Trauma (oral surgery) Flashcards
What are the types of primary injury as a result of a blast?
Eardrum rupture, abdominal haemorrhage, blast lung
How do primary injuries differ from the secondary, tertiary and quaternary injuries during blasts?
Primary = the blast wave itself Secondary = Debris and fragments launched from the blast Tertiary = Result of being thrown by the blast Quaternary = Not due to primary, secondary, or tertiary mechanisms
How common is trauma?
Almost half a million people hospitalised and 12000 deaths
Males make up 59% of trauma injuries
Indigenous people 2x as likely
What causes most injuries requiring hospitalization from trauma?
Most injuries are a result of traffic accidents, falls, self-harm, and assault.
What causes most deaths as a result of trauma?
Falls
Suicides
Transport accidents
TRUE OR FALSE: trauma is the 2nd most common cause of death among people aged 1 - 46
FALSE, it is the most common cause of death of people between 1 - 46 years of age.
How is trauma typically managed?
A systematic approach is typically used involving multiple disciplines.
What is the trimodal distribution of death from trauma injuries?
Typically death from trauma follows a trimodal distribution. Immediate death occurs 50% of the time, 30% middle
What causes immediate deaths following trauma?
Fatal injury to the great vessels, heart, brain, brainstem, or upper spinal cord.
This results from failed oxygenation of vital organs or CNS injury.
Injuries occur in predictable patterns based on mechanism of injury, patient, and environmental conditions.
What causes late trauma mortality?
Primarily due to sepsis and multi organ failure
What is ATLS?
Advanced Trauma Life Support.
Training program for medical providers in the management of acute trauma cases, developed by the American College of Surgeons
Standard of care built around a consistent approach to patient evaluation
Ensures that the most life-threatening conditions are quickly identified and addressed in the order of risk potential
What does the golden hour refer to in trauma?
First hour after a traumatic injury when emergency treatment is most likely to be successful. It can have a significant impact on morbidity and mortality
Why is triage necessary with trauma patients?
To avoid delay and to have the best initial management of poly trauma
How is triage done with trauma patients?
Prioritize patients according to the severity and urgency of their injuries and availability of care.
Consider vital signs, prehospital clinical course, mechanism of injury, patient’s age, and comorbid conditions.
What tools are used to predict outcomes of trauma injuries?
Glasgow Coma Scale: Quantify the severity of a head injury
Revised Trauma Score: Characterizing the physiological status of injured patient, and predicting mortality using revised trauma score.
Injury Severity Score: Deals with multiple traumatic injuries, rate the severity of the injury in each of the 3 most severely damaged organ systems.
What does the Glasgow Coma scale do?
It quantifies the head injury by looking at:
Eye opening response
Best verbal response
Best motor response
The total is then calculated and given a rating.
What does the revised trauma score look at?
Physiological status
Predicts mortality from Glascow Coma Scale, SBP, and RR
What is the injury severity score?
ISS = sum of 3 highest squared abbreviated injury score which is calculated from the organ system affected by the trauma
What is the function of the primary survey ABC?
Crucial initial assessment of a seriously injured patient.
Patients assessed and treatment priorities are established based on injuries, stability of their vitals, and injury mechanism
Patient’s vital functions must be assessed quickly and efficiently
What does the primary survey assess?
ABCDE
Airways (airway maintenance with C-spine control)
Breathing (Chest wall may move but no air moves through the resp system, ensure breathing is effective) Endotracheal intubation helps protect airways if necessary.
Circulation (Control bleeding and restore tissue circulation, most common cause of shock in traumatized patient caused by haemorrhage)
Disability (Neurological exam. Awake, Voice stimulation, Pain stimulation, Unresponsive)
Exposure (All body needs to be visualized, palpated, and examined)
Which injuries require special considerations?
Patient with burns, cold injuries, and electrical injuries.
What should be done for burns patients?
Full thickness burns of thorax or extremity require escharotomies to prevent impairment of ventilation.
Early intubation, mechanical ventilation if upper airway affected.
Patients with large burns require large volumes of crystalloid resuscitation fluids
How is the surface area of a burn estimated?
Rule of 9s.
Chest, abdomen, limbs, upper back, lower back, anterior surface of each lower limb and posterior surface of each lower limb
How does the degree of a burn get assessed?
First degree = epidermis only
Second degree = epidermis extending into the dermis
Third degree = extending through the epidermis and dermis to the connective tissue layer
How are electrical burn patients treated?
Usually affects superficial skin and a large portion of skin. So treatment usually involves debridement of eschar and skin grafts.
How are high-voltage electrical injuries diagnosed?
Tissue injury may sometimes not be apparent due to myonecrosis and soft tissue damage occurring underneath the superficial layers of skin.
Measurement of compartment pressures and performing decompressive fasciotomies.
Monitor urine output for myglobinuria
Continual cardiac monitoring as risk of direct myocardial injury and hyperkalemia arising from myonecrosis
How is skin grafting done?
Split-thickness skin grafts are harvested from front or outer thigh, abdomen, buttocks or back and used to cover large areas.
What is spray-on skin?
Technology used for treatment of burn victims where small samples of patient’s skin is sprayed on the wound
How is severe hypothermia treated?
Treated by rewarming
Immerse in water warmed to 40 degrees centigrade.
Do not stop resuscitation efforts until patient is rewarmed thoroughly
What is a tertiary trauma survey?
A patient evaluation that identifies and catalogues all injuries after initial resuscitation and operative intervention. Decreases morbidity and mortality by earlier identification and treatment
How can injury be prevented and controlled nationwide?
Prevented:
Enhance biomechanics research
Enhance trauma care
Develop national policy
Controlled:
Engineering and technology
Enforcement and legislative
Education and behavioural
