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TRAUMA:Intro to Acute Care Medicine: Golden Hour
Kate
39
Aerospace Engineering
Pre-School
07/16/2010

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Cards

Term

Who is the acute care provider?

 

(3)

Definition

Critical care providers

 

emergency medicine providers

 

primary care providers

Term
What is the significance of the golden hour?
Definition

beginnign from the time that traumatic injury occurs; golden hour refers to the following 60 minutes

 

Importance: interventions durin gthis time often dictate morbidity and mortality outcome

Term

Define the trimodal distribution of mortality.

 

(3)

Definition

prehospital: usually due to devastating head or vascular injury

 

emergency department: head, chest, or abdominal injury

 

intensive care unit: frequently a result of systemic response to traumatic injury

Term
What's the difference between penetrating and blunt trauma?
Definition

Penetrating: localized, obvious

 

blunt: underlying structure, less obvious

Term

Who are the prehospital personnnel?


What are they doing?

Definition

first responders: EMT, Fire Rescue, Paramedics, Police

 

Initial evaluation

 

Stabilize

 

Transportation to appropriate facility

 

"Eyes of the Emergency Department"

Term
What cervical injury would DEFINITELY require intubation?
Definition
C1-C2
Term
What does ABCDE stand for?
Definition

A airway

B breathing

C circulation

D disability/neurological status

Exposure: expose entire pt so you can see very part

Term

What type of things are you looking for when accessing neck and thorax?

 

(5)

Definition

deviated trachea

chest wall movement, symmetry

sucking chest wound

neck or chest crepitus

rib fracture, sternal fracture

Term
How do you ventilate trauma pts?
Definition
100% O2
Term
Pt who has flail chest- what happens when they breathe?
Definition
multiple rib fractures: so chest will sink in when they breathe in
Term

What is a subcutaneous emphysema?

 

How can you assess on physical exam?

Definition

rupture of pulmonary system- tracheal/esophageal or lung space into tissue

 

oxygen in subcutaneous tissue so will push on skin and hear crackling

Term

if pregnant women having difficulty with circulation: what do you do?

 

why?

Definition

roll patient on L hip

 

taken pressure off vena cava

Term

How do you assess for volume status?

 

(3)

Definition
BP, jugular venous filling, quality of heart sounds
Term
What is the necessary fluid resuscitation?
Definition
infusion of 2L warm crystalloid solutions/ lactated ringers, check for Beck's triad
Term

What is Beck's triad?

 

What is it assessing?

Definition

Cardiac Tamponade

 

triad of low arterial blood pressure, jugular venous distention, and distant, muffled heart sounds

Term

DISABILTY/NEURO EXAM

 

What are you looking for in the abbreviated neuro exam?

 

LPAM

Definition

level of consciousness

pupillary reactivity,

anisocria

motor functioning

Term

What is the golden standard for determining neuro status?

 

What is imp about the neuro status?

Definition

Glasgow Coma Scale

 

Imp to continuously check

Term
When doe secondary exposure begin?
Definition
after the patient has been completely exposed
Term
What could falsify the Glasgow Coma Scale?
Definition
if patient has comorbid conditions (ie. ETOH, Drugs, blindess. mental retardation)
Term

What is a trauma score?

 

What does it consist of?

Definition

physiologic scoring system

 

helps to determine if patient needs transport to trauma center

Term
What is an injury severity score?
Definition
anatomical scoring system used to correlate expected mortality/morbidity
Term
What is the role of the trauma team captain?
Definition

usually the resuscitiation physician, maybe the trauma surgeon

 

assigns duties of trauma team assistants

 

performs primary survey

 

receives information directly from prehospital personannel

 

directes primary care, ABCDS

Term

1. Who performs the primary survery?

 

2. What are they looking for?

 

3. Name 5 things patient is looking for.

Definition

1. Team Captain

 

2. Rapid evaluation of lethal injuries

 

3. size, sex, body build, color, patient alertness

Term

What is included in the pre-hospital report?

 

(7)

EPLIMBA

Definition

Evaluation and treatment of airway patency

 

pusle and respirations/vital signs

 

level of consciousness

 

immobilization

 

mechanism of injury

 

blood loss at scene

 

anatomic sites of apparent injury

Term

What are assignments of the team members?

 

(6)

 

RPPIPD

Definition

restraining the pt

providing an easily visualized pt- cutting off clothing

palpation of a radial or brachial pulse

insertion of a large bore (14-16g) IV catheter into each arm, drawing pertinent bloods and transporting to laboratory

 

Placement of ECG monitor leads: avoid subclavian area incase of central line need

 

documentation of event

Term
What do you do during second survey?
Definition

HEAD/SCALP

 

scalp injury

eyes/pupils

ears

mouth

nose

Term
What do raccoon eyes indicate?
Definition
skull fracture
Term
What does a battle sign indicate?
Definition

basal skull fracture

 

(located behind ear)

Term

SECONDARY SURVERY

 

What do you do for neck and thorax?

Definition

xrays may have been taken

 

need to clear cervical spine, evaluate endotracheal tube placement- to clear cervical spine prefer, lateral, AP, odontoid views of neck

 

Need CXR: AP and alteral preferred

 

Consider stabilty of spine when choosing x-ray views, CT scan, MRI studies, what do you need to see

Term
Odontoid view allows you to see what well?
Definition
good view of C1 and C2
Term
LOOK IN BATES- know deviated- ipsilateral, etc
Definition
Term

SECONDARY SURVERY:

 

ABDOMEN EXAM: what are you looking for?

Definition

any notes gross abnormality (seatbelt sign)

 

note contusion

 

NG tube placement, if only for prophylaxis

 

if worsening hypotension with unknown source for blood loss, consider diagnostic peritoneal lavage, also can utilize echo to evaluate for retroperitineal hemorrhage

Term

SECONDARY SURVEY:

 

Gential area: What are you examining?

Definition

examine external, internal, perineum, scortal area, DO A RECTAL EXAM

 

foley placement, unless contraindicated

 

Must x-ray abdominal /pelvic area to evaluate bony structures, often can be used to assess internal injury

 

Consider KUB/urethrogram if blood noted on exam, signficant pelvic injury

Term
SECONDARY SURVEY: Extremity Evaluation
Definition

necessary x-rays to evaluate

 

are injuries surgical emergencies

Term
When do you monitor for hemodynamic status?
Definition
throughout primary and secondary survey
Term

What do you consider when assssing hemorrhagic shock?

 

(5)

 

IMP SLIDE!!

Definition

LOC

Skin color

magnitude of peripheral pulses

HR (worse when tachy)

BP (SBP-DBP)

Term
Name and 4 Hemorrhagic Classes.
Definition

Class I: blood loss up to 15% of volume, may not be accompanied by signs and symptoms.

 

Class II: increasing blood loss, signs and symptoms may become apparent, blood loss to 25%

 

Class III: obvious shock, gross hypotension recognized as hypoperfusion

 

Class IV: blood loss over 40% volume, decreased BP, HR >140, decreased pulse pressure- fluid/colloid replacement critical

Term
What are foundations of trauma resucitation?
Definition

1. go back to the beginning: if the pt's condition worsens, return to step one, remember ABCs

 

2. BE THOROUGH- attention to detail by every team member is essential

 

3. BE SKILLED: time is essetnial, never attempt to perform any procedure unless you are adequately skilled

 

4. BE A TEAM PLAYER

 

5. BE SUSPICIOUS: always beawre of mechanism of injury

Term

TRIAGE:

 

How do you classify an injury?

Definition
Urgent, Emergent, Critical
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