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MBBS 3: Surgery > Trauma Assessment and Resuscitation > Flashcards

Trauma Assessment and Resuscitation Flashcards

1
Q

What is ATLS?

A

Training program for medical providers in the management of acute trauma cases/emergencies
- Advanced Trauma Life Support

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2
Q

What is the ATLS Concept?

A

A - Airway
B - Breathing
C - Circulation
D - Disability/Neurologic status
E - Exposure/Environment

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3
Q

Components of initial assessment/management?

A
  1. injury
  2. primary survey
  3. resuscitation
  4. reevaluation
  5. secondary survey
  6. reevaluation
  7. optimize patient status
  8. transfer
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4
Q

What is initial assessment?

A

primary survey and resuscitation of vital functions are done simultaneously - a team approach

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5
Q

How do you assess the airway?

A
  1. LOOK
    - Inspect for any foreign bodies
  2. 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
  3. FEEL
    - Inspect for any foreign bodies
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6
Q

Airway interventions?

A
  1. Supplemental oxygen
  2. Suction
  3. Chin lift/jaw thrust
  4. Oral/nasal airways
  5. Definitive airways
    - RSI for agitated patients with c-spine immobilization
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7
Q

When to do chin lift/jaw thrust?

A

when the tongue has rolled back into the mouth

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8
Q

Describe an oral airway intervention?

A

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

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9
Q

Describe a nasal airway intervention?

A

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)

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10
Q

What is a definitive airway?

A

a tube placed in trachea with cuff inflated below the vocal cords connected to oxygen enriched assisted ventilation and is secured in place

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11
Q

Features of a definitive airway?

A
  1. tube connected to oxygen enriched assited ventilation
  2. airway is secured in place with a tape
  3. tube placed in the trachea
  4. the cuff is inflated below the vocal cords
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12
Q

Types of definitive airway?

A
  1. orotracheal
  2. nasotracheal
    e.g. endotracheal intubation
  3. surgical airways
    e.g. cricothyroidotomy/tracheostomy
    Note: cricothyroidotomy does not need sedation
  4. rapid sequence intubation/induction
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13
Q

What is rapid sequence induction?

A

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

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14
Q

Whats the primary survey for a patient with a suspected C-spine injury?

A
  1. spinal protection
  2. C-spine x-ray when appropriate
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15
Q

How do you assess breathing?

A
  1. 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
  2. CXR to evaluate lung fields
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16
Q

Breathing interventions?

A
  1. Ventilate with 100% oxygen
  2. Needle decompression if tension pneumothorax suspected
  3. Chest tubes for pneumothorax / hemothorax
  4. Occlusive dressing to sucking chest wound
  5. Analgesia for flail chest
17
Q

How do you assess circulation?

A

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

18
Q

Circulation interventions?

A
  1. CPR
  2. Control hemorrhage
    - Pressure
    - Splint
    - Explore and clip
    - Surgery
  3. Establish IV access
    - 2 large bore IVs
    - Central lines if indicated
  4. Cardiac tamponade decompression if indicated
  5. Volume resuscitation
19
Q

Contraindications of foley catheter?

A

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

20
Q

Describe fluid resuscitation?

A

1-2 LITRES IN ADULT
20ML/KG IN CHILDREN

21
Q

Assessment of disability?

A

baseline neurologic evaluation
1. GCS scoring
2. pupillary response
- observe for neurologic deterioration

22
Q

What is AVPU?

A

criteria for neurologic evaluation
1. Alert
2. Verbal
3. Pain
4. Unresponsive

23
Q

Describe the AVPU score?

A

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

24
Q

Name the common causes of decreased mental status which are easiest to address?

A
  1. hypoxia
  2. glucose
25
Q

Assessment of exposure?

A
  1. Complete disrobing of patient
  2. Logroll to inspect back
  3. Rectal examination
  4. Warm blankets/external warming device to prevent hypothermia which leads to coagulopathy.
26
Q

Describe the process of resuscitation?

A
  1. protect and secure the airway
  2. ventilate and oxygenate
  3. stop the bleeding
  4. vigorous shock therapy
  5. protect from hypothermia
27
Q

What are the adjuncts to primary survey?

A
  1. vital signs
  2. ABGs
  3. pulse oximeter and CO2
  4. urinary/gastric catheters unless contraindicated
  5. urinary output
  6. ECG
28
Q

Diagnostic tools for adjuncts to primary survey?

A
  1. chest and pelvic x-rays
  2. DPL
  3. ultra sounds
29
Q

Describe reevaluation?

A

proceed to secondary survey after
1. primary survey completed
2. ABCDEs are reassessed
3. vital functions returning to normal

30
Q

Key components of secondary survey?

A
  1. history
  2. physical examination : head to toe
  3. tubes and fingers in every orifice
  4. complete neuro exam
  5. special diagnostic tests
  6. reevaluation
31
Q

History in secondary survey?

A

A - Allergies
M -Medications
P - Past illnesses
L - Last meal
E - Events/Environment
Note: remember mechanisms of injury

32
Q

Normal heart rate by age?

A

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

33
Q

Normal BP by age in children and adolescents?

A

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

34
Q

Normal respiratory rate by age?

A

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

35
Q

What is GCS?

A

practical method for assessment of impairment of conscious level in response to defined stimuli

36
Q

How to score GCS?

A

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)

MBBS 3: Surgery (42 decks)

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