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Multisystem > Trauma (Overview) > Flashcards

Trauma (Overview) Flashcards

1
Q

Components of GCS?

A

Eyes (4)
Verbal (5)
Motor (6)
(E4, V5, M6 = GCS 15)

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2
Q

Eye evaluation in GCS?

A
  • Spontaneously (4)
  • To voice (3)
  • To pain (2)
  • No response (1)
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3
Q

Verbal response in GCS?

A
  • Answers appropriate (5)
  • Confused (4)
  • Inappropriate worse (3)
  • Incromprehensible sounds (2)
  • No verbal response (1)
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4
Q

Motor Response in GCS?

A
  • Obeys commands (6)
  • Localises to pain (5)
  • Withdraws from pain (4)
  • Decorticate (flexion) (3)
  • Decerebrate (extension) (2)
  • No response (1)
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5
Q

Categories of GCS score?

A
  • 13-15 = mild injury

- 9-12 = moderate injury

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6
Q

What are the broad principles of trauma management?

A
  • Pre hospital care
  • Preparation
  • Airway and Cervical Spine immobilisation
  • Breathing
  • Circulation and management of shock
  • Disability
  • Exposure
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7
Q

What is the primary survey?

A

ABCDE

Airway, Breathing, Circulation, Disability, Exposure

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8
Q

Initial steps of trauma management on hospital arrival?

A
  • Primary Survey
  • CXR +/- PXR
  • IV fluids and analgesia
  • Take bloods
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9
Q

Trauma panel bloods?

A
  • Cross match
  • Clotting
  • BSL
  • FBE
  • UEC
  • LFT
  • Lipase
  • Lactate
  • V gas
  • Cardiac enzymes
  • Beta HCG
  • +/- Police BAC
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10
Q

Causes of tachycardia in major trauma?

A
  • Blood loss
  • Tension pneumothorax
  • Pericardial tamponade
  • Myocardial contusion
  • Neurogenic (inc cerebral irritability)
  • Pain
  • Drugs
  • Anxiety
  • Sepsis (late)
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11
Q

What is the resuscitation fluid of choice in major trauma?

A

Saline
BUT Blood best - give early.
Massive transfusion protocol requires 1:1:1 of PRBC/ platelets/ clotting factors.

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12
Q

How may level of consciousness be assessed in major trauma?

A 
AVPU
Alert
Verbal stimuli
Painful stimuli
Unresponsive
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13
Q

Signs of airway obstruction?

A
  • Agitation/confusion
  • Respiratory distress
  • Failure to speak / dysphonia
  • Cyanosis
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14
Q

Principles of BASIC airway management?

A
  • Protect C spine
  • Head tilt or jaw thrust (if cleared C spine)
  • Sweep and suction to clear foreign material from mouth
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15
Q

What are the options for definitive airway management?

A
  • ETT intubation (orotracheal/ nasotracheal)

- Surgical airway (cricothyroidotomy)

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16
Q

Indications for definite airway?

A

A – eg: impending airway obstruction (burns, penetrating or blunt neck injury) or injury that may distort airway anatomy (e.g. neck hematoma)
B – eg: Respiratory insufficiency due to a large pulmonary contusion, flail chest, or other thoracic injury.
C – eg: multisystem trauma with shock
D – eg: Reduced GCS (especially

17
Q

Principles of airway assessment?

A
  • Secure airway
  • Assess ability to breathe and speak
  • Employ simple manouevers (e.g. jaw thrust)
18
Q

How is breathing (B) assessed clinically?

A
  • LOOK: mental status, colour, chest mvt, respiratory effort
  • LISTEN: percussion, sounds of obstruction, breath sounds, symmetry of entry, air escaping
  • FEEL: flow of air, tracheal shift, chest wall for crepitus, flail segments, sucking chest wounds, subcutaneous emphysema
19
Q

How is breathing assessed (tests)?

A
  • RR
  • Pulse oximetry
  • ABGs
  • A-a gradient
20
Q

Management of breathing?

A
  • High flow O2 15L/min via non-rebreather mask on arrival
  • Venturi mask: used to control O2 delivery
  • Bag-Valve mask and CPAP to supplement ventilation
21
Q

Assessment of circulation?

A

PR, BP, capillary refill, warmth of peripheries

22
Q

Early clinical signs of shock?

A
  • Tachycardia
  • Tachypnoea
  • Reduced cap refill
  • Reduced central venous pressure
  • Narrow pulse pressure
23
Q

Late clinical signs of shock?

A
  • Hypotension
  • Altered mental status
  • Reduced urine output
24
Q

Causes of shock?

A

SHOCKED

  • Septic, spinal/neurogenic
  • Haemorrhagic
  • Obstructive (e.g. tension pneumothorax, cardiac tamponade, PE)
  • Cardiogenic (e.g. blunt myocardial injury, arrhythmia, MI)
  • AnaphylactiK
  • Endocrine (Addison’s, myxedema coma)
  • Drugs
25
Q

Mx of hemorrhagic shock?

A
  • Secure airway
  • TREAT CAUSE (control external bleeding etc)
  • Surgical consultation (internal bleeding)
  • 2 x large bore cannulas (14/16G)
  • Rapid infusion 1-2L NS/RL (warm for massive transfusion)
  • Monitor (HR, BP, urine, mentation, O2)
26
Q

Contraindications to Foley catheter?

A
  • Blood at urethral meatus
  • Scrotal haematoma
  • High riding prostate
27
Q

Hx in trauma? (where possible)

A

Use AMPLE Hx

  • Allergies and ADT status
  • Medications
  • Past Medical History
  • Last ate and drank; LMP (check for pregnancy in females of child bearing age)
  • Events / environment related to injury (i.e. a detailed account of the mechanism of injury)

Multisystem (14 decks)

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