Trauma (Overview) Flashcards
Components of GCS?
Eyes (4)
Verbal (5)
Motor (6)
(E4, V5, M6 = GCS 15)
Eye evaluation in GCS?
- Spontaneously (4)
- To voice (3)
- To pain (2)
- No response (1)
Verbal response in GCS?
- Answers appropriate (5)
- Confused (4)
- Inappropriate worse (3)
- Incromprehensible sounds (2)
- No verbal response (1)
Motor Response in GCS?
- Obeys commands (6)
- Localises to pain (5)
- Withdraws from pain (4)
- Decorticate (flexion) (3)
- Decerebrate (extension) (2)
- No response (1)
Categories of GCS score?
- 13-15 = mild injury
- 9-12 = moderate injury
What are the broad principles of trauma management?
- Pre hospital care
- Preparation
- Airway and Cervical Spine immobilisation
- Breathing
- Circulation and management of shock
- Disability
- Exposure
What is the primary survey?
ABCDE
Airway, Breathing, Circulation, Disability, Exposure
Initial steps of trauma management on hospital arrival?
- Primary Survey
- CXR +/- PXR
- IV fluids and analgesia
- Take bloods
Trauma panel bloods?
- Cross match
- Clotting
- BSL
- FBE
- UEC
- LFT
- Lipase
- Lactate
- V gas
- Cardiac enzymes
- Beta HCG
- +/- Police BAC
Causes of tachycardia in major trauma?
- Blood loss
- Tension pneumothorax
- Pericardial tamponade
- Myocardial contusion
- Neurogenic (inc cerebral irritability)
- Pain
- Drugs
- Anxiety
- Sepsis (late)
What is the resuscitation fluid of choice in major trauma?
Saline
BUT Blood best - give early.
Massive transfusion protocol requires 1:1:1 of PRBC/ platelets/ clotting factors.
How may level of consciousness be assessed in major trauma?
AVPU Alert Verbal stimuli Painful stimuli Unresponsive
Signs of airway obstruction?
- Agitation/confusion
- Respiratory distress
- Failure to speak / dysphonia
- Cyanosis
Principles of BASIC airway management?
- Protect C spine
- Head tilt or jaw thrust (if cleared C spine)
- Sweep and suction to clear foreign material from mouth
What are the options for definitive airway management?
- ETT intubation (orotracheal/ nasotracheal)
- Surgical airway (cricothyroidotomy)
Indications for definite airway?
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
Principles of airway assessment?
- Secure airway
- Assess ability to breathe and speak
- Employ simple manouevers (e.g. jaw thrust)
How is breathing (B) assessed clinically?
- 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
How is breathing assessed (tests)?
- RR
- Pulse oximetry
- ABGs
- A-a gradient
Management of breathing?
- 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
Assessment of circulation?
PR, BP, capillary refill, warmth of peripheries
Early clinical signs of shock?
- Tachycardia
- Tachypnoea
- Reduced cap refill
- Reduced central venous pressure
- Narrow pulse pressure
Late clinical signs of shock?
- Hypotension
- Altered mental status
- Reduced urine output
Causes of shock?
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
Mx of hemorrhagic shock?
- 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)
Contraindications to Foley catheter?
- Blood at urethral meatus
- Scrotal haematoma
- High riding prostate
Hx in trauma? (where possible)
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)
