Trauma Management Flashcards
Newton’s first law of motion
An object in motion will remain in motion, and an object at rest will remain at rest, unless active bond by a force
Newtons second law of motion
Force = Mass x Acceleration (F=MA)
Newtons third law of motion
For every action, there’s an equal and opposite reaction
Le Fort fracture
Le Fort 1- mandible only
Le Fort 2- mandible and cheekbones
Le Fort 3- mandible, cheekbones and orbital bones.
Circulation assessment
> identify life threats and bleeding control
cardiac output-maintain MAP of 60mmHg
evaluate HR— >120= decompensated shock
BP is a waste of time initially. 30-40% loss in blood volume is when you will see a drop in blood pressure. Class 3 Blood Loss(BL).
shock index= HR/SBP (>0.9 is bad)
Blood loss classes
Class 1- <750mL, 15%, vitals normal
Class 2- 750-1500mL, 15-30%, mild tachycardia
Class 3- 1500-2000mL, 30-40%, HR>120, decreased BP
Class 4- >2L, >40%, HR >140, and decreased BP
GCS(EVM)
E4, V5, M6
E- Spontaneous =4, Voice = 3, Pain = 2, None = 1
V- Oriented = 5, Confused = 4, Inappropriate words = 3, Incomprehensible sounds = 2, None = 1
M- Follows commands = 6, Localizes to pain = 5, Withdrawals = 4, Flexion = 3, Extension = 2, None = 1
Becks Triad
1- narrow pulse pressure
2- JVD
3- muffled heart tones
*Only if X-ray is available- widened mediastinum on chest x-ray
Causes of widened mediastinum
> Thoracic aortic aneurysm at the ascending and proximal descending aorta
Aortic dissection at the ascending and proximal descending aorta
Unfolding of the aorta
Traumatic aortic rupture
Hilar lymphadenopathy; infectious or malignant.
Mediastinal masses like lymphoma, seminoma and thymoma
Mediastinitis
Cardiac tamponade
fractured ribs or thoracic vertebrae
Tension pneumothorax symptoms
> severe respiratory distress
decreased or absent breath sounds
tracheal shift(late find)
subcutaneous air
JVD
high CVP
Tx: needle decompression or chest tube in the 4-6th intercostal space.
Hemothorax symptoms
> decreased breath sounds
midline trachea
flat neck veins
decreased LOC
Tx:
chest tube
fluid replacement(PRBC/FFP)
airway management
Chest tube should be clamped at 1500 cc initial output to avoid re-expansion pulmonary edema
Flailed chest symptoms
> paradoxical movement
respiratory distress
tachypnea with shallow depth
grunting
accessory muscle use
chest pain
Tx:
Self splinting
intubation
place injured side down
aggressive pain management and treat for nausea
What is the number one most commonly injured organ
Spleen
Grade 1-5(3-5 mean surgery or fatal)
What is the second most common organ injury?
Liver
Grade 1-6(4-6 mean surgery or fatal)
Colon or bowel trauma
Usually penetrative or tearing/ripping, and are complicated by infection/sepsis.
Requires surgical intervention
Aortic trauma
18-20% of MVA fatalities have aortic involvement
Requires surgical intervention
Pelvic trauma
Unstable
> anterior/ posterior compression- result from crushing forces.
> lateral compression- results results from side impact or crushing forces
> Vertical sheer- is most ominous and often fatal
Tx:
> compression of the pelvis(binder)
> check for blood at meatus
> Disrupted pelvis can hold 4L or 80% of blood volume.
REBOA
Resuscitative Endovascular Balloon Occlusion of the Aorta
> inserted via art line
Placed as early as possible(ultrasound, guided)
zone 1- injuries above diaphragm max 1hr
zone 3- primary insertion site. Best for vertical sheer, liver/spleen lac. Max 4-6 hr
zone 2- OFF LIMITS!!
Electrolyte imbalance phase 1
0-36hrs
>Hyponatremia and hyperkalemia
> intravascular loss
> increased vascular permeability
> cellular edema
> Interstitial osmotic pressure increase
Electrolyte imbalance phase 2
3-7 days
>Hypernatremia, Hypokalemia, hypophosphatemia, hypomagnesemia, and hypocalcemia
> reabsorption of cellular edema
> Urinary retention — stimulation of ADH
Burn classifications
First-degree burn— epidermis
Second-degree burn— dermis
Third-degree burn — hypodermis
Rule of nines (Adult)
Head = 9%(front and back)
Chest = 18%
Back = 18%
Arms = 9% each
Legs = 18% each
Perineum = 1%
Palmer method— each area the size of the patient’s palm = 1%. Most accurate way of estimating percentage
Rule of nines (Child)
Head = 18%(front and back)
Chest = 18%
Back = 18%
Arms = 9% each
Legs = 13.5% each
Perineum = 1%
Palmer method— each area the size of the patient’s palm = 1%. Most accurate way of estimating percentage
Burn injury zones
> Zone of coagulation- where tissue death occurs
Zone of stasis- outside of the zone of coagulation, usually has limited perfusion but no tissue death occurs
Zone of Hyperemia- usually more superficial and just redness.
Escharotomy vs Fasciotomy
Escharotomy is a superficial(first layer) cut to allow for lung expansion and proper perfusion.(no pain or bleeding)
Fasciotomy is performed if tissue perfusion does not return after Escharotomy.(surgical procedure)
Fluid resuscitation
> Parkland formula:
kg x TBSA% x 4mL = volume/24hrs(half over first 8hrs)
> Consensus formula: (combo of Brooks and Parkland)
kg x TBSA% x 2-4mL = volume in 24hrs(half over first 8hrs)
2mL/kg for adults
3mL/kg for peds
4mL/kg for electrical burns
Volume based on urine output
LR for burn patients
Electrical injury components
1- injury caused by current. Generates heat along path of current. Damages, nerves, blood vessels, and muscles.
2- injury from arcing(breathing hot gases in)
3- flash burn from power source, or from clothing igniting
4-trauma due to intense muscle spasm.
Secondary injuries of electrical burns
> Pulmonary- assess for inhalation injury, or restricted chest movement.
Renal- muscle damage leads to myoglobin release, which leads to rhabdo
Rhabdomyolysis
Caused by massive muscle damage. If left untreated result in acute tubular, necrosis and renal failure.
Tx:
> aggressive fluid resuscitation
> watch urine output— 1-2mL/kg/hr
> give Sodium bicarb to alkalize the urine
> Mannitol
> diuretic (Lasix)
What is the trauma diamond previously known as the trauma triad?
Hypocalcemia
Hypothermia
Acidosis
Coagulopathy
