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18 Cards in this Set

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Common presentation of tension pneumothorax
Hypotension, tachycardia, deviation of the trachea, neck veins distention, decreased unilateral breath sounds
- Need immediate niddle decompression
Most common cause of postinjury death
Hypovolemic shock due to hemorrhage
Primary survey
ABCDE
Airway with c spine control
Breathing and ventillation
Circulation and control of hemorrhage
Disability (neuro status)
Exposure/Environment
How do you assess airway
Look for foreign bodies or signs of facial, mandibular or tracheal/laryngeal fractures that can cause obstruction. Remain suspicion for c-spine injury and provide immobilization of the neck. Suspect c spine injury in any patient with altered consciousness, blunt injury above clavicles or multisystem trauma
How do you assess breathing and ventilation
Breathing and ventilation involve lungs, chest, diaphragm and nervous system. Decreased consciousness, pneumothorax, flail chest, pulmonary contusion, hemothorax or rib fractures can impair ventillation - visually examine and auscultate chest
How do you assess circulation and control hemorrhage
Identify acute massive hemorrhage rapidly by assessing level of consciousness, skin color and pulse. Decrease in circulating blood volume can result in altered consciousness. Ashen or white skin can indicate significant blood loss. Rapid, diminished or absent peripheral pulses can be a sign of acute hypovolemia
Absent central pulses indicate massive volume loss and require immediate fluid resuscitation.
Life threatening hemorrhages can occur into abdominal and thoracic cavities, into muscles secondary to fractures or externally secondary to penetrating trauma. Control external bleeding by direct manual pressure - do not use tourniquettes or hemostats
How do you assess disability
Perform rapid neurological assessment
Use AVPU method - alert, responsive to vocal stimuli, responsive to painful stimuli, unresponsive.
Glasgow Coma Scale - if less then 8 severe intracranial trauma
What does exposure and environmental control stand for
Patient must be completely undressed and examined front to back - after that cover patient with warm blanket to protect from hypothermia
Describe resuscitation
Perform resuscitation with primary survey addressing each problem as it is identified.
- Airway resuscitative maneuvers include jaw thrust, chin lift and nasopharyngeal airway. Endotracheal intubation may be required to maintain airway patency
-Ventillation and breathing -supplemental oxygen (face mask)
- Establish at least two large bore peripheral IV catheters, draw blood for type and crossmatch
- Initiate immediate fluid resuscitation with 2 L of IV crystalloid solution (Ringer lactate or normal saline) for patients with sign of hemorrhage
- If patient doesnt respond to fluid resuscitation - administer blood immediately - type specific or O negative
What does secondary survey consist of
- Complete more thorough head-to-toe exam
- X ray - lateral c spine, chest, pelvis and extremities if needed
- Place urinary catheter to decompress bladder and monitor urinary output
- Place gastric catheter to empty stomach and prevent aspiration
- Continuously monitor heart, BP and pulse to see if resuscitation is working
What do you do after secondary survey
Consult with ortho, surgery etc about further diagnostic tests and definitive treatment. Diagnostic tests include CT scans of head, abdomen and pelvis and diagnostic peritoneal lavage
Dysrrhythmias in trauma patient can indicate _
Blunt cardiac injury
Electric pulseless activity of heart can be sign of _
Cardiac tamponade
Tension Pneumothorax
Profound hypovolemia
How do you take history in trauma patients
AMPLE method - allergies, medications, pregnancy/past illness, last meal, environment/events of injury
Battle sign
Bruising of mastoid
Cardiac tamponade
Distant heart sounds + narrow pulse pressure
6 Ps of compartment syndrome
Pain (out of proportion)
Paresthesias
Pallor
Paralysis
Pressure (palpable)
Pulselessness
Traumatic rhabdomyolysis
Urine dipstick test is positive for HGB but negative for RBC's under microscopic examination - could be due to myoglobin presence
Alkalinization of urine is necessary with sodium bicarb to prevent precipitation of myoglobin