Trauma Assessment & Management Flashcards
Assessment and Management Priorities
Rapid primary survey
Resuscitation of vital functions
Detailed secondary survey
Initiate definitive care
Components of Primary Survey
A: airway and c-spine control B: breathing and ventilation C: circulation and hemorrhage control D: disability (neuro status) E: exposure (completely undress patient)
Airway and C-Spine Control
Open airway
Suction airway
Insert mechanical airway
Immobilize neck
Diagnostic Test for Clearing of C-Spine
Cross-table lateral C-spine film
Breathing
Look for chest movement
Patent airway does not equal adequate ventilation
Need oxygen and volume
3 Conditions that Compromise Ventilation
Tension pneumothorax
Open pneumothorax
Large flail section with pulmonary contusion
Circulation
Hypotension: assume hypovolemia
State of consciousness
Skin color
Pulse
How much blood loss must occur prior to becoming unconscious?
50% or more
How much blood loss must occur to having ashen, grey skin and white, drained extremities?
30% or more
How much blood loss must occur prior to losing carotid and femoral pulses?
50% or more
Primary Survey and Obvious Bleeding
Control via direct pressure
Disability Acronym
AVPU
What does AVPU stand for?
A: alert
V: verbal stimuli
P: pain stimuli
U: unconscious
Other Tests for Disability in the Primary Survey
Pupil size and reaction
Decrease in LOC
Exposure
Completely undress patients
Cut away clothing, shoes, etc.
Remove all field dressing and assess
Resuscitation Phase of Trauma Assessment and Management
Airway/ventilation/oxygenate IV lines/warm fluids Shock management Manage life-threatening injuries Foley catheter and NG tube
What EKG changes may indicate cardiac contusion?
Atrial fibrillation
PVCs
ST segment changegs
What EKG change may indicate tamponade, tension pneumothorax, or class IV hemorrhage?
PEA
What EKG change may be due to hypo perfusion or hypothermia?
Bradycardia
Secondary Survey: Head
Pupil size and reactivity Fundi for hemorrhage Lens for dislocation, evidence of conjunctival laceration or penetrating trauma REMOVE CONTACTS Maxillofacial trauma
Secondary Survey: Neck/C-Spine
All blunt injury to maxillofacial area
Absence of neurological deficit or pain does NOT rule out injury
All helmets must be removed while maintaining immobilization
Penetrating trauma through platysma should be assessed in the OR
Secondary Survey: Chest
Visually inspect
Palpate entire chest: ribs, clavicles, sternum
Auscultate chest: apex, bases
Secondary Survey: Abdomen
Recognize abdominal injury has occurred
Serial exams over several hours
Call surgeons early and frequently
FAST
Secondary Survey: Rectal Exam
Assess presence of blood in bowel lumen High-riding prostate Presence of pelvic fracture Integrity of rectal wall Quality of sphincter tone
Secondary Survey: Fractures
Visualize extremities
Palpate bones: tenderness, crepitation, abnormal movements
Document peripheral pulses and distal neurological status
Thoracic and lumbar spine injuries
Secondary Survey: Neurological
Motor and sensory check
Evidence of paralysis or paresis
Evidence of epidural/subdural hematoma, depressed skull fractures, or other intracranial injuries
Glascow Coma Scale
Eye Opening of Glasgow Coma Scale
4: spontaneous
3: speech
2: pain
1: none
Verbal Response of Glasgow Coma Scale
5: oriented
4: confused
3: inappropriate
2: incomprehensible
1: none
Motor Response of Glasgow Coma Scale
6: obeys commands
5: localizes to pain
4: withdraws from pain
3: flexion to pain
2: extension to pain
1: none
Definitive Care Phase
Comprehensive management
Fracture stabilization
Operative intervention
Stabilization and transfer
AMPLE History
A: allergies M: medications P: past illnesses/surgeries L: last intake E: events leading up to event
Energy Waves in Blunt Trauma
Extends from blunt trauma
Energy Waves in Missile Trauma
Extends lateral from missile trauma
Likely Frontal Impact Injuries
C-spine
Central flail chest
Myocardial contusion
Fractures spleen/liver
Likely Side Impact Injuries
Contralateral neck sprain or cervical fracture Lateral flail chest Pneumothorax Acceleration injury to aorta Fractured pelvis or acetabulum
Penetrating Trauma/GSW
Region of body Distance of object from source Temporary cavitation Missile deformity after entering body Tissues impacted
