Term
| _____ surgical disease; proper care is immediate surgical intervention to repair internal hemorrhage sites |
|
Definition
|
|
Term
| mortality rate for head trauma is ____ |
|
Definition
40%
only 40-50% recover totally |
|
|
Term
| blunt chest trauma has a ___ mortality rate when the patient presents to the ED in shock |
|
Definition
|
|
Term
| penetrating chest wounds which arrive in the ED alive, have a ____ survival rate for gun shot wounds and _____ for stab wounds |
|
Definition
70% gun shot
85% stab wounds |
|
|
Term
| _____ can be deceptive because the true nature of the injury is often hidden, and evidence of the serious injury is very subtle or even absent |
|
Definition
|
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Term
| patients who lose their pulse in route to the ED and receive a thoracotomy upon arrival have a __ survival rate |
|
Definition
32%
we bleed in teh chest and we can't get in there and stop it very quickly |
|
|
Term
regional trauma center
all types of speciality trauma 24/7 |
|
Definition
|
|
Term
area trauma center
MC trauma emergencies with surgical capability 24/7 |
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Definition
|
|
Term
community trauma center
specialized ED and some surgical capability |
|
Definition
|
|
Term
trauma facility
small community hospitals (stabilize and tranfer) |
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Definition
|
|
Term
| shock is usually secondary to.... |
|
Definition
| hemorrhage and hypovolemia |
|
|
Term
| the treatment of trauma is the treatment of... |
|
Definition
| shock (inadequate tissue perfusion) |
|
|
Term
|
Definition
primary survey
resuscitation phase
secondary survey
definitive care phase |
|
|
Term
|
Definition
establish 2 large gauge IVs of NS or LR peripherally
O2 supplementation as needed
cardiac monitor
puls ox
repeat VS Q 3-5 min til stable if stable (reflex diagnostics) |
|
|
Term
| Reflex diagnostics --> labs |
|
Definition
–Draw trauma labs: CBC, PT, PTT, CMP, Amylase, obtain UA- check BHCG
–Type and Cross for blood transfusion
–Immediate: Blood glucose, urine dipstick
–As indicated: may also check cardiac enzymes
–Altered Mental Status: Requires addition of Drug screen and alcohol level |
|
|
Term
| Reflex diagnostics --> imaging |
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Definition
oTrauma CT- (faster, with better images if able to get pt into machine)
nHead, Cervical
oX-rays (Standardized)
nC-spine (must have AP, Lateral and Odontoid views in order to clear!)
nChest
nPelvis
oX-rays (As Indicated)
nAbdominal, Extremities as indicated |
|
|
Term
| additional "reflex" items |
|
Definition
o EKG as indicated
o Tetanus tox. /Hypertet
o Antibiotics (IV)
o CT (Head/Abd/C-Spine)
o (FAST Exam or DPL), or straight to the OR? |
|
|
Term
|
Definition
A - Allergies
M - Medications
P - Past medical, surgical, and social hx
L -Last meal
E - Events leading to injury
L - last menstrual period
T - last tetanus toxoid |
|
|
Term
|
Definition
establish an airway
always assume a c-spine injury until proven otherwise
|
|
|
Term
| normal c-spine x-ray does not |
|
Definition
| rule out a c-spine injury |
|
|
Term
| a normal neurological eamination does not... |
|
Definition
|
|
Term
| immediate airway complications : |
|
Definition
apnea
respiratory distress
airway obstruction
class III-IV hemorrhage
unexplained hypotension
loss of gag reflex (disability, NS deficit)
severe flail chest or pulmonary contusion |
|
|
Term
|
Definition
chin lift/jaw thrust
oral or nasal airway
tracheal intubation
nasotracheal intubation (c-spine)
may require sedation and chemical paralysis
cricothyrotomy
transtracehal jet ventilation
large bore dental suction kept ready |
|
|
Term
| surgical airway - severe facial trauma |
|
Definition
|
|
Term
| most airways can be maintained by good..... |
|
Definition
| bag-face-mouth techniques |
|
|
Term
| primary survey - breathing |
|
Definition
expose chest & evaluate status
goal 100% oxygenation
assist ventilation as needed - 12-15 ml/kg 100% O2 |
|
|
Term
| during the primary survey (breathing) observe for : |
|
Definition
tension pneumothorax
open pneumothorax (roll the patient)
flailed chest
pulmonary contusions |
|
|
Term
primary survey - breathing
LOOK |
|
Definition
| look for paradoxical rise in chest wall |
|
|
Term
primary survey - breathing
LISTEN |
|
Definition
| listen to anterior and posterior lung fields |
|
|
Term
primary survey - breathing
FEEL |
|
Definition
| feel for rib fractures, crepitation, or subcutaneous emphysema |
|
|
Term
| look for tracheal deviation, jugular venous distention, and swelling of the neck during.. |
|
Definition
| the primary survey (breathing) |
|
|
Term
| Need to listen everywhere in the lung fields - listen in the gutter (inferior portion posteriorly) because.... |
|
Definition
| this is where blood goes first |
|
|
Term
| tracheal deviation is a very late sign of ... |
|
Definition
tension pneumo
should diagnose before this |
|
|
Term
| primary survey - breaqthing intervention |
|
Definition
100% O2 via NRB device
patient positioning
assisted ventilation PRN (BVM device)
ABG (+/-) not necessarily pertinent in primary survey |
|
|
Term
|
Definition
nNeedle to midclavicular line second intercostal space opposite side of tracheal deviation; side of decreased breath sounds
oPut in affected side |
|
|
Term
| massive hemathorax treatment |
|
Definition
nInsertion of a chest tube
nIf 1500-2000 cc blood is obtained at initial placement of chest tube or 200cc/hr for 4 hours, a thoracotomy is indicated to find source |
|
|
Term
|
Definition
if open, cover wound with an occlusive dressing
(sucking chest wound)
oBefore a chest tube is placed ensure the endotracheal tube is not down the right main stem bronchus
nWithdrawl of ET Tube from right mainstem bronchus
nReintubation |
|
|
Term
| primary survey - circulation |
|
Definition
observe for acute signs of shock
check pulses, bilateral blood pressures, capillary refill, < 2 second normal |
|
|
Term
| primary survey - circulation - Quick check 60-70-80 rule |
|
Definition
carotid pulse = systolic BP of at least 60
femoral pulse = systolic BP of at least 70
radial pulse = systolic BP of at least 80 |
|
|
Term
| control acute bleeding with... |
|
Definition
|
|
Term
| scalp bleeds are treated with... |
|
Definition
| raney clips - because they bleed profusely |
|
|
Term
| pneumatic splints may be useful in.. |
|
Definition
severe extremity bleeding
(MAST pants) |
|
|
Term
| In extremities look for ______ caused by bleeding into muscle |
|
Definition
compartment syndromes
(avoid hemostats and torniquets) |
|
|
Term
| During primary suvey (circulation) - look for signs of cardiac tamponade |
|
Definition
muffled heart sounds
neck vein distention
low blood pressure
QRS complexes on cardiac monitor (get small)
elevated venous pressure
treat with immediate pericardiocentesis |
|
|
Term
| Primary survey - Disability/Neurological assessment |
|
Definition
A - alert
V - responds to verbal stimuli
P - response to pain
U - unresponsive
glascow coma score |
|
|
Term
| the goal of resuscitation is perfusion of the... |
|
Definition
brain
heart
lungs
kidneys |
|
|
Term
| administer ____ to all trauma patients upon arrival, you can always remove it later |
|
Definition
|
|
Term
| use of peripheral lines is preferred over central lines or cutdowns |
|
Definition
|
|
Term
| DO NOT initially treat hypovolemic shock with.... |
|
Definition
|
|
Term
| resuscitation - signs of shock |
|
Definition
- low BP not responding to fluid challenges, give O negative blood after 1500-2000 cc of IV
- increasing pulse pressure w/ increased tachycardia
- look at patient - do they look like they are in shock
|
|
|
Term
|
Definition
MC in trauma
severe blood loss
volume loss from burns (plasma loss) |
|
|
Term
|
Definition
| beck's triad, tamponade/MI/tension pneumothorax/cardiac contusion |
|
|
Term
|
Definition
| fever, wide pulse pressures |
|
|
Term
|
Definition
hypotension w/o tachycardia
peripheral vascular resistance is gone - can't support a BP - can't perfuse the organs |
|
|
Term
| Hemorrhagic shock - table slide 38 |
|
Definition
|
|
Term
|
Definition
thorax & abdomen
pelvis
long bone fractures
|
|
|
Term
| initial bolus of resuscitation fluids for adults |
|
Definition
|
|
Term
| initial bolus of resuscitation fluids for peds |
|
Definition
|
|
Term
| If you have to give more than 2L of fluid then you need to give.. |
|
Definition
|
|
Term
| Resuscitation fluids : circulation |
|
Definition
best blood is typed & cross
packed RBC: administer @ least 4-6 units
Rh negative for females
O negative : universal - emergently if no response after 2L of crystalloids |
|
|
Term
___ should be placed if there is no facial trauma which can communicate to the brain
|
|
Definition
|
|
Term
| check for non-clotting blood from the nose, ears, or mouth |
|
Definition
|
|
Term
| ____ after rectal examination has been performed |
|
Definition
foley
ensure no blood at the meatus, scrotal hemorrhage, or high-riding prostate on exam |
|
|
Term
| The biggest mistake made in trauma is that the trauma manager does not continually.... |
|
Definition
| go back every few minutes as re-evaluate the ABCDs |
|
|
Term
Secondary survey - head
check for: |
|
Definition
pupil size
examine fundi
look for conjuctival hemorrhage
always obtain a visual acuity on every eye injury (early on)
x-ray or CT penetrating eye injuries
look for lens dislocation
look for hemotypanum |
|
|
Term
| secondary survey - facial injury |
|
Definition
remember to treat airway problems first, then facial trauma
if midfacial fxs suspected, place gastric tubes per oral route not nasal route
assume C-spine fractures with facial trauma |
|
|
Term
| penetrating neck injuries should be... |
|
Definition
| explore in the OR not the ER |
|
|
Term
| patients who arrive with helmets on should have a c-spine taken before... |
|
Definition
|
|
Term
| used to be liberally applied to anyone with a "concerning" MOI |
|
Definition
|
|
Term
| CT scan emerging as image study of choice |
|
Definition
|
|
Term
| secondary survey - chest injuries |
|
Definition
look @ the chest
palpate the chest
ausculatate the anterior, posterior, and lateral chest
listen to the heart in all four areas
remember abdominal contents can be in the thorax |
|
|
Term
| secondary survey - abdominal injuries |
|
Definition
look, listen, feel a fully exposed abdomen
inspect for distention
palpate for tenderness
percuss for dullness or tympany
consider to likelihood of injury based on MOI
u/s or CT |
|
|
Term
|
Definition
|
|
Term
|
Definition
| pelvic ring with single fracture |
|
|
Term
| pelvic fracture class III |
|
Definition
| pelvic ring with double fracture |
|
|
Term
|
Definition
|
|
Term
| high index of suspicious of bleeding if they have a ____ - just assume they are in shock and treat accordingly |
|
Definition
|
|
Term
| secondary survey - back injuries |
|
Definition
| look for spinal alignement, ecchymosis, deformity or tenderness |
|
|
Term
secondary survey - genitourinary
indications for examination |
|
Definition
n gross or microscopic hematuria
n fracture of the transverse process of the lumbar vertebrae
n pelvic fractures/injuries
n high velocity deceleration injuries
n pain, tenderness, palpable mass |
|
|
Term
| secondary survey - rectal examination |
|
Definition
o Look at rectum
o Examine for tone and in males location of prostate
o Note color of stools & Guaiac for blood
o Examine the integrity of the rectal wall and the bony pelvic structures
main thing we are looking for is blood |
|
|
Term
| secondary surveys - fractures |
|
Definition
o Visually inspect all extremities
o Document neurological and vascular status of the extremities
o Observe for facial grimacing in a less than conscious patient when palpating extremities
o Splint fractures, remember to reassess the neurological and vascular status after splint application |
|
|
Term
secondary survey - neurological examination
examine : |
|
Definition
CN
DTR
extremity strength
glascow coma score
constant reassessment of the patients neurological status should be performed |
|
|
Term
| perfect score for glascow coma score |
|
Definition
|
|
Term
| lowest score possible for glascow coma scale |
|
Definition
|
|
Term
| glascow coma scale - EYES |
|
Definition
open eyes spontaneously 4
opens eyes when told to do so 3
opens eyes after painful stimuli 2
no response 1 |
|
|
Term
| glascow coma score - VERBAL |
|
Definition
speaks and makes sense (oriented) - 5
speaks but is confused (disoriented - 4
speaks but makes no sense - 3
makes only sounds - 2
no speech - 1 |
|
|
Term
| glascow coma scale - MOTOR |
|
Definition
|
|
Term
|
Definition
|
|
Term
| all females are pregnant until |
|
Definition
proven otherwise
document LMP, G, P, Ab status |
|
|
Term
| secondary survey - the female patient |
|
Definition
LMP, G, P, Ab status
perform HCG on all patients
perform bimanual exam on all females
perform speculum exam if vaginal lac or pelvic suspected |
|
|
Term
| best treatment of the fetus is... |
|
Definition
| good oxygenation of the mother |
|
|
Term
| Special considerations - pregnant patients |
|
Definition
blood volume incrases by 45% at term
leukocytosis of 18-25,000 normal
a "dilutional anemia" is present
increased HR
second trimester BP falls 15-20 mmHg |
|
|
Term
| why is there a decrease in systolic BP in pregnant patients? |
|
Definition
| pressure on the vena cava decreases return |
|
|
Term
| pregnant trauma patients are at an increased risk of... |
|
Definition
| venous thrombosis and the release of thromboplastic materials which can lead to DIC |
|
|
Term
| Bladder is more anterior and superior, it loses its pelvic protection |
|
Definition
|
|
Term
| decreased rebound tenderness and rigidity |
|
Definition
|
|
Term
| place the 20+ week patient on their left side in order to.... |
|
Definition
| keep uterus off of vena cava |
|
|
Term
| watch vital signs closley because the pregnant patient can lose 30-35% of their volume before... |
|
Definition
| they show signs of hypovolemia |
|
|
Term
| special considerations for pregnant patients....more |
|
Definition
fematomaternal hemorrhage
abruptio placentae
pelvic fxs uterine rupture
postmortem cesarean and cardiac arrest |
|
|
Term
| postmortem cesarean and cardiac arrest |
|
Definition
< 5 minutes - excellent
5-10 minutes - good
10-15 minutes - fair
15-20 minutes - poor
> 20 minutes - ulikely |
|
|
Term
|
Definition
| get them to the "proper" surgical service |
|
|
