Trauma Management Flashcards
Trauma Management - Definition
Traumatic injury occurs when the body’s tissues are exposed to energy levels beyond their tolerance
Goal of Care
Efficient scene management and expeditious transport to hospital
Overview
See Top 10 Best Practice Trauma Priniciples
Pts w/ significant trauma often require rapid surgical therapy
Most likely causes of field death from trauma are massive blood loss, catastrophic thoracic injury or massive head injury
Early hospital deaths are usually due to uncontrolled shock or head inj.
Survival in this group can be improved by shortening transport time to hospital care
Late hospital deaths are due to the complications of shock and can also be reduced by rapid appropriate early care
Types of Trauma
Penetrating trauma - is more likely to result in massive bleeding, internal and external. Heart wounds may cause pericardial tamponade, which can be fatal if not urgently treated
Blunt Trauma - is more complicated and difficult to assess and include a spectrum of conditions such as transection of great vessels, rupture of solid organs or cardiac rupture, brian injury, spinal cord injury and major otheropaedic
Gunshot wounds - cause a combination of penetrating and blunt injury from the shock wave
Crush Injury - is a special circumstance which requires several additional considerations
- Alkalizing the blood may be necessary
- Accomplished through delivery of large volumes of intravenous fluids
- The addition of sodium bicarbonate to a bag of NS vs bolus administration is preferred
- Early contact w/ CliniCALL is recommended for all pts who have experienced a crush inj
Special Note 1
If administration of fluids or medication prior to releasing the entrapped body area is not possible, consider application of a tourniquet proximal to the injury site on the extremity
Guiding Principles
Trauma pts in general cannot be stabilized in the field
Life threatening occult bleeding can usually only be stopped by the surgeo in the OR. Pts will continue to deteriorate until they receive definitive surgical care
To maximize survival, scene time must be kept to a minimum. The focus must be on basic care with provision of oxygen, basic airway care, control of bleeding, prevention of further spinal injury, and transport.
Anything that can be done on route should be done on route
Special Note 2
Be aware of region specific trauma destination guidelines when selecting the most appropriate destination hospital
Special Note 3
Young, healthy patients will not necessarily show signs of shock until they are fully decompensating
Patients with some fatal injuries such as aortic rupture or splenic rupture may look completely normal until the final moments
This is why patients need to be transported based on mechanism of injury despite their clinical appearance
Guiding Principles - Hypothermia
The impact of hypothermia on survival cannot be overstated.
Survivability decreases dramatically as the pt temperature drops.
Avoid situations that promote hypothermia in all trauma cases
Guiding Principles - Target BP
The optimum target blood pressure for a trauma pt is unknown but best information is that it is not necessary to give IV fluids to push the pressure higher than 90 systolic
Optimally, target perfusion should only be to the return of peripheral pulses. Higher blood pressures can increase blood loss and large amounts of crystalloid cause dilution
Guiding Principles - Tranexamic Acid (TXA)
TXA is an atifibrinolytic agent that inhibits clot breakdown, promoting hemostatis and reducing blood loss
It is a very safe drug, it does NOT promote new clots formation so it does not cause strokes or heart attacks. IT must be given within 3 hours of trauma
If given after 3 hours it may cause harm
The survival benefit of TXA decreases w/ time to TXA, however starting this therapy should not be at the cost of delaying transport
TXA should be given if there is a MOI suggestive of major trauma and suspicion of ongoing occult bleeding OR injuries identified on primary survey AND HR >110 or SPB <90
Guiding Principles - Airway Management
There is significant controversy in the literature regarding the best way to manage airways in trauma pts
It is clear that the old standard of hyperventilation negatively affects outcomese and even transients hypoxia or hyperventilation during airway management should be avoided.
The principle of airway management taught in the AIME courses are sound current standards
Intervention Guidelines - EMR
EMR
Triage
Assess wakeful
