WEEK 10 - Traumatic Events 1

Question 1

What types of dislocations can be reduced?

Answer 1

• lateral patellar dislocation that is still in tact
• shoulder? Consider ICP

Question 2

Management of a fracture/ dislocation?

Answer 2

• full secondary
• peripheral limb
• analgesia
• clean any wounds
• splinting/ traction

Question 3

Signs and symptoms include:

Answer 3

pain
bruising
swelling
limited ability to move the affected joint/muscle
often hear a ‘pop’ in the joint (sprain)
muscle spasm/cramping (strain)

Question 4

Treatment of a sprain/strain

Answer 4

RICE (rest, ice, compression, elevation)
analgesia/anti-inflammatories
possible surgery/physiotherapy depending on severity

Question 5

Patients should be considered to have cervical spine injury if they present with any of the following:

Answer 5

• Blunt force trauma to head, neck or back, or significant MOI
• Traumatic injury with loss of consciousness or altered mental status
• Neurologic deficits (weakness/parasthesia) in torso, legs, or arms not explained by peripheral nerve injuries
• Pain on palpitation of the cervical spine
• Pain in the cervical spine or paraspinous muscles

Question 6

Prehospital management of spinal injuries

Answer 6

• back up for extrication (request vac Matt) - extrication log roll and spinal board lift
• maintain C spine (GCS 15 can self mobilise, do manual in line if not)
• thorough secondary survey
  With signs of neurogenic shock
• aim to maintain normal temp
• request early clinical support
• aim to maintain a MAP of 80mmHg or a systolic BP of 100mmHg (20ml/kg of saline in 250ml aliquots)

Question 7

Signs of neurogenic shock

Answer 7

The loss of sympathetic tone and unopposed parasympathetic tone below the injury may lead to hypotension, bradycardia, and temperature dysregulation.

Question 8

Why do patients with a high spinal cord injury often develop neurogenic shock

Answer 8

due to dysregulation of the autonomic nervous system

Question 9

Examples of A closed head injury

Answer 9

• Concussion – temporary dysfunction of normal brain function.
• Intracranial hematoma – a condition in which a blood vessel ruptures causing a pool of blood to form around the brain (subdural hematoma) or between the brain and the skull (epidural hematoma). Can be a medical emergency.
• Cerebral contusion – a bruise to the brain tissue which is local in nature.
• Diffuse axonal injury – an injury to the axon of the neuron (frequently seen in car accidents and cause permanent damage to the brain). Severe diffuse axonal injuries often lead to comas or vegetative states

Question 10

Signs and symptoms of head injury depend on the part of the brain affected, but include:

Answer 10

headache/dizziness
confusion/altered GCS
nausea and vomiting
unequal pupils
seizure
LOC
loss of autoregulation

Question 11

Management of a TBI

Answer 11

• supporting ABCs as required
• maintaining adequate perfusion (50% of these patients lose the ability to autoregulate with increasing intracranial pressure, meaning their cerebral perfusion pressure (CPP) is dependent on an adequate blood pressure)
• oxygenation
• ondansetron to prevent rises in intracranial pressure
• universal care
• clinical support ( ICP, medstar, extrication crew)
• IV fluids ( aim to maintain a MAP of 90 or a systolic of 110)
• optimise cerebral venous return by tilting head 30 degrees (on stretcher)