Trauma - Exam 2 Flashcards
What are the components of the primary survey? What are the components of the secondary survey? What should you do if there is any change in pt’s status?
Primary Survey:
Airway
Breathing
Circulation
Disability
Exposure
Secondary Survey:
Head to Toe Physical
History as able (AMPLE)
need to start over again at AIRWAY
_____ is a good indicator if the patient has ABCD intact. When should you do a primary survey?
if the pt can hold a conversation, then ABCD is usually intact
with the first 10-90 seconds!!
What things should you be looking for as you are assessing a pt’s airway? When should you intubate?
Foreign Bodies (Teeth)
Facial, Mandibular, tracheal or laryngeal fractures
Fluids: Blood, Mucus, Water (Suction)
need to remove obstructions while keeping the cervical spine motion restricted-> assume cervical spine injury until it has been ruled out
GCS less than 8 = intubate
What are some reasons why a combative patient might be combative?
Combative patients can be intoxicated, but often represent respiratory failure / airway / breathing problems!
**Draw the GCS coma scale
What is the definition of a definitive airway? What type of pts get a definitive airway automatically?
a tube placed in the trachea with the cuff inflated below the vocal cords, the tube connected to a form of oxygen-enriched assisted ventilation, and the airway secured in place with an appropriate stabilizing method OR surgical airway is also definitive
significant facial or neck swelling or burns -> because the airway will swell
Are LMA and King airways definitive?
NO! good field options but not definitive airways
How should you assess a pt’s breathing as part of the primary survey?
expose chest wall!! watch for even rise and fall of the chest
Ascultate - are breath sounds equal and present?
What is the difference between Oxygenation and ventilation?
Oxygenation - getting oxygen into the blood stream, increases partial pressure of oxygen on ABG -> INHALATION
Ventilation - moving air in and out of the lungs, reduces PCO2 on ABG -> EXHALATION
For breathing, most trauma pts will have either _____ or ______
definitive airway
have supplemental oxygen via mask with bag and pulse oximeter
What are the options to control external bleeding? What if the skull is bleeding?
Significant Direct pressure
Tourniquet-> needs to be tight!!
staples with skull bleeding
hypotension is a trauma pt is ________ until proven otherwirse. What should you think if the HR is high and the BP is low?
hemorrhage
high HR with low BP think hemorrhagic shock!!
During circulation, if there is obvious blood coming from somewhere, where should you think to look first?
Chest
Abdomen / Retroperitoneum
Pelvis
Long Bones
look in these 4 quadrants if there is obvious bleeding!
What imaging should you order next to find the source of the bleeding?
FAST ultrasound exam or CXR / pelvic XR gotten bedside in a trauma
As part of circulation, what is the protocol for replenishment?
need to get 2 large bore IVs (if you cannot then IO)
1L of warmed NS/LR then switch to blood products
______ is used to prevent the body from breaking down blood clots. What is the regimen?
Tranexamic Acid
Severely ill patients receive a 1,000 mg IV bolus and then receive 1,000 mg IV over the next 8 hours
What should you do if the pt comes in on a spinal board? What are the criteria to remove the c-spine collar? Can you remove the c-collar in an intoxicated pt?
Remove from board quickly
no localized pain
no neuro deficit
no head injury
not intoxicated
or if negative imaging
NO!! cannot remove c-collar in an intoxicated pt even if there is negative imaging
What should be included as part of your neuro exam in a trauma pt?
GCS
EOMs
Pupillary size and shape
Roll pt and palpate entire spine for tenderness/step off
Rectal exam
AMS?
What should you assume if the trauma pt presents with AMS? What are some other things you should consider?
it is CNS related until proven otherwise
alcohol, drugs, hypoglycemia, sepsis, hypercapnia, DKA, hyperammonemia
What is the correct way to remove a pt from a spinal board?
one person stabilizes the head and two other criss cross hands at the pt’s hip and rolls them towards themself
What is the final step in the primary survey?
E: Exposure
completely undress pt and cover with warmed blankets, warm fluids but normal temp blood products
What are the monitoring requirements for a trauma pt? When are foley caths indicated?
All patients should be placed on a monitor with cardiac monitoring, Pulse oximetry, BP monitor, CXR, Pelvis XR
Foley contraindicated if blood at urinary meatus or concern for urethral injury, pelvic fracture, perineal ecchymosis
decompress stomach
Where does fluid collect in the RUQ?
Morrison’s pouch: space between liver and Right kidney
Where does fluid collect in the LUQ?
Splenorenal recess: between the spleen and the Left kidney