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Flashcards in The Multiply Injured Patient Deck (27)
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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

Where do trauma patients usually get transferred for further management?

Theatre
-Operative management (DCS)

Interventional radiology
-Control of bleeding

ITU
-ICP monitoring
-Ventilation
-Continued resuscitation