TRAUMA REVIEW Flashcards
1
Q
Types of Shock
A
- Hypovolaemid: Inadequate tissue perfusion as consequence of circulatory fluid loss.
- Cardiogenic: Inadequate tissue perfusion as consequence ofcardiac failure
- Neurogenic: Occurs after an injury to the spinal cord. Sympathetic outflow is disrupted resulting in unopposed vagaltone
- Anaphylactic: is an acute multi-system severe allergic reaction. The allergic response has cardiovascular, pulmonary, and neurogenic components
- Septic: decreased tissue perfusion and oxygen delivery as a result of severe infection and sepsis. Persistent arterial hypotension remains despite adequate fluid resuscitation
2
Q
Classes of Shock
A
- Class 1 <15% few signs
- Class 2 15-30% Increased HR/RR, decreased pulse pressure
- Class 3 30-40% HR>120, RR 30-40, decompensation (Syst
BP <90 mmHg) - Class 4 > 40% HR>140, marked decrease in systolic bp, profound lethargy.
3
Q
Trauma Management Principles
A
- Scene assessment
- Catastrophic bleeding (with haemorrhage control as required)
- Primary Survey (with C-Spine consideration)
- Airway management/ventilatory support (as required)
- Oxygen therapy as per CPG 1.5
- Haemorrhage control as per CPG 5.4
- Immobilisation (as required)
- Consider IV fluids if hypotensive and signs of poor organ perfusion
- Secondary / CNS Survey (as required)
- Consider analgesia
- Consider ECG monitoring
- Consider prevention of hypothermia
4
Q
Spinal Trauma Indications
A
- GCS < 15 at time of initial assessment.
- Spinal pain, tenderness or deformity.
- Neurological deficit with paraesthesia in the extremities or other clinical suspicion
- Significant mechanism of injury in conjunction with distracting injury or inability to communicate.
5
Q
Spinal Trauma Distracting injuries
A
- Burns
- Long bone fractures
- Large lacerations
- Degloving
- Crush injuries.
6
Q
Fluid Guidelines - Trauma
A
- Adult patients with blunt trauma or isolated head injury with hypotension (SBP < 90 mmHg) and signs of impaired organ
perfusion – infuse 250ml and reassess (2L max) - Adult patients with penetration trauma, ectopic pregnancy or aortic aneurysm with hypotension (SBP <70 mmHg) and signs of impaired organ perfusion – infuse 250ml and reassess (2L max)
- Hypotensive paediatric patients (SBP < 70) should receive IV fluids – 10ml/Kg (Max. 250ml bolus) and reassess. Maximum total fluids 40mls/Kg not exceeding 1L in total.
7
Q
Pelvic Trauma T POD
A
- Trauma Pelvic Orthotic Device
- A relevant mechanism of injury and associated hypotension should be assumed as having a time-critical pelvic injury until proven otherwise.
8
Q
TBI management
A
- Open, clear, maintain and protect the airway (consider C- Spine injury).
- Oxygen – maintain SpO2 > 90%.
- IV/IO Access.
- Manage and prevent hypotension.
- 30º head elevation if condition permits to improve venous drainage.
- Maintain euglycaemia (BSL > 4mmol).
- Consider Ondansetron (CPG 11.30).
- Consider Ketamine for combativeness (CPG 11.23).
- Frequent vital sign monitoring.
- Urgent transport (preferably to a trauma centre).
9
Q
Burns Trauma Precautions
A
Asessment of the patient includes:
- the time of burn injury
- inhalation injury;
- % TBSA affected;
- site and depth of wounds;
- the patient’s age;
- the presence of other injuries,
- the echanism of injury;
- any areas of circumferential burns,
- co-morbidities
- psychosocial issues;
- Reddened and intact skin areas should not be included when calculating % TBSA burnt;
- There may be entry and exit point for electrical burn injuries;
- Patient suffering electrocution injuries should be monitored for dysrhythmias (and 12-lead performed);
- Water gel dressings can be used, but water is preferred to cool burns
10
Q
Burns Trauma Fluids
A
Fluid replacement formula:
Adults:
- < 15% TBSA = no fluid;
- 15 – 25% TBSA and > 30 minutes for transportation to ED = 1 litre over 1 hour (Max 1 litre);
- > 25% TBSA = 1 litre stat followed by 1 litre over 1 hour (Max 2 litres);
Paediatrics:
- > 10% TBSA and > 30 minutes for transportation to ED = 10ml /Kg over 1 hour;
11
Q
Burns Trauma burns unit
A
- Inhalation injury
- Partial / full thickness burns with any of the following criteria:
- Children under 10 years of age, or adults older than 50 years of age
- Burns of more than 10% TBSA
- Burns involving face, hands, feet, genitalia, perineum and major joints
- Burns with complicating trauma where the burn poses the greatest risk
- Chemical burns
- Electrical burns
12
Q
Burns Rule of Nines
A
13
Q
3 MVA impacts
A
- Vehicle impact, will occur when the car hits the tree
- Body impact, will occur when the occupant hits some structure inside the car (eg., windshield, steering wheel, or dashboard)
- Organ impact, will occur within the body of the occupant, when movable organs (i.e., brain, heart, liver, spleen, or intestines) impact with the supporting structures i.e., the skull, sternum, ribs, spine, or pelvis)
14
Q
Newtons First and Second Laws
A
- A body in motion or at rest will remain in that state until it is acted upon by an outside force
- Force (f) equals mass (m) multiplied by acceleration (A) or deceleration (D)
15
Q
Down and Under Injuries
A
- knee dislocation
- patellar fracture
- femur fracture
- fracture or posterior dislocation of the hip
- fractured acetabulum
- vascular injuries
