Trauma Management Flashcards
List the three concepts of trauma management
- Mechanism of injury
- Severity of injury
- Kinematics
Define mechanism of injury
- Mechanism whereby energy is transferred from the environment to the person
Define severity of injury
- Dependent on type of force
Define kinematics
- Process of looking at an event and determining what injuries are likely to occur given the forces and motion involved
What are the three peaks of deaths from trauma?
- First peak: time of injury (death from mechanism/immediate injuries)
- Second peak: within the next hour or so - “golden hour” (death from reversible conditions)
- Third peak: days/weeks later (death from complications of injury/treatment)
What is the golden hour in trauma?
- Period of time in which the lives of a majority of critically injured trauma patients can be saved if definitive surgical intervention is provided
What is the triad of death?
See pp. 39
Coagulopathy
> Lactic acidosis
Metabolic acidosis
> Decreased myocardial performance
Hypothermia
> Halt coagulation cascade
- The combination of these markers indicates poor prognosis
What are the aims of initial trauma management?
1 Resuscitate
> Avoid triad of hypothermia, acidosis and coagulopathy
2 Stabilise
> Treatment is aimed at:
- Restoring compromised organ perfusion
- Minimising hypoxic tissue damage
3 Diagnose
What is the pathophysiology of the triad of death?
- Hypothermia increases O2 demand (shivering increases O2 consumption by 400%)
- Hypothermia causes shift in oxyhaemoglobin dissociation curve
- -> Increases affinity for O2 but decreases release of O2 into tissues contributing to hypoxia and acidosis
- Hypothermia depresses cardiac/ventilatory/renal/hepatic functions
- Hypovolaemia causes decreased circulating Hb which contributes to hypoxia and shock (acidosis)
- Results in coagulopathy (altered platelet function)
What does management and treatment of trauma involve?
- Adequate resuscitation
- Ventilation
- Invasive monitoring
- Temperature management
- Acid/base correction
- Appropriate sedation (minimises shivering)
- Inotropic support
- Haemorrhage control and blood component replacement
List complications of trauma
- Compartment syndrome
- Fat embolus
- DVT/PE
- Infection
What is compartment syndrome?
- Increased pressure (due to bleeding/swelling) within confined anatomic space compresses blood supply causing nerve damage, ischaemia and rhabdomyolysis.
What are the signs and symptoms of compartment syndrome?
- 5 Ps > Pain > Pallor/cyanosis > Paraesthesia > Pulselessness > Paralysis
- Elevated compartment pressure
What does treatment of compartment syndrome involve?
- Pain relief
- Remove external pressure
- Elevate
- Fasciotomy
What is a fat embolism?
- Occurs when fat globules are released from bone marrow and combine with platelets to form emboli
- Most common in long bone or multiple fractures and severe burns
