Trauma management basics Flashcards
What is the trimodal death distribution following trauma?
- Immediately following injury
- In early hours following injury
- Days following injury
What are 4 examples of causes of immediate deaths following trauma?
- Brain injury
- High spinal injuries
- Cardiac damage
- Great vessel damage
What are 3 examples of causes of death in the early hours following traumatic injury?
- Splenic rupture
- Subdural haematomas
- Haemopneumothoraces
What are 2 examples of causes of death in the days following traumatic injury?
- Sepsis
- Multi organ failure
What is the general approach to trauma management?
- A-E
What are 4 key things to remember about the initial management of trauma?
- Tension pneumothoraces will deteriorate with vigorous ventilation attempts
- External haemorrhage is managed as part of the primary survey
- Urinary catheters and NG tubes may need inserting but be wary of basal skull fractures and urethral injuries
- If head and neck trauma, assume to have cervical spine injury until proven otherwise
As a general rule what is the approach to management of external haemorrhage in the primary survey of a trauma patient?
- packing is preferred method
- tourniquets shouldn’t be used, blind applications of clamps will damage surrounding structures
What are 8 key thoracic injuries resulting from trauma?
- Simple pneumothorax
- Mediastinal traversing wounds
- Tracheobronchial tree injury
- Haemothorax
- Blunt cardiac injury
- Diaphragmatic injury
- Aortic disruption
- Pulmonary contusion
What is the management of a simple pneumothorax in acute trauma?
insert chest drain
Why is aspiration risky in simple pneumothorax in a trauma patient?
the pneumothorax may be from lung laceration so it could convert to tension pneumothorax
What type of trauma can cause mediastinal traversing wounds?
stabbings
What are mediastinal traversing wounds?
exit and entry wounds in separate hemithoraces
What does the presence of a mediastinal haematoma with mediastinal traversing wounds indicate?
likelihood of great vessel injury
What investigations should all patients with mediastinal traversing wounds undergo? 2 key things
- CT angiogram
- Oesophageal contrast swallow
What are the indications for thoracotomy (surgery to open chest) in mediastinal traversing wounds related to?
blood loss
How common are tracheobronchial tree injuries?
unusual injuries
in blunt trauma, most injuries occur within 4cm of the carina
What are 4 clinical features of tracheobronchial tree injury?
- Haemoptysis
- Surgical emphysema
- Very large air leak
- Tension pneumothorax
What usually causes haemothorax in trauma?
laceration of lung vessel or internal mammary artery by rib fracture
What is the initial management of haemothorax?
wide bore 36F chest drain
What are 2 indications for thoracotomy to treat haemothorax?
- blood loss of >1.5L blood initially
- ongoing losses of >200ml per hour for >2 hours
What are 2 features associated with cardiac contusions?
- Cardiac arrhythmias
- Overlying sternal fracture often present
What is a contusion?
type of haematoma; any collection of blood outside of a bloood vessel
What investigations must be performed in suspected cardiac contusions and why?
echocardiography to exclude pericardial effusions and tamponade
After what time period does the risk of arrhythmias associated with cardiac contusions fall?
after 24h
On which side is diaphragmatic injury more common?
left sided more common
What is the management of diaphragmatic injury?
direct surgical repair performed
What is the commonest cause of death following a RTA or fall?
traumatic aortic disruption
What is the commonest type of injury in traumatic aortic disruption?
incomplete laceration near ligamentum arteriosum
What will all survivors of traumatic aortic disruption have?
contained haematoma
What proportion of patients with traumatic aortic disruption have a normal chest x-ray?
only 1-2%
What is the onset of pulmonary contusion?
common and lethal problem - insidious onset
What is the management of pulmonary contusion?
early intubation and ventilation
What type of injury mechanism leading to abdominal trauma is common?
deceleration injuries
In blunt trauma requiring laparotomy, which organ is most commonly injured?
spleen (40%)
Which organ is most commonly damaged by stab wounds that traverse structures?
liver
Which organ is most commonly damaged by gunshot wounds?
small bowel (50%)
If a patient has a stab wound but no peritoneal signs, what is the likelihood the wound has entered the peritoneal cavity?
only 25%
What does blood at the urethral meatus suggest?
urethral tear
What does a high riding prostate on PR examination following trauma suggest?
urethral disruption
How many times should mechanical testing for pelvic stability be performed?
once only
What is the indication for diagnostic peritoneal lavage following trauma?
document bleeding if hypotensive
What are the advantages of diagnostic peritoneal lavage following trauma?
early diagnosis and sensitive; 98% accurate
What are the disadvantages of diagnostic peritoneal lavage following trauma?
invasive and may miss retroperitoneal and diaphragmatic injury
What is the indication for an abdominal CT scan?
document organ injury if normotensive
What are the advantages of performing an abdominal CT scan following trauma?
most specific for localising injury; 92-98% accurate
What are the disadvantages of an abdominal CT scan following trauma?
location of scanner away from facilities, time taken for reporting, need for contrast
What is the indication for USS following trauma?
document fluid if hypotensive
What are the advanatges of USS following trauma?
early diagnosis, non-invasive and repeatable
86-95% accurate
What are the disadvanatges of USS following trauma?
operator dependent and may miss retroperitoneal injury
What will amylase show following pancreatic trauma?
may be normal
What investigation is indicated if suspected urethral injury?
urethrography
What are trauma alerts?
situations that require multiple specialties, rapid assessment, treatment and a logical thought process understress
What is the version of ABC approach that has been modified for trauma situations?
Advanced Trauma and Life Support: ATLS (also European Trauma Course ETC is a valid approach)
Where are most major trauma patients taken to by the emergency service?
most now bypass local hospitals going to ‘Major Trauma Centres’ that in theory are able to deal with any form of trauma
