Trauma Trevor Stuff Flashcards
Primary survey
Always done in the initial assessment of a patient.
Checks for “ABCDE”
- airway
- breathing
- circulation
- disability
- avoid hypothermia
Always redone when patient status changes.
Assessment of glasgow scale is here
Tension pneumothorax is most commonly seen life-threatening pulmonary injury
Secondary survey
Completed after each primary survey.
Involves a through head-to-toe examination documenting all abnormal findings.
Always protect against hypothermia if expected.
Contains SAMPLE
Continuous treatment and stabilization during this
Glasgow coma scale
Assess for need to intubate airways
8 or lower = intubation
Eyes: 1 = no response 2 = response only to pain 3 =. Responds to loud voice and pain 4 =. Responds normal
Verbal 1 = nothing 2 = incomprehensible words 3 =. Words but not right words 4 =. Confused but can speak 5 =. Normal
Motor 1 = nothing 2 = abnormal extension 3 =. Abnormal flexion 4 =. Withdraws to pain 5 =. Localized pain 6 = normal
EFAST
Chest radiograph and lung ultrasound ordered during primary survey (after B) if breathing appears off or suspected intraabdominal hemorrhage or any kind.
SAMPLE
Situation
Allergies
Past history
Last meal
Environment and expose
Should be obtained as best as possible during secondary survey
Classes of hemorrhagic shock
Determined via blood percentage loss. And heart rate/BP
Class 1: less than 15%
- No changes in vitals
Class 2: 15-30%
- heart rate and pulse pressure changes slightly
Class 3: 31-40%
- heart rate, BP, pulse pressure, respiratory rate and urine out put all change
Class 4: greater than 40%
- all the same vital signs change but marked very high heart rate increase and near no urine output.
Glasgow coma scale with eyes
Spontaneous movement: 4
Respond to sound: 3
Respond to pressure: 2
No response: 1
Glasgow coma scale with verbal
Oriented and not confused: 5
Confused: 4
Can only speak words with no cognitive ability to make sense: 3
Can only speak sounds with no cognitive ability to make sense: 2
No verbalization: 1
Glasgow coma scale with motor
Obeys commands with actions: 6
Localized movements: 5
Normal flexion: 4
Abnormal flexion: 3
Extension only: 2
No movement: 1
NEXUS criteria for no cervical spine X-rays
No posterior midline tenderness of cervical spine
No evidence of intoxication
Normal level of alertness and stability
No focal neurological defects
No painful distracting injuries
Pediatric trauma characteristics
Injuries mostly from blunt trauma
Head injuries are the most common cause of death
Often have significant blood loss before hypotension is measured
Ligamentous injuries are more common than bone.
Geriatric Trauma characteristics
Blunt trauma caused by falls are the most common injury
Five common characteristics in geriatrics are cirrhosis, congenital coagulopathy, COPD, ischemic heart disease and diabetes mellitus
More likely to develop bone fractures than ligamentous damage.
Pregnant trauma patients
Preventing maternal shock is the #1 thing to focus on in treatment
- vena cave is often compressed by uterus in trauma (patient should be placed in left-lateral decubitus to prevent this)
- amniotic fluid ruptures are prevalent
- immunoglobulin therapy is to be given to Rh-negative mothers.
Shock treatment
Class 1 or 2: fluid resuscitation with up to 1L warm saline is recommended
Class 2 or greater hemorrhages are always treated with blood product resuscitation
- usually low ratioed blood products with less crystalloid to prevent thrombosis
Pulsus paradoxes
Abnormally large decrease in stroke volume, systolic blood pressure by greater than 10mmHg
5 Ps of extreme trauma (and compartment syndrome)
Pain (Early)
Paraesthesia (Early)
Pallor (Late)
Paralysis (Late)
Pulselessness (Late)
Early signs only = treat with fasciotomy
Late signs only = treat with amputation and will likely cause irreversible ischemia
Extremity trauma blood loss is the pelvius and fever
1L for femur
2L for pelvis
Femur fractures require high mechanisms of injury
Most common sites for compartment syndrome
Leg and thigh
Most common complication of lower extremity injury
Cushing triad
Hypertension
Bradycardia
Irregular breathing (Biots)
Estimated blood pressure based on palpation of important pulses
Carotid = 60mmHg or greater
Femoral = 70 mmHg or greater
Radial = 80 mmHg or greater
Dorsalis pedis = 90 mmHg or greater
Average blood volume calculation
7% of body weight in kg
Most likely cause of respiratory impairment in cervical spine injuries
Diaphragmatic paralysis
Most important first question to ask patients who have a traumatic injury
What was the mechanism of the injury?
Estimation of blood pressure based on palpable arteries
Carotid = 60 mmHg
Femoral= 70 mmHg
Radial = 80 mmHg
Dorsalis pedis = 90 mmHg
