Week 2: AMS, trauma, toxicology Flashcards
Primary survey steps
A - airway B- breathing C- circulation D- disability (neuro) E- exposure/environment
Airway: judgement, considerations, treatment
Have patient speak/look for cyanosis
Consider obstruction, bleeding, fractures, burn/allergy (swelling)
GCS<9 = intubation
C-spine, naso/oral airway, RSI, cric
Breathing: assessment
Inspect chest: cyanosis, JVD (tension/tamp), deformity
Auscultate/percuss
Two possible problems with breathing that need intervention during primary survey
Tension PNX - needle decompression
Massive hemothorax - chest tube/OR
Pulse location and associated SBP
Radial: 80mmHg
Femoral/carotid: 60mmHg
Primary exam: disability
Alert/voice/pain/unresponsive
Gross motor/sensory
Pupils
GCS
GCS
Eyes - 4
Verbal - 5
Motor - 6
Tests performed during primary survey
CXR
US FAST
FAST exam
sub-xiphoid cardiac
spleno-renal
hepato-renal
bladder
AMS DDx
AEIOU TIPS
Alcohol Epilepsy/electrolytes (Na, NH3) Insulin Opiates Uremia Trauma/temperature/tox Infection Psychiatric Shock/stroke
Categories of AMS
Delirium
Dementia
Psychosistae
Reversible toxicology aka ‘coma cocktail’
100% O2 via nonrebreather
Fingerstick BGL (hypoglycemia)
Narcan (opioid)
-> Intubation
Best parts of PE for overdose/tox
Vitals Mental status Pupils Skin color Track marks \+/- sweat Bladder size
Toxidromes: anticholinergic
Mad as a hatter (AMS) Blind as a bad (mydrasis) Hot as hell Red as a beat Dry as a bone Filled as a flask (urinary retention)
TCA’s, Antihistamines, OAB meds
Toxidromes: cholinergic
SLUDGE
Salivation Lacrimination Urination Diaphoresis/defecation GI upset Excessive brady/tachycardia (muscarinic or nicotinic)
