Trauma principles Flashcards by Nader Raafat

Components of airway assessment in primary survey

Listen: Patient talking? Quality? Airway noise (bubbling/stridor)

Look: Bleeding/soft tissue swelling, objectsin airway

Feel: Crepitus/emphysema, C-spine stepping

Immobilise if blunt trauma above clavicle or high-energy trauma

Resuscitate: C-spine immobilisation, airway adjunct, inform ITU

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Components of breathing assessment in primary survey

Look: Bruising, injuries, chest movements (symmetry, paradoxicality), respiratory rate

Listen: Air entry throughout

Feel: Chest expansion, percussion, midline trachea

Investigate: Oximetry, CXR

Resuscitate: O2 if required

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Components of circulation assessment in primary survey

Look: peripheral and central capillary refill, bleeding (external, abdomen, pelvis)

Feel: Pulse - rate, rhythm

Investigate: IV access, BP, ECG, ?echo, FAST scan, pelvic XR

Resuscitate: Warm colloid/blood/FFP, tranexamic acid, activate major haemmorhage protocol

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Components of disability in primary survery

Brainstem reflexes (esp pupils)
GCS (incl unequal responses to pain indicating weakness)
Plantars
Blood glucose

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Components of exposure in primary survey

Temperature - measure and treat accordingly

Expose patient + log-roll for other sources of injury

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Sources of blood in trauma

On the floor and:

Chest –> drain
Abdomen –> surgery
Long bones –> splint
Pelvis –> binder

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Life-threatening chest injuries

ATOM FC

Airway obstruction

Tension pneumothorax

Open pneumothorax

Massive haemothorax

Flail chest

Cardiac tamponade

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Management of airway obstruction

Clear foreign objects, suction for aspiration, airway adjuncts, ITU

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Management of tension pneumothorax/massive haemothorax

Finger thoracostomy + chest drain insertion in safe triangle

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Anatomical borders of safe triangle

5th intercostal space

pec major

lat dorsi

Base of axilla

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Management of open pneumothorax

Three-way dressing, chest drain insertion

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Reversible causes of cardiac arrest

4Hs and 4Ts

Hypothermia

Hypo/hyperkalaemia

Hypovolaemia

Hypoxia

Tension pneumothorax

Tamponade

Thrombosis

Toxins

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Management of cardiac tamponade

clamshell thoracotomy

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Describe the major fracture patterns

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System for describing a fracture

Bone: Which bone(s)? Where in bone?
Type of fracture: Spiral, oblique, etc…
Displacement: Rotation, translation, angulation, shortening (refer to distal fragment)
Joint: Intra- or extra-articular; dislocation/subluxation
Neurovascular: O/E any compromise
Soft tissues: Open/closed, compartment syndrome

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AO classification for diaphyseal fractures

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AO classification for metaphyseal fractures

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Forms of fracture management

No treatment (beware in neuropaths)
Non-surgical immobilisation
External surgical fixation
Internal surgical fixation
- Intramedullary/extramedullary
Replacement

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Rule of 3s for fracture healing

Closed

Paediatric

Metaphyseal

Upper limb fracture

Takes 3 weeks. Any change = doubling of healing time

Risk factors for poor fracture healing

Older age

Co-morbidity (e.g. diabetes, malignancy)

Smoking

NSAIDs/steroids

Osteoporosis

Local infection/poor blood supply

Principles of fracture management

Reduction

Immobilisation

Rehabilitation

Aims of fracture reduction

Anatomical position to promote union
Maintain neurovascular supply
Pain relief
Stability

Indications/advantages of external fixation

Burns/skin loss/open fractures

Minimises soft tissue disruption + allows postoperative manipulation

Indications/advantages of internal fixation

2 #s in one limb

Unstable fractures

Intra-articular #s

allows early restoration of function

Forms of internal fixation for fractures

**Plate and screws:** Used for long bones, bu may hold apart **Intramedullary nail:** For shaft fractures **Dynamic screws:** Compression screw plate aka dynamic hip screw --\> allows it to be forced together as NOF **K-wires:** For small metaphyseal segments

Initial management of open fracture

* Assess neurovascular stuts * Assess for compartment syndrome * IV antibiotics * Tetanus prophylaxis * Irrigate * Wound cover - saline-moistened sterile occlusive dressing * Splintage and immobilisation * X-ray and photograph * Debride **IN THEATRE**

Gustillo grade I fracture definition

Open wound \<1cm, clean, minimal soft tissue injury

Gustill-Anderson grade II open fracture

Wound \>1cm, without extensive soft tissue damage

Gustillo-Anderson grade IIIa

Open wound, soft tissue damage (flaps, avulsions) but with adequate cover

Gustillo-Anderson grade IIIb

Bone exposure (extensive soft tissue damage

Definition of compartment syndrome

Raised pressure within a closed compartment (fascial, burns, plaster) resulting in tissue ischaemia and necrosis

Clinical presentation of compartment syndrome

Red, swollen, tender muscle Very painful for passive stretch Pain out of proportion to clinical appearance

Injuries with high index of suspicion for compartment syndrome

Crush gunshot burn polytrauma (+ low GCS) Tight plaster casts

Treatment of acid burns

ABC Irrigation Calcium gluconate Treat hyperkalaemia + protect kidneys (fluids)

Analgesia in trauma settings

IV diamorphine up to 10mg titrated to effect 2nd line: Ketamine

Medication for major haemmorhage

1g TXA

GCS - Eye response

Spontaneously Verbal command Pain None

GCS - motor response

Obeys commands Localises pain Flexion/withdrawal Abnormal flexion Extension No response

GCS - vocal response

Oriented Disoriented Words Sounds None

CURB-65 scoring

\>=2 --\> admit **C**onfusion **U**rea \>7 **R**R \>30 **B**P: \<90/60 Age \>**65**

Gold-standard treatment of traumatic pneumothorax

Bilateral finger thoracostomy + chest drain

Classes of haemmorhagic shock

**I:** 0-15% blood loss, pulse \<100 **II:** 15-30% blood loss, pulse 100-120 **III:** 30-40% blood loss, pulse 120-140 **IV:** \>40% blood loss, pulse \>140

Complications of open fractures

Infection (esp gas gangrene from C. perfringens) Compartment syndrome Neurovascular damage

Ortho history taking components

**Pain** (esp night pain) **Loss of f(x)** - ADL, occupation **Swelling** - timing **Stiffness** **Deformity** **PMHx-** esp ortho, hip replacements

Approach to MSK radiology - COPE

**C**heck - right pt, right date, right side, right view **O**ld/other films - \>1 view if necessary **P**enetration - adequate? **E**xposure - Full view given on film?

Approach to MSK radiology -ABCS

**A**lignment - check joint space, bone lines **B**one - Check for any jagged edges, colour change, density change, cysts, enlargement **C**artilage/cortex - Check for cartilaginous defect or breaks in bone cortical edge/periosteal reactions **S**oft tissue - check for swelling, bleeding, hardware/foreign bodies