WEEK10-Major trauma Flashcards
whats the foundations of the major trauma primary survey
danger, ppe, pat, response, consent, catastrophic haemorrhage, c-spine, airway, breathing, circulation
what is cat hem
extreme bleeding likely to cause death within minutes
whats an adults circulating volume litres of blood
4.5-6 litres
how can u evaluate how much bleeding a person has undergone
check the rate and volume of bleeding that you can see
how can you tell if there’s an arterial bleed
can be recognised by spiriting thats rhythmic this will match the pulse rate
what are the 2 types of haemorrhages
internal (blood loss beneath skin)
external (blood loss from traumatic wound)
how do you conduct cat hem on the primary survey
assess for life threatening external bleeding
whats the stepwise approach to extrenl bleeding managament
direct pressure, indirect pressure pressure dressing, hemostatic gauze, torniquet
whats the indications for pressure dressing
mild to moderate bleeding
whats the indications and how do you conduct hemostatic gauze
bleeding thats uncontrolled by any sort of pressure
pack into the wound until bleeding has stopped
contraindications of haemostatic gauze
must not be used in eyes or mouth
why do guidelies state you shoudlnt use haemostatics on non-compressible wounds
because wounds to non- compressible wounds like the chest and abdomen cant be controlled through direct pressure.
indications and how to conduct a tourniquet
bleeding that uncontrollable
apply 2-3cms above the site of bleeding. twist until the bleeding stops. ensure its secured
whats the saying if the c-spine
c3,4 and 5 keep you alive!
what is the c-spine
cervical spine is made of 8 vertebrae with multiple nerves running within
the nerves help conduct signals from brain to body.
fractured vertebral bodies can lead to severe spinal cord injuries
what does c-spine immobilisation ensure
that no secondary spinal cord injuries occur and performing manual in-line spinal immobilisation ASAP
what is c0spine immobilisation
manual in-line spinal immobilisation is when someone physically supports the patients head and neck to prevent it from moving
one conducted do not move unless c-spine injury has been completely ruled out.
can you conduct head tilt chin lift with c-spine injury if not why
no because can’t move neck if c-spine injury is present
what are the guidelines for who and when to conduct c-spine immobilisation
any patient that has drugs or alcohol
if they are confused or have reduced gcs
any history of spinal injuries
a high mechanism of injury (falling of a horse)
indications of a non-occlusive dressing
if patient has evidence of a penetrating chest wound then the rusell chest seal should be applied
do you give 100% oxygen for major trauma
yes in every patient, including people with copd
should be given 15 litres of oxygen regardless of the spo2 reading
whats blood on the floor and 4 more
helps detect internl bleeding.
the 4 cavities to check are:
chest
abdomen
pelvis (hips)
long bones (legs)
what do you check for during blood on the floor, 4 more
chest-bruising, flailed segments
abdomen- palpating rigid and observation of bruising or external marks
pelvis- don’t move. just look and base on mechanism of injury
long bones- assess for injuries that could cause blood loss like a mid femur fracture
indications and contraindications of a pelvis binder
pelvis holds 4-6 litres of blood therefore must intervene asap
pelvic binder is sued for suspected pelvic bleeding caused by unstable pelvic fractures. or any mechanism of injury that might have caused structural damage
dont conduct if theres an impaled object through the pelvis
how do you conduct a pelvis binder
expose pelvis
open binder and place under legs and use a see-saw motion to move upwards
palpate the greater trochanter and place centre of binder on this site
apply tension and secure
indications and contraindications of a traction splint
femur fracture can loose up to 1,.5 litres of blood (30%)
use a traction splint on a suspected id shaft femur fracture open/closed
dont conduct if theres fractures to ankle/foot or partial amputation/avulsion with bone separation. also fracture’s to knee tib/fib
how to conduct a traction splint
measure pole against good leg
expose leg
place blue thigh strap over patient and attach the metal pole
place foot into heel strap and attach to pole
apply yellow knee strap (just above or below knee)
apply traction y pulling red tab on ankle strap
secure by applying red and green strap
what is hypvolemic shock
inadequate organ perfusion caused by loss of intravascular volume
characteristic= bleeding
blood loss of up to 1L-1.5L required before classic signs appear (like anxiety, abnormal behaviour, tachycardia)
whats the shock triggered by
critical drop in circulating blood volume. massive loss in red blood cells intensifies the tissue hypoxia
what are the 4 key stages of blood loss
stage 1: volume loss= up to 15% of total blood (750ml)
heart rate= normal or minimally elevated
usually no change in blood pressure, pulse, respiratory
patient= pale and anxious
stage 2: volume loss= from 15% to 30% of total blood volume (750-1500ml)
heart rate/respiratory rate= elevated
pulse pressure becomes narrow (diastolic increases)
stage 3: volume loss= from 30% to 40% of total blood volume (1500-2000ml)
heart and respiratory rate= are significantly elevated and capillary refill is delayed
patient= is extremely pale, cold, and sweaty
significant drop in blood pressure and confusion
stage 4: volume loss is +40%
hypotension and narrow blood pressure (less than 25 mmHg between systolic/diastolic)
tachycardia (+120 bpm) cap refill= delayed/absent
likely to have reduced LOC and mental state increasingly down
what are the specific numbers for hypovolemic shock stages 1-4
stage 1:
blood loss= 750ml (15%)
bpm= up to 100
blood pressure= normal
RR= 14-20
urine output= more than 30ml per hour
cns symptoms= normal
stage 2:
blood loss= 750-1500ml (15-30%)
bpm= above 100
blood pressure= decreased
RR= 20-30
urine output= 20 to 30ml per hour
cns symptoms= anxious
stage 3:
blood loss= 1500-2000ml (30-40%)
bpm= above 120
blood pressure= decreased
RR= 30-40
urine output= 5-15ml per hour
cns symptoms= confused
stage 4:
blood loss= above 2000ml (40%+)
bpm= above 140
blood pressure= decreased
RR= above 35
urine output= none
cns symptoms= lethargic
