Trauma/ Extremity Trauma Flashcards
What is the leading cause of accidental deaths in the US? What is a factor?
MVAs
Alcohol
What is the 2nd leading cause of accidental death for ages 45-75 yrs?
Falls #1 cause of unintentional death for those age 75 and older
First peak of death
Seconds-minutes
Brain injury, high spinal cord injuries, large vessels, cardiac arrest
Best treated by prevention
Second peak of death
Minutes-hours
Sub/epidural bleeds, HTX/PTX, spleen/liver lac
Best treated by ATLS principles
“Golden hour”
Third peak of death
Days-weeks
Sepsis, multi-organ failure
Directly correlated to earlier tx
Primary trauma evaluation
Airway maintenance with C-spine control Breathing and ventilation Circulation with hemorrhage control Disability or neurological status Exposure and environmental control
Airway
Control with basic to advanced maneuvers Suction 100% oxygen Hyperventilation Prepare to intubate Paralyze the pt Use appropriate tx -HTN, hyperkalemia, elevated ICP Intubate: maintiain in-line traction
Circulation
Control exsanguinating hemorrhage Control external bleeding promptly 2 large-bore IV (14-16 g) -Blood draw for type and cross Add pressure bags if needed -Nl saline/LR -Blood -No pressors
Class I circulation
Up to 15% blood loss (750 mL)
Class II circulation
15-30% blood loss (750-1500 mL)
Class III circulation
30-40% blood loss (1500-2000 mL)
Class IV circulation
> 40% loss (>2L)
GCS- eye opening
4-spontaneous
3-to speech
2-To pain
1-none
GCS- verbal response
5-oriented 4-confused 3-inappropriate 2-incomprehensible 1-none
GCS- motor response
6-obeys commands 5-localizes to pain 4-withdraws from pain 3-flexion to pain 2-extension to pain 1-none
Exposure/environmental control
Get them naked
Cut off clothes for ease/keeping pt immobilized
Assess entire body
Rectal/vaginal exam
Cover with blankets/bear hugger to prevent hypothermia
Adjuncts to primary survey
ECG/monitor
Pulse ox
CXR
Urinary/gastric catheters
Secondar survey
Complete head-to-toe exam with detailed hx
Reassess vital signs
Fully examine each body region/system
Complete neuro exam (GCS if not already done)
FAST exam
Hx
Allergies Medications Past illnesses/pregnancy Last meal Environments/events related to the injury
What criteria are used to determine whether to get films to determine whether to release from C-spine?
NEXUS criteria Focal neurological deficit MIdline spinal tenderness Altered level of consciousness Intoxication Distracting injury If none present, C-spine can be cleared clinically. No radiographs needed.
Trauma in pregnancy
Hemodynamical differences -Decreased SVR and VR -CO is ~25% higher -HR is 15-20% higher than nl So...avoid prolonged supine position Left lateral decubitus prevents supine hypotensive syncrome
Blunt trauma in pregnancy
Placental abruption Uterine rupture Amniotic fluid embolism -80% mortality Fetomaternal hemorrhage -Rh neg mothers (Rhogam)
Penetrating trauma in pregnancy
More intentional
Work up the same as blunt
Evaluation of trauma in pregnancy
Hx ABCs Secondary survey Fetal monitoring -Variability -Accelerations/decelerations U/s
Causes of compartment syndrome
Crush injuries Burns Overly tight bandages Prolonged compression Surgery Thrombus
What are the Ps of compartment syndrome?
Pain Paresthesia Pallor Paralysis Pulselessness Poikilothermia
Dx of compartment syndrome
High degree of suspicion Frequent reassessments -Distal neurovascular status Doppler flow does not exclude diagnosis Definitive dx -Direct measurement of pressure in the compartment
Compartment pressures as high as _______ require surgical intervention
30-45 mm Hg
Orthopedic tests
ACL -Lachman -Anterior drawer Meniscal injuries -McMurray -Apley Achilles tendon injury -Thompson Allen's
Displacement
Distal fragment moves laterally away from the proximal fragment but maintains alignment along the long axis
Angulation
Deranged orientation of long axis of the bone
Expressed in degrees and direction noted
Salter-Harris classification
Type I: growth plate Type II: growth plate and metaphysis Type III: growth plate and epiphysis Type IV: metaphysis, growth plate, and epiphysis Type V: growth plate crush injury
When to consult on extremity injuries
In the ED, every possible fx Compound Intra-articular Septic joints -Red/hot/swollen/pain Salter-Harris 3, 4, 5
Tx options for extremity fxs
Sedation -Versed -Etomidate Passive weight reduction Active reduction -Abduct arm 45. Elbow at 90% -Externally rotate -Downward traction -Abduct shoulder if necessary -Immobilize shoulder
