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52 Cards in this Set
- Front
- Back
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What is the first step in taking care of a trauma patient?
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Universal precautions
-Cap -Gown -Gloves -Face shield |
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What's the first thing you're going to do after universal precautions?
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While I'm starting the primary survey I'd like the nurse to remove the patient's clothes and cover with warm blankets, then start 2 large bore IV lines in the antecubital fossa with 2 L LR warmed
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Is that all you want her to do?
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No I'd also like her to send a blood sample for ABG and Type/Crossmatch, and a urine sample for UA/pregnancy test
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Ok, now what?
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I want to assess the airway
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How do you assess the airway?
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Patency - can patient talk
Obstructions - remove visible, suction if necess Maintain Cspine alignment |
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Airway assessment shows no obstructions, patent but patient is having some difficulty breathing. Now what?
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1. Jaw thrust to increase airway
2. Administer O2 airway with a nasopharyngeal airway |
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What if the patient was unable to maintain an adequete airway?
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I would put in a definitive airway - ETT or cricothyroidotomy
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When is a cricothyroidotomy indicated?
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When a nonsurgical airway cannot be established
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What should you do after establishing the definitive airway?
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Assess and reassess:
-Airway patency -ETT placement (epigastric/BLBS) -Efficacy of ventilation |
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What should you do after assessing and managing the airway?
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RE-ESTABLISH Cspine immobility
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The patient is breathing spontaneously with O2 nasopharyngeal airway; now what?
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I want to assess breathing
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How do you assess breathing?
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Look - expose ch, look at rate/depth of respirations, trachea midline
Listen - Auscultate bilaterally Feel - for crepitus, bone breaks Percuss - hypo/hyperresonance |
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The patient is breathing at a rapid/shallow rate; what do you want to do?
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Manage breathing
-High conc O2 w/ nonrebreathable mask |
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What if the patient were unconscious?
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I'd use a bag-valve mask device
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By the way when you intubate a trauma patient how should you do it?
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RAPID SEQ INDUCTION
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What are the steps in Rapid sequence induction?
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1. cricoid pressure
2. rapid inducing agent 3. succinylcholine 4. intubate 5. ensure ETT placement 6. release pressure |
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So going back to breathing what are 5 signs of a tension pneumothorax?
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-Shock
-JVD -Tracheal deviation away -Decreased breath sounds -Hyperresonance |
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What is the treatment for tension pneumo?
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-Needle decompression
-Tube thoracostomy later |
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What are the signs of an open pneumothorax?
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It'll be pretty obvious - a hole in the chest
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When is an open pneumo especially bad?
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When the hole is >2/3 the size of the tracheal diameter - airflow will preferentially go through this resulting in hypoxia/hypercarbia in the patient!
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How would you treat an open pneumothorax?
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Occlusive dressing
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Ok so your patient you gave high conc O2, what else do you want to do?
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Attach an ET CO2 monitor and Pulse ox please
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What now?
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Assess circulation
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What are the 4 steps in Assessing Circulation?
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-Identify bleeding source - ext vs int
-Pulse - rythm/rate/regularity -Skin color -Blood pressure |
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What should you ask if it's an elderly patient?
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Are they on any BP medications?
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How can you tell if a patient has a simple pneumothorax?
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They won't have any shock bc there is no decreased VR
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How are you going to manage circulation?
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-Direct pressure if ext bleeding
-Surgical consult if internal bleeding -IV access - 2L warm LR, blood if nec. -Maintain body temp |
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What is the most common type of shock you'll see?
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Hemorrhagic
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What are 4 types of nonhemorrhagic shock to consider?
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-Tension pneumo/Massive hemothorax
-Cardiac tamponade -Neurogenic -Septic |
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How can you differentiate Tension pneumo from Cardiac tamponade?
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Tension Pneumo - diminished BSB
Cardiac Tamponade - normal BS, muffled heart sounds |
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What are the hallmark signs of Neurogenic shock?
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-Decreased BP
-Bradycardia -Warm extremities |
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What is the only way that management of neurogenic shock would differ from hemorrhagic?
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Giving a vasopressor would help in neurogenic
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What are the 4 classes of Hemorrhagic shock? Responses?
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1. Responder
2. Transient responder 3. Transient nonresponder 4. Nonresponder |
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How much blood is lost in each class?
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1. <750 ml, 15%
2. 750-1500 ml, 15-30% 3. 1500-2000 ml, 30-40% 4. >2000 ml, >40% |
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What is the treatment for each class of hemorrhagic shock?
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1. 2 L warmed LR
2. 2 L warmed LR 3. 2 L warmed LR + Blood 4. 2 L warmed LR + Blood + OR |
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What is the treatment for Tension pneumothorax?
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Needle decompression + Tube thoracostomy
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What is the treatment for Massive hemothorax?
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Volume resuscitation (2L LR)
Tube thoracostomy |
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What is the treatment for Cardiac Tamponade?
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Needle pericardiocentesis
Operation |
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So our patient responded to 2 L NS, his BP is back up and heartrate normal; now what?
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Assess Disability - neurologic status
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What would you have done if your patient had a known head injury?
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Have already called neurosurg consult
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What if your patient had not responded to the 2L of LR, or had responded but then got worse?
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I would have given 2 units of Oneg PRBCs
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Ok so how do your do the neurologic assessment?
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-GCS score
-Pupils |
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At what GCS score would you have intubated?
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8 or worse
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So the patient's neurologic status is ok.. now what?
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The nurse already removed all clothes and warmed with blankets
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What else should you do in the Environment/Exposure step?
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Expose any back injuries! Log Roll! Palpate the spine for injuries and do a rectal exam
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What adjuncts do you want at this time?
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-Foley cath
-Gastric cath |
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When would you NOT put in FOLEY?
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If there is evidence of urethral injury
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What are 3 signs of urethral injury?
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-Hi riding/nonpalpable prostate
-Blood at the meatus -Perineal echymosis/hematoma |
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When would you NOT put in a gastric catheter?
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Evidence of oromaxillofacial trauma
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What 5 MONITORS do you definetely want?
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-Vital signs
-ECG -ABG -Resp rate -Pulse ox -ET Co2 |
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What diagnostic tools does everybody get?
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-CXR/Pelvic XR/Cspine xr if appropriate
-DPL or FAST if necess to see if there's internal bleeding |
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What would you add to the 2L LR for neurogenic shock?
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Phenylephrine - a-agonist
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