Trauma- assessment, resuscitation, and stabilization Flashcards
What is the third most common cause of death in US?
trauma
What contributes significantly to mortality r/t trauma?
delay or failure to diagnose
75 percent mortality from trauma occurs what hours after the trauma?
within 48 hours
2 most common causes of early mortality trauma related? one third of these die how early after admission?
CNS injuries and hemorrhage; within 4 hours
Most common mechanism of injury and largest number of associated deaths?
motor vehicle injury
Second most common mechanism of injury?
falls
Third most common cause of trauma injury?
gun shot wounds
What type of trauma is associated w the highest percentage of death?
gunshot wounds
What is included in the primary survey?
presence of immediate life threatening injuries, ABCDs
What does ABCDE stand for?
airway, breathing, circulation, disability, exposure
6 situations in which airway is usually compromised?
altered LOC, smoke inhalation injury, maxillo facial injuries, penetrating wound or hematoma to neck, SQ emphysema of face, neck, upper chest, evidence of vomiting
3 of concern wounds related to breathing?
sucking chest wounds, open pneumo, flail segments
How do you evaluate airway?
is it patent?
How do you evaluate breathing?
expose, palpate, auscultate, pattern, tracheal deviation, skin color
How do you evaluate circulation?
2 large bore IVs, pulse rate, character, etc., cap refill, BP, pulse pressure, bleeding, hypovolemia, blood samples, EKG
A palpable radial pulse corresponds with an SBP of what?
> /- 80
A palpable femoral pulse corresponds with an SBP of what?
> /- 70
A palpable carotid pulse corresponds with an SBP greater than or equal to what?
60
Poor cerebral blood flow with an SBP less than?
60
How do you evaluate disability?
neuro status, AVPU, check pupils
AVPU stands for?
alert, responds to verbal stimulus, responds to pain, unresponsive
3 components of GCS?
eyes open, best motor response, best verbal response
How do you evaluate exposure?
expose the patient for complete exam
Goal of resuscitation?
restore tissue oxygenation
Anesthesia’s 3 primary concerns during assessment of trauma patient?
preserve CNS ftn, maintain adequate respiratory gas exchange, achieve circulatory homeostasis
How do you preserve CNS function?
avoid movement of spinal cord in unstable fracture that decreases blood flow to the brain
How do you complete c spine stabilization?
hold head while someone intubates and the front comes off the collar
Avoid NTT/NGTs in patients w what type of fracture?
basilar skull fractures
Whats a technique to try if pt breathing spontaneously, but it increases ICP?
nasal intubation
Awake intubation should be avoided in which type of trauma pt? Why?
vascular neck trauma; gagging coughing can increase ICP and accelerate bleeding
Blind nasal or oral intubation should be avoided in what patients?
blood in airway, maxillofacial injuries bc tissue, bone fragments, or teeth may be pushed into trachea
Cricothyroidotomy is not recommended in which pts?
laryngeal fracture
Cricothyroidotomy is reserved for what pts?
severe facial or upper airway obstruction
The pt is at risk for coagulopathy if they get greater than how much of hetastarch?
1 L
What lethal triad should you avoid in resuscitating a trauma pt?
acidosis, hypothermia, coagulopathy
How do you know there is still bleeding if the pt has been crystalloid resuscitated with 2L?
hr >120
Sign of significant blood loss and cardiac tamponade?
decreased pulse pressure
Most common cause of coagulopathy in trauma pt?
dilutional thrombocytopenia
Dose of Factor VII?
70-90 mcg/kg
In young people hypotension will not develop until what percent of blood volume is lost?
30-40%
In young people tachycardia will not develop until how much blood is lost?
20-25%
Art line in what 3 cases for sure?
chest, neck, head
What happens in the secondary survey?
complete head to toe exam including rectal
AMPLE stands for?
allergies, medications, pmh, pregnancy, last meal, tetanus, and menses, events and environment r/t injury
Ex of penetrating trauma?
knives, bullets, projectiles
Ex of blunt trauma?
accel decel, continuous pressure, shearing, direct impact, rotary forces, disruption of conn tissue, blood vessels, nerves, seen w collisions and falls
What do you want to know from MVA pt?
location, safety devices, site of impact, extent of damage
