Trauma management Flashcards
What are some common interventions performed in pre-hospital emergency setting?
Low-threshold interventions that may be performed by emergency personnel prior to transport to a hospital include, but are not limited to:
- Placement of a cervical collar (if cervical spine trauma is suspected)
- Intubation or oxygen delivery via nasal cannula (if respiratory distress or altered mental status is suspected)
- Administration of intravenous fluid (if hemorrhage or hypotension is suspected)
- Administration of analgesia
- Placement of tourniquets or pressure bandages for control of bleeding
What technique/protocol do we use in primary survey?
Advanced Trauma Life Support (ATLS) -> ABCDE steps performed in order
What are components of ‘A’ (ABCDE) ?
Airway assessment
(and cervical spine stabilization)
- If appropriately answering questions ->patient has a patent airway (at least for the moment)
- Observe patient for signs of respiratory distress
- Inspect mouth and larynx for injury or obstruction
- Assume cervical spine injury in blunt trauma patients until proven otherwise
- If patient is unconscious (and therefore unable to protect their airway) or in respiratory distress, the threshold for intubation is very low
Do we intubate patients with burns?
Patients with burn injuries + evidence of respiratory involvement -> often intubated out of precaution
What to do if orotracheal intubation fail?
Perform cricothyrotomy
How to ‘prove’ that there is no C-spine injury?
- no evidence of fracture on cervical x ray
- no signs of tenderness in an otherwise neurologically normal patient
Possible signs of respiratory distress (3)
- tachypnoea
- use of accessory muscles
- stridor
Components of ‘B’ assessment (ABCDE)
Breathing
- Assess oxygenation status with pulse oximetry
- Inspect and auscultate chest wall for injuries -> absence of breath sounds, asymmetric or abnormal movement
Inunstable patient, if we suspect tension pneumothorax/ haemothorax; do we treat first or do we perform imaging to confirm?
In unstable patients, do not delay treatment of tension pneumothorax or hemothorax in favor of imaging.
What central pulses do we palpate?
Central pulses
- carotid
- femoral
What peripheral pulses do we palpate?
radial, popliteal, posterior tibial, dorsalis pedis
Components of ‘C’ (ABCDE)
Circulation
- palpate pulses: central and peripheral
- BP (if possible, but if it cannot be done then just move to the other steps of assessment)
- place IV lines -> intraosseous line if IV placement impossible
- control of haemorrhage -> ongoing pressure or tourniquet placement
- look for signs of hypovolaemic shock
What IV lines should be placed in the patient during ‘C’ component? Why?
Place two large-bore intravenous lines (at least 16 gauge) for blood typing and crossmatch, and resuscitation (if needed).
How do we control ongoing hemorrhage in prehospital setting?
Manual pressure or tourniquet
What do we do if the patient is hypotensive?
Bolous IV saline fluid administration
What if we do not know the patient’s blood group and there is an ongoing hemorrhage?
0 type blood transfusion
What to do if there are persistent blood loss and hemodynamic instability?
Transfuse: plasma, platelets and RBCs - 1:1:1 ratio
*this also will prevent coagulopathy caused by: trauma and massiv transfusion of blood
How much blood is required to be lost in order for the hypovolaemic shock to occur?
at least 1.5 L
*but haemorrhage may be both: internal and external
What are the components of ‘D’ (ABCDE)?
Disability
- GCS
- pupil size
- if a patient is interactive: assess motor and sensory function (neuro)
What are ‘E’ components in (ABCDE)?
Exposure
- undress patient completely -> examine patient’s body (including back) for other injuries
- blanket - if hypothermia
- palpate for rectal injuries and anal tone (PR)
What can be a gross haematuria sign of?
bladder, kidney, urethral injury
What can be a microscopic haematuria sign of in a setting of trauma?
Microscopic haematuria is normal after trauma in adults - but should be investigated in paediatrics
When do we perform a secondary survey?
After:
- primary survey (ABCDE) has been completed
- patient is stable
Components of secondary survey
- throughout examination
- history
Free fluid in splenorenal recess
- what does it look like?
- what does it indicate?
Free fluid in splenorenal recess
It is an anechoic area between left kidney and spleen
It indicates the presence of free abdominal fluid
FAST exam in the setting of trauma
- what is it?
- what is it used for?
FAST = Focused Assessment with Sonography for Trauma
- rapid, standardized bedside USS of polytrauma
- it is to screen for the presence of free fluid -> which may mean blood (internal hemorrhage)
What areas are examined on FAST (4)?
FAST -> looks for free fluid (e.g. blood)
Areas of examination:
- peri-hepatic space and hepato-renal space
- peri-splenic and splenorenal space
- pelvis and suprapubic region
- pericardium
What is the main goal of the secondary survey?
To reduce the risk of ‘missed injuries’
Tertiary survey
- when is it performed?
- what is it aim?
- delayed re-examination of the patient (usually ∼ 24 hours after admission)
- main goal is to detect changes due to previously undetected injuries
