Trauma pt eval Flashcards
Most common causes of Trauma Mortality?
CNS injury (1/2) Exsanguination
Exacerbating factors in Trauma Mortality? (3)
Warfarin
Low Glascow Coma rating
Old age
Immediate death from Trauma U result of? (4)
(death at scene) Disruption of: Great vessels Heart Lungs Major body cavity
Early death from trauma U result of?
(w/i 4 hrs of injury)
CV or pulmonary collapse
Late death from trauma U result of?
(days to wks post)
sepsis
multiorgan failure
Level I Trauma Center provides?
Tertiary care
24 hr in-house surgeons + promptly available specialists
Level II Trauma Center provides?
Initiates definitive care
24 hr surgeon + specialty except for cardiac or microvascular surgery, dialysis
Level III Trauma Center provides?
Assessment, resuscitation, stabilization, intensive care
24 hr ER docs and general surgeons
Level IV Trauma Center provides?
Advanced traumatic life support prep for transfer
24 hr ED and labs
Level V Trauma Center provides?
Eval, stabilization, diagnostics, prep for transport
After hr protocols
ATLS includes? (4)
1) initial eval
2) resuscitation
3) stabilization
4) transfer
Initial Eval of trauma includes? (4)
Stabilization
Identification of life-threat injury
Initiate support
Rapid organization of definitive care or transfer
Primary Eval must assess and address?
Airway Breathing Circulation Disability Exposure
End-organs are? (4)
Brain
Heart
Kidneys
Eyes
Airway management includes? (5)
1) Assess conscious pt (w/ question)
2) Protect airway/cervical spine of unconscious pt
3) Observe (signs of difficulty)
4) Inspect mouth/throat (obstacles)
5) Inspect/palp anterior neck
Tracheal Intubation used to?
How?
Mechanical ventilation
Endotracheal tube passed b/w vocal cords,
Requires direct visualization of cords,
Tube tip placed 1/2 b/w clavicle and carnia (trach spit into bronchi)
Cricothyroidotomy is?
insertion of tube thru incision in cricothyroid membrane
Breathing/Ventilation management includes? (6)
1) O2
2) Chest wall inspection (asymm/paradox mvmt)
3) Auscultate (apices and axillae)
4) Palpate (crepitus/deformity)
5) CXR for unstable pt
6) r/o pneuom/hemothorax, tamponade
Treatment when signs of pneumothorax?
hypoTN, dyspnea, ipsilateral ↓ breath sounds
Needle Decompression:
2nd ICS @ MCL
5th ICS @ MAL
Tube thoracostomy:
immediately follows needle decomp
5th ICS, MAL
Vent treatment when unstable pt?
anticipate pneuno/hemothorax
Tube thoracostomy
Circulation management includes? (5)
1) Palpate central pulses (carotid/femoral)
2) Observe for external hemorr
3) Place IV catheters
4) Blood typing
5) Determining exact BP not necessary
Arterial Hemorrhage management?
Manual pressure
Proximal compression
Elevation
Hemostatic agents
Venous hemorrhage management?
Direct pressure
Tx for pts w/o central pulse?
emergency thoracotomy
Disability/Neuro management includes? (4)
1) Eval level of consciousness / Mental status
2) Pupil size, symm, light response
3) Motor/Sensory
4) Imaging
Exposure/Environment Control includes?
1) Visualize entire body
2) Hypothermia
If pt is hemodynamically unstable, next step after primary survey?
Skip 2° survey
Send right to angio or major trauma center
2° Survey in trauma includes? (3)
Head to toe exam (fingers and tubes in every hole)
Detailed hx (of traumatic event and of pt’s medical hx)
X-Ray/CT
Common Misses in trauma:
Blunt Abd?
Penetrating Abd?
Thoracic?
Extremity?
Blunt abd trauma:
hollow viscus
pancreatoduo
diaphrag
Penetrating abd trauma:
rectal or urethral
Thoracic trauma:
pericardial tamponade
aortic injuries
esophageal perf
Extremity trauma:
fractures
vascular disruption
compartment synd
2° Survey: C-Spine management
Clear (no x-ray needed) if: non-tender alert not intoxicated no distracting injury
If can’t clear, do CT
*neg CT AND tenderness, still cannot clear
2° Survey: Tube considerations?
Foley:
blood at meatus
pelvic fracture
NG Tube:
mid face fractures
2° Survey: Abdomen?
Diagnostic Peritoneal Lavage
CT
US
Most frequently injured organ w/ penetrating trauma?
liver
Most frequently injured organ w/ blunt abd trauma in adults?
Spleen
What vaccines recommended w/ loss of spleen?
pneumo
h. flu
meningococc
Common result of splenectomy?
thrombocytosis
2° Survey: Chest? (6)
Crepitus Tenderness JVD (SVC compression) Tracheal deviation (tension pneumothorax) Respiratory effort CXR
