited ventilation
- airway is secured in place with a tape
- tube placed in the trachea
- the cuff is inflated below the vocal cords
Types of definitive airway?
- orotracheal
- nasotracheal
e.g. endotracheal intubation - surgical airways
e.g. cricothyroidotomy/tracheostomy
Note: cricothyroidotomy does not need sedation - rapid sequence intubation/induction
What is rapid sequence induction?
rapid induction of anaesthesia and paralysis followed by immediate intubation without intervening attempts at ventilation
- used when patient is at risk of aspiration
e.g. nonfasting state, GI bleed, bowel obstruction, pregnancy
Whats the primary survey for a patient with a suspected C-spine injury?
- spinal protection
- C-spine x-ray when appropriate
How do you assess breathing?
- Inspect, palpate, and auscultate
- Respiratory distress – RR, work of breathing
- Deviated trachea, crepitus, flail chest, sucking chest wound, absence of breath sounds
- Saturations, mental status - CXR to evaluate lung fields
Breathing interventions?
- Ventilate with 100% oxygen
- Needle decompression if tension pneumothorax suspected
- Chest tubes for pneumothorax / hemothorax
- Occlusive dressing to sucking chest wound
- Analgesia for flail chest
How do you assess circulation?
Rapid assessment of hemodynamic status
1. Level of consciousness
2. Skin color and temperature
3. Pulses rate
4. Blood pressure and pulse pressure
5. Cool peripheries
Note: Hemorrhagic shock should be assumed in any hypotensive trauma patient
Circulation interventions?
- CPR
- Control hemorrhage
- Pressure
- Splint
- Explore and clip
- Surgery - Establish IV access
- 2 large bore IVs
- Central lines if indicated - Cardiac tamponade decompression if indicated
- Volume resuscitation
Contraindications of foley catheter?
signs of possible urethral injury
1. Blood at urethral meatus
2. Perineal eccymosis
3. Blood in the scrotum
4. High riding prostate
5. Pelvic Fractures
Note: If suspicious of urethral injury -retrograde urethrogram prior to insertion
Describe fluid resuscitation?
1-2 LITRES IN ADULT
20ML/KG IN CHILDREN
Assessment of disability?
baseline neurologic evaluation
1. GCS scoring
2. pupillary response
- observe for neurologic deterioration
What is AVPU?
criteria for neurologic evaluation
1. Alert
2. Verbal
3. Pain
4. Unresponsive
Describe the AVPU score?
system by which a health care professional can measure and record a patients level of consciousness
Alert = GCS 15
Voice = GCS 13
Pain = GCS 8
Unconscious = GCS 6
Name the common causes of decreased mental status which are easiest to address?
- hypoxia
- glucose
Assessment of exposure?
- Complete disrobing of patient
- Logroll to inspect back
- Rectal examination
- Warm blankets/external warming device to prevent hypothermia which leads to coagulopathy.
Describe the process of resuscitation?
- protect and secure the airway
- ventilate and oxygenate
- stop the bleeding
- vigorous shock therapy
- protect from hypothermia
What are the adjuncts to primary survey?
- vital signs
- ABGs
- pulse oximeter and CO2
- urinary/gastric catheters unless contraindicated
- urinary output
- ECG
Diagnostic tools for adjuncts to primary survey?
- chest and pelvic x-rays
- DPL
- ultra sounds
Describe reevaluation?
proceed to secondary survey after
1. primary survey completed
2. ABCDEs are reassessed
3. vital functions returning to normal
Key components of secondary survey?
- history
- physical examination : head to toe
- tubes and fingers in every orifice
- complete neuro exam
- special diagnostic tests
- reevaluation
History in secondary survey?
A - Allergies
M -Medications
P - Past illnesses
L - Last meal
E - Events/Environment
Note: remember mechanisms of injury
Normal heart rate by age?
newborn : 100-160
0-5 months : 90-150
6-12 months : 80-140
1-3 years : 80-130
3-5 years : 80-120
6-10 years : 70-110
11-14 years : 60-105
15 years or older : 60-100
Normal BP by age in children and adolescents?
1-12 months : 75-100/50-70
1-5 years : 80-110/50-80
6-13 years : 85-120/55-80
14-18 years : 95-140/60-90
Normal respiratory rate by age?
newborn : 30-50
0-5 months : 25-40
6-12 months : 20-30
1-3 years : 20-30
3-5 years : 20-30
6-10 years : 15-30
11-14 years : 12-20
15-20 years : 12-30
adults : 16-20
What is GCS?
practical method for assessment of impairment of conscious level in response to defined stimuli
How to score GCS?
Sum of scores for
1. best motor response : score of 1-6
2. best verbal response : score of 1-5
3. best eye response : score of 1-4
- Ranges from 3 to 15.
Severe head injury (3-8)
Moderate head injury (9-12)
Mild head injury (13-15)
