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80 Cards in this Set

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  • Back
what is the primary survey?
A B C D E F G H I
airway
breathing
circulation
debilitation
exposure
foley
gastric tube
HPI
initiate transfer
what is Airway?
absence of obstruction b/t mouth, oropharynx, larynx, trachea
what is Breathing?
movement of air to & from lungs, req.s intact airway & diaphragmatic contrxn to create neg. intrathoracic P
what is Circulation?
CO that provides oxygenated blood to vital organs
PULSES present radial, femoral, carotid
what is Debilitation?
neurologic compromise, either global depression of consciousness or specific neuro deficits (GCS)
what is Exposure?
fully exposed so that no injuries are missed
what is Foley?
seriously injured pt.s should have a Foley catheter placed to monitor urine output & check for hematuria, essential to do a RECTAL EXAM before Foley is placed in male pt.s to ensure NL prostatic position
what is Gastric tube?
orogastric tube should be placed in all intubated pt.s to decompress stomach, reducing risk of aspiration
For HPI in trauma pt., get it from who?
pt., EMS, witnesses
this detailed hx should be obtained during the 2ndary survey
what are the components of the 2ndary survey in trauma?
general
head
ears
eyes
nose
mouth
neck
chest
ABD
pelvis
GU
rectal
extremities
back
neurologic
what should the trauma Hx include?
mechanism & sites of apparent injury
damage to vehicle including windshield starring, **injuries to other ppl**
passenger compartment intrusion, seat belt use, airbag deployment
any blood loss at the scene, descriptions of weapons used, vital signs recorded at scene
meds, allergies, alcohol use, illicit drugs

**death to an individual correlates with serious injuries
in trauma review of hypotensive, tachycardic pt., most immediate goal is what?
to ID a source of BLEEDING by both the 2ndary survey & ancillary imaging techniques available in the trauma bay (CXR for hemothorax, aortic injury...FAST exam for intraperitoneal blood, & pelvic XR)
what's the advantage of trauma series over CT, MR, or angiography?
trauma series can be done IN the ED

(for the unstable pt. who requires rapid stabilization & workup in the bay)
primary & 2ndary surveys should guide doc to appropriate interventions & imaging studies, such as what?
intubation, chest tube, admin of blood

FAST, trauma series, CT scan
what does the 2ndary survey include in order to inspect for bleeding scalp lacerations, to palpate the back, & to perform a rectal exam?
a LOG ROLL
pneumothorax is a ____ dx
hemothorax is a ______ dx
CLINICAL (if you suspect a pneumo, dont need a CXR to confirm!)

radiological
supine CXR:
Rt ant. ribs 6-10 fx w/o obvious underlying pneumothorax
mediastinum somewhat widened, diffuse haziness of Rt lung
NEXT STEP??
intubate 1st (could be pulmonary contusion)
then, Rt-sided chest tube for hemothorax (a radiological dx)
supine CXR: diffuse haziness of whole lung compared with other side bc of pooling of blood posterior to the lung
hemothorax

(likely given rib fxs & possible intercostal A laceration)
anterior breath sounds are often unchanged in supine pts w/ hemothorax, why?
bc lung floats atop blood
how does pulmonary contusion present?
w/ rib fxs
results in hypoxia
NOT hypotension
what is the BECK's triad of pericardial tamponade?
hypotension
distended neck Vs
distant heart sounds

**most impt: fluid in pericardial sac on FAST exam
DDX of slightly widened mediastinum on supine CXR
aortic injury
pericardial tamponade
pt with hemothorax.
you drain 1500cc of blood w/ chest tube, pt becomes pale & loses consciousness, loses carotid pulses. what NEXT?
intubate
CPR
ED thoracotomy
what is thoracotomy?
incision into pleural space to dx or tx

indications depend on whether its blunt or penetrating trauma
loss of vital signs in the field or ED, pt. has penetrating trauma, what's indicated?
ED thoracotomy
pt. w/ blunt trauma, in cardiac arrest, what's indicated?
not ED thoracotomy...these pt.s less amenable to EDT given wide extent of injury
pt. w/ blunt trauma, arrives to ED w/o vital signs, what is futile at this point?
ED thoracotomy
pt. w/ blunt trauma, loses vital signs IN the ED, has a suspected reversible cause for decompensation, what's indicated?
ED thoracotomy

i.e. for pericardial tamponade, massive hemothorax
pt. w/ penetrating trauma, bleeding coming from discrete lesion that can be repaired under direct visualization (i.e. laceration to LV), what's indicated?
ED thoracotomy

(typically more successful here)
what is shock? how does it manifest?
inadequate tissue perfusion
manifests clinically: as hemodynamic disturbances & organ dysfxn
what is shock at the cellular level?
results from insufficient delivery of req'd metabolic substrates, principally O2, to sustain aerobic metabolism
in the setting of trauma, what is the MC cause of shock?
loss of circulating blood volume from hemorrhage

(others would be: inadequate oxygenation, mechanical vascular obstruction, neurologic dysfxn, cardiac dysfxn)
what is the 2nd leading cause of death from trauma?
1. traumatic brain injury
2. SHOCK (common, frequently treatable)
what is an imbalance in oxygen supply and demand?
shock

these pts suffer from critical reduction in O2 available to mitochondria
(ATP still from anaerobic glycolysis but at only 5-10% of NL rate)
anaerobic glycolysis gives pyruvate, thus lactate
how does the sympathetic NS physiologically compensate for/respond to acute hemorrhage (to maintain adequate O2 delivery to tissues)?
in HR
vasoconstriction
inc ventricular contractility
as shock state progresses, vital organ (heart & brain) perfusion can only be maintained at the expense of what?
nonvital organs
if shock process is not reversed, what can lead to worsening systemic metabolic ACIDosis?
progressive lactate production

*along w/ hypoxia, this ultimately causes the loss of peripheral vasoconstriction & CV collapse
what is the DDX for shock?
cardiac tamponade
tension pneumothorax
pulmonary contusion or hemothorax
MI or contusion (cardiogenic shock)
SC injury (neurogenic shock) RARE
effects of pharm or tox agents
fat or air embolism
hypovolemia
pt. with shock sxs, and C1/2 fx...would you think neurogenic shock etiology?
NO, this is too rare a cause of shock
ATLS manual describes how many classes of hemorrhage to emphasize the early signs of the shock state?
4 classes of hemorrhage
ATLS classes of hemorrhage: significant drops in BP begin to manifest in which class? before this occurs, how much of pt.s blood volume may already be lost?
class III hemorrhage


30%
where are the 5 possible locations at which large scale bleeding can occur?
external hemorrhage
thoracic cavity
peritoneal cavity
retroperitoneal space (pelvic fx)
M of subQ tissue (long bone fx)
what traumas kill pt.s in seconds to minutes? (at the scene)
high SC injury (occiput, axial)
cardiac lacerations
aortic tears
what traumas kill pt.s in minutes to hours?
ruptured spleen
liver laceration
epidural hematoma
what traumas kill pt.s in days to weeks?
sepsis
multisystem organ failure
what are the earliest signs of hemorrhagic shock?
tachycardia & vasoconstriction
what is the initial tx for hemorrhagic shock?
volume resuscitation using warmed crystalloids
what is Class I hemorrhagic shock?
blood loss 0-15%
0-750cc
HR <100 but still tachycardic
tx w/ crystalloids
no blood products
what is Class II hemorrhagic shock?
blood loss 15-30%
750-1500cc
tachypnea
tachycardia >100
narrow pulse P
tx w/ crystalloids 1st, then blood products prn
what is Class III hemorrhagic shock?
blood loss 30-40%
1500-2000cc
tachypnea
tachycardia HR>120
DEC in systolic BP
change in MS
blood products & crystalloids (typed blood if possible)
what is Class IV hemorrhagic shock?
blood loss >40% (>2L)
tachycardia >140
dec BP
confusion
lethargy
blood warmers, 2L crystalloid & O Rh Neg for women, Rh Neg or Pos for men
definition of shock
abnormality in circulatory system resulting in inadequate organ perfusion & tissue oxygenation
what 4 components must all be working properly to avoid shock?
airway
pump (heart)
pipes (As/Vs)
fluid (blood)
what is NL adult blood volume?
5L

tx of hypovolemic shock must be based on signs & sxs bc blood volume loss is almost impossible to measure in the field
what are the 3 types of shock?
hypovolemic
distributive
cardiogenic
how is hypovolemic shock caused? its caused by what 4 things?
caused when blood or fluid loss exceeds the body's ability to compensate & provide adequate tissue perfusion & oxygenation
1. significant blood loss
2. burns
3. severe dehydration (i.e. cholera)
4. severe vomiting/diarrhea
500cc blood loss
1/2 L
Class I
NO sxs
subtle inc in HR, resp.s
no advanced tx usually
1000cc blood loss
1L
Class II
minor MS changes
inc in HR, resp.s
w/ no tx--> death unlikely
1500cc blood loss
1.5 L
Class II
SEEING SXS
anxious
HR>100
Resps >or =30
weak pulses in arms & legs
w/ no tx--> death unlikely
2000cc blood loss
2L
Class III
confused, lethargic
HR>120
resps >or =35
weak/no pulses in arms & legs
w/ no immediate tx--> DEATH POSSIBLE
*look for capillary reflex in nailbeds
2500cc
2.5L
Class 4
unconscious
HR>140
resps>35
no pulses in arms & legs
w/ no immediate tx--> DEATH LIKELY
what is Distributive shock? give 3 possible causes
when the body loses the ability to control the diameter of the blood vessels (causes dec in BP)
1. neurogenic, spinal injury RARE
2. septic, severe body infxn
3. anaphylaxes, severe allergic rxn
2.
what is Cardiogenic shock?
caused when heart is damaged & can no longer adequately pump
blood

usually seen in massive heart attacks where large portion of heart M has died (40% died)
what are the 4 stages of shock?
1. initial injury/early
2. compensatory
3. decompensating
4. irreversible!
what is #1 Initial/early shock?
when pt. is able to maintain BP w/o intervention

slight anxiety
BP NL or ~ elevated 120/80
HR NL or ~ elevated 100
RR NL or ~ elevated 16-20
what is #2 Compensatory shock?
inc force of heart contrxn (rapid HR, blood directed to vital organs)

mildly anxious & restless
BP slightly <NL
HR elev.
RR elev.
what is #3 Decompensating shock?
dec O2 available at cellular level, body can no longer compensate!

changes in MS
BP rapidly falling <90 sys
HR elev. >120
RR elev. >30
what is #4 irreversible shock?
body loses all abilities to compensate!!
mortality rate>65%
permanent organ damage (energy stores depleted, cell memb compromised, organ death, varies w/ pt health status)

severe AMS or unconscious
BP <70 or undetectable
HR extremely elev., then rapidly falling
RR extremely elev. >40, then rapidly falling
what is the 1st sign of shock??
anxiety & restlessness!

other signs & sxs:
rapid breathing
rapid HR
AMS
cold skin
weak peripheral pulses
dec or no urine output
sweating
heart rhythm changes
low BP
what are the resuscitative measures for a shock pt.?
give appropriate interventions as reqd
- hemorrhage control
- correct airway obstruction
- correct pneumothorax

interventions used are dictated by skill levels of practitioner & agency protocols
give 5 points for general shock managment
1. position the pt. w/ feet/legs elev. (protect Cspine prn)
2. est. adequate oxygenation
3. gain IV access (admin fluids, ot. is NPO)
4. keep pt. warm & calm
5. add appropriate adjuncts to fluid & O2 tx if able to determine type of shock
what is the ultimate measure of resuscitation?
URINE OUTPUT
what is the ultimate fluid replacement?
BLOOD
initial therapy is almost always what?
IV fluids
what makes up 50% of all injuries that lead to death?
head trauma!
what is the max. GCS score?
15

GCS is descriptive and prognostic
what are the 3 components of the GCS?
1. best EYE response
2. best VERBAL response
3. best MOTOR response
GCS best EYE response. give 4 categories.
1. no eye opening
2. to pain
3. to verbal command
4. open spontaneously
GCS best VERBAL response. give 5 categories.
1. no verbal response
2. incomprehensible
3. inappropriate
4. confused
5. oriented
GCS best MOTOR response.
give 6 categories.
1. no motor response
2. extension to pain
3. flexion to pain
4. withdrawal from pain
5. localizing to pain
6. obeys commands