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44 Cards in this Set
- Front
- Back
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Prehospital Resuscitation
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Goal = stabilize and transport
*airway, bleeding, shock, immbolize Communicate with triage for advanced planning and readiness *warm room, fluids, blankets *intubation and ventilation set up *continue immobilization until clear |
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ER Resuscitation
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Primary survey (rapid)
Vital functions support Secondary survey (detailed) Initiate definitive care |
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Primary Survey
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1-2 minutes
identity life threatening injuries *airway *breathing *circulation *disability (neuro) *expose, environment |
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Airway
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immobilize c-spine
assess for obvious trauma *RR, deformity, trachea, cyanotic, LOC *stridor, dullness, resonance secure airway by procedure *ETT, naso, orpho, cricothyroidotomy |
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Cricothyroidotomy
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small puncture through thyroid
small ET tube is placed used until more secure airway placed |
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Breathing
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assess for spontaneous breathing
*RR, symmetry, wall integrity, open wounds, accessory use, blunt |
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Absent breathing
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intubate
ventilate |
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Ineffective breathing
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assess for threats
*tension pneumothorax, flail chest give oxygen therapy continuous pulse ox |
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Circulation
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assess for hemorrhage
*pulses, bleeding, LOC, pallor *HR > 120, MAP < 65 initiate ECG monitoring |
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No pulse
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CPR
defibrillation |
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Ineffective pulse
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assess threats
*uncontrolled bleeding, shock 2 large bore IVs or central line serum labs fluids |
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Disability
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Neuro status
*Glasgow coma scale *pupil size, reactivity *posturing, agitation *lack of movement, sensation |
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Exposure
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assess soft tissues
*injury,crepitus, deformity, edema remove all clothing prevent hypothermia |
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Resuscitation phase
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2 large bore IVs, central line, or IO
Draw labs *CBC, electrolytes, BUN/Cr, lactate *PT, PTT, amylase, liver enzymes *alcohol, toxicity, pregnancy test Warmed NS or LR fluids O negative blood Foley catheter, NG tube |
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Rapid Response
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React quickly to bolus
Remain hemodynamically stable *BP increases, HR decreases, diuresis Fluids are slowed, pt stays stable |
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Transient Response
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Improves after first bolus
Unstable when fluids are slowed *Still bleeding or poor resuscitation Continue fluids, blood transfusions Rapid surgery is response continues |
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Minimal/NO Response
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No response to fluids or blood in ER
*hemorrhage Surgery is needed immediately |
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3:1 Rule
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Give 3mL of fluid per 1mL blood lost
Effectiveness is based on response *UO, LOC, BP, HR, labs (lactate, base) Good response: *50 mL/hr of UO for an adult |
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Massive Blood Transfusions
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Massive = > 10 units in 24 hours
*life-threatening bleeds, coagulapathy Whole blood is best, not available 1:1:1 Ratio *1 unit PRBC, 1 unit plts, 1 unit FFP |
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Complications of blood transfusions
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Electrolyte imbalance
*low CA, low Mg, low or high K Dilutional coagulapathy (bleeding) Third spacing (1-2 days later) *Give albumin and colloids Hypothermia |
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Goal for 1st 24 hours
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Perfusion centered care
-Improve oxygen delivery -Normalize labs: *base deficit, lactate level, pH |
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Secondary Survey
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Full head to toe assessment
After life-threatening injuries stable *Cut off clothing(fracture, lacerations) *Special procedures are completed *ECG, FAST, radiographic study *Past medical history *allergy, meds, illness, events, meal *Involve the family |
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Rib Fracture
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Most common injury w/ chest trauma
Risk for respiratory dysfunction *indicates serious organ injury |
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Management of rib fracture
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Assess oxygenation and ventilation
Effective pain control *allows pulmonary exercise Educate, prevent pneumonia *pillow splinting, spirometry,TCDB Early ambulation |
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Rib fracture location
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Clavicle/first = unstable, major vessels
Middle = pneumo, heart/lungs injury 10-12 = liver, spleen, kidneys injury |
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Flail Chest
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2 or more adjacent ribs are broken
Results in as free floating segment *paradoxical chest movement *high RR, increased work of breathing *Late = hypoxemia TX: intubate, ventilate, oxygen |
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Diaphragmatic Injury
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Person is thrown forward over the steering wheel in a deceleration MVC
Diaphragm can rupture or tear *abdominal viscera enters thorax |
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Pulmonary Contusion
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Common death from chest trauma
*copious blood sputum, bruising *chest abrasion, PaO2 < 60 room air Xray may be clear for hours or days TX: ventilation, slow fluids, pain Complications *pneumonia, atelectasis, hemorrhage *ALI, resp distress, edema |
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Tension Pneumothorax
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Emergency!
*trachea deviation, mediastinal shift *high HR, low BP, low CO, low BS *chest pain, respiratory distress *Late = cyanosis TX: needle decompression, chest tube |
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Open Pneumothorax
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Air is still able to move in and out
*hypoxia, hemodynamic instability TX: 3 sided occlusive dressing *leave 4th side open for air passage *chest tube on affected side *chest x-ray to verify placement |
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Cardiac Tamponade
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Rapid accumulation of fluid (blood)
High pressure lowers venous return *cardiac output goes down *pulsus paradoxus, high RAP, JVD *Beck's triad TX: pericardiocentesis at bedside STAT *emergency thoracotomy, surgery |
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Priority for chest trauma
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Oxygenation
Ventilation Pain management Prevent Complications |
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Cullen's sign indicates?
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Bruising of the umbilicus
Blood in abdominal wall |
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Turner's sign indicates?
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Bruising in flank area
Retroperitoneal bleeding Possible injury to pancreas |
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Kehr's sign indicates ?
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Pain referred to the left shoulder
Possible ruptured spleen |
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Distended abdomen indicates?
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Accumulated blood, fluid, gas
Perforated organ Ruptured blood vessel |
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Flank hematoma indicates?
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Possible kidney injury
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Rigidity/tenderness indicates?
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Peritoneal inflammation
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Abd. SQ emphysema indicates?
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Free air due to ruptured bowel
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FAST sonograpghy
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Initial Dx of abdominal trauma
Detects abdominal fluid Unstable patients |
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Abdominal Dx
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Stable = CT scan (best)
Unstable = FAST Also, peritoneal lavage, irrigation |
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Liver injury
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Penetrating trauma
CT scan for Ex Unstable = surgery for hemorrhage |
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Spleen injury
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Blunt trauma
Life threatening hemorrhage Unstable = splenectomy *risk for sepsis *risk for streptococcal pneumonia *give pneumonia vaccine |
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Intestinal injury
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Bile, stool, enzymes, bacteria leak
Surgery for multiple CT findings *risk for sepsis, abscess, fistula |
