Flashcards in The Multiply Injured Patient Deck (27)
Loading flashcards...
1
Why is trauma important?
-Leading cause of death for the first 4 decades of life
-For every death there are 2 survivors with significant disability
-Trauma deaths in Scotland higher than rest of the UK
2
What advances have been made in trauma care?
-Advanced trauma life support
-Battlefield advanced trauma life support
-HEMS/MERT
3
What is in place to help doctors improve their trauma skills?
-Standard operating procedures (SOPs)
-Checklists
-Simulation
-Study days
-Debrief
-Documentation
-Audit (STAG, TARN)
4
When should trauma management start?
-From time of injury
-Golden hour/ platinum 10 minutes
5
What should be established in pre-hospital care?
-Time of injury
-Mechanism of injury
-Speed/forces involved
-Ejection/pedestrian
-Likely serious injuries
-Vital signs
-Interventions carried out
6
What preparation is required pre-arrival?
-A Trauma call pre-alerts the trauma team of a patient.
-Team is made up of ED, anaesthetics, radiology, ICU and surgical specialities.
-Equipment and drug set up takes place prior to arrival.
-An ABC approach for this helps.
7
What is involved in a primary survey?
-ABC
-Detects and treats immediate threats to life
8
What is involved in a secondary survey?
-Identification of all injuries and planned management
9
What is the goal of damage control resuscitation?
-Minimise blood loss
-Maximise tissue oxygenation
10
ATLS Primary Survey.
-Airway with C-spin control
-Breathing with O2
-Circulation with haemorrhage control
-Disability
-Exposure and environment
11
BATLS Primary Survey
-Catastrophic haemorrhage control
-Airway with C-spin control
-Breathing with O2
-Circulation with haemorrhage control
-Disability
-Exposure and environment
12
How is airway assessed?
Noises
-Speech
-Gurgling
-Stridor
Visual
-Swelling/deformity
-Vomit/blood/debris
13
How can airway be managed?
-Manoeuvres
-Suction
-Adjuncts
-Advanced procedures
14
When should a c-spine injury be assumed?
-Major trauma
-Reduced conscious level
-Dangerous mechanism
-Injury above clavicles
-Neurological signs
-If distracting injuries during clinical assessment
15
How is breathing assessed?
Expose the chest
-Look for work of breathing/expansion and effort
-Feel (palpate and percussion)
-Auscultate
16
How is circulation assessed?
Clinical
-HR
-Palpable radial pulse
-CRT
-BP
-Pulse pressure narrows
-Urine output
-Confusion
-Blood tests (HB and lactate)
-US and CT
17
What are the 5 sites for blood loss?
-Chest
-Abdomen
-Pelvis
-Long bones
-Floor
18
How can fluid be replaced?
-IV access
-IO access
-Massive transfusion protocols
19
How can volume replacement be monitored?
-Vital signs
-Urine output
-Lactate
20
What is the lethal triad?
-Coagulopathy
-Acidosis
-Hypothermia
21
What neurological examination should be carried out for disability?
-AVPU
-GCS
-Pupillary responses
-Tone and reflexes
22
How should 'E' be assessed?
-Expose to allow full examination
-Then cover and keep warm
23
What does 'G' stand for?
Glucose
24
What bedside tests can done for glucose?
-ECG
-ABG
-Urine dip
25
What is the traditional method for secondary survey and investigations?
Primary survey x-rays
-C-spine
-Chest
-Pelvis
Secondary survey
-Meticulous head to toe
-Log roll
-“Spring the pelvis”
-Check all orifices – PR etc
26
What is the modern approach for secondary survey and investigations?
Ultrasound
-Pneumothorax
-Fast scan
Minimal handling
-Possibly no log roll
CT secondary survey
-NNtB 17
27
