Trauma & Burn 1 Flashcards
Abdomen (secondary survey)
- Inspect/auscultate
- palpate/percuss
- reevaluate
- special studies
Perineum (secondary survey)
Contusions, hematomas, laceration, urethral blood, pelvic fx
*Ppl die from pelvic fx
Pelvis (secondary survey)
- Pain on palpation
- Leg length unequal
- Instability
- Do not rock pelvic. Pelvic blood loss is huge!
Compartment syndrome: what to look for
- Out of proportion pain
- Weak or absent of palpation
Neurologic exam: what to report to neurosurgery
The best neurologic exam
How to assess C-spine
- Pt is awake & alert
-
How do you minimize missed injuries?
- High index of suspicion
- Frequent reevaluation and monitoring
How do I know the airway is adequate?
- Patient is alert and oriented.
- Patient is talking normally.
- There is no evidence of injury to the head or neck.
- You have assessed and reassessed for deterioration.
Signs and symptoms of airway compromise
- High index of suspicion
- Change in voice / sore throat
- Noisy breathing (snoring and stridor)
- Dyspnea and agitation
- Tachypnea
- Abnormal breathing pattern
- Low oxygen saturation (late sign)
Protective airway reflexes
- Ability to cough
- Ability to swallow
- Oropharyngeal airway
- Nasopharyngeal airway
How do I manage the airway of a trauma patient?
- Chin lift maneuver/jaw thrust
-
How do I predict a potentially difficult airway?
- Maxillofacial trauma and deformity
- Mouth opening
- Anatomy
- Beard
- Short, thick neck
- Receding jaw
- Protruding upper teeth
Definitive Airway – Easy
- Oral intubation (medication assisted)
- suction, back-up *coricoid pressure is no longer needed
- Maintain c-spine immobilization - Plan for failure:
- Gum elastic bougie
- LMA/LTA
- Needle cricothyroidotomy
- Surgical airway
Induction agent for rapid sequence intubation
Ketamine
- Increase BP (ideal)
Definitive Airway – Difficult
- Get help
- Be prepared
- Consider rapid sequence intubation vs. awake intubation
- Maintain c-spine immobilization - Consider use of:
- Gum elastic bougie
- LMA / LTA
- Surgical airway
- Other advanced airway techniques, eg, fiberoptic intubation
How do I know the tube is in the right place?
- Visualize it going through the cords
- Auscultation
- CO2 detector
What is shock?
Inadequate profusion at cellular level
S/Sx of shock
- Alteration in level of consciousness, anxiety
- Cold, diaphoretic skin
- Tachycardia
- Tachypnea, shallow respirations
- Hypotension
- Decreased urinary output
- In ICU always monitor trend. You don’t rely on one point of values
What is the cause of the shock state? (hypovolemic shock)
- Blood loss
- Fluid loss
What is the cause of the shock state? (nonhemorrhagic shock)
- Tension pneumothorax
- Cardiac tamponade
- Cardiogenic
- Septic
- Neurogenic
Tension pneumothorax
- Clinical diagnosis, not by x-ray
2. Immediate decompression: Needle, chest tube
Frail chest management
- Analgesia
-Intubate as indicated
-
Cardiac tamponade: S/Sx
- Narrowing systolic & diastolic BP
- Distended neck veins
- Muffled heart sounds
- Pulseless electrical activity
Basilar skull fracture: S/Sx
- Racoon eye
- Battle sign
Primary survey: ABCDE
Airway w/ spinal protection Breathing w/ adequate oxygenation Circulation w/ hemorrhage control Disability Exposure/Environment
Who needs special consideration when trauma occur?
Elderly, pediatric, pregnant women
How to assess and ensure adequate oxygenation and ventilation?
RR
Chest movement
Air entry
SpO2
How to assess for organ perfusion?
- Level of consciousness
- Skin color and temp.
- Pulse rate and character
Circulatory management methods
Control hemorrhage, restore volume, reassess Pt
*Watch out for elderly, children, athletes, meds
How do you assess for disability
Baseline neuro eval
1. GCS score 2. pupillary response
How do you assess for exposure/environment?
Completely undress the Pt
Resuscitation: 5 points
- Protect and secure airway
- Ventilate and oxygenate
- Stop bleeding
- Vigorous shock Tx
- Prevent hypothermia
Dx tools for blunt abdominal trauma (BAT)
FAST (focused assessment w/ sonography in trauma)
Secondary survey (definition)
Complete Hx and physical examination
1. Hx; 2. PE; 3. Neuro exam; 4. Dx tests; 5. reeval
When do you start the secondary survey
Primary survey is completed
ABCDEs are reassessed
Vital functions are returning to normal
How do I minimize missed injuries
High index of suspicion
Frequent reeval and monitoring
*Think of what do you do in ICU
When should the transfer occur
ASAP after stabilizing measures are completed:
Airway and ventilatory control
Hemorrhage control
How do I know the airway is adequate
Pt is A&O
Pt is talking normally
No evidence of injury to the head or neck
Assessed and reassessed for deterioration
S/Sx airway compromise
- High index of suspicion
- Change in voice/sore throat
- Noisy breathing (snoring and stridor)
- Dyspnea and agitation
- Tachypnea
- Abnormal breathing pattern
- Low SpO2 (late sign)
Airway management: Basic techniques
Chin-lift maneuver
Jaw-thrust maneuver
Airway management: basic adjuncts
Oropharyngeal airway
Nasopharyngeal airway
How do you know the tube is in the right place (Airway confirmation)
Watch the chest
Auscultation; SpO2; CO2 detector
CXR (definitive)
What is shock
Generalized state of hypoperfusion
Inadequate O2 delivery –> catecholamines and other responses –> anaerobic metabolism –> cell dysfunctinon –> cell death
Shock: S/Sx
Altered LOC, anxiety; cold, diaphoretic skin; tachycardia; tachypnea, shallow resp.; HoTN; decreased urinary output
Two causes of shock state
Hypovolemic: blood/fluid loss
*Trauma Pts often 2/2 blood loss
Nonhemorrhagic: tension pneumothorax, cardiac tamponade, cardiogenic, septic
How do you locate the bleeding
Physical exam
Diagnostic adjuncts: CXR, FAST, pelvic X-ray
Technique for stop bleeding
Direct pressure/tourniquet Angio-embolization Reduce pelvic volume Splint fx Operation
Class 1 hemorrhage: Definition, S/Sx, what to give
750 mL BVL (15%)
S/Sx: slightly anxious, normal BP, HR < 100 bpm, RR wnl, urinary output 30 mL/hr
Crystalloid
Class 2 hemorrhage: Definition, S/Sx, what to give
750-1500 mL BVL (15-30%) loss
S/Sx: anxious, BP wnl, HR > 100 bpm, decreased pulse pressure, RR 20-30/min, urinary output 20-30 mL/hr
Crystalloid, ?blood?
Immediately life-threatening chest injuries (6)
- Larygeotracheal injury/airway obstruction; 2. Tension pneumothorax; 3. Open pneumothorax; 4. Flail chest and pulmonary contusion; 5. massive hemothorax; 6. cardiac tamponade
