Topic 6 - Trauma

Question 1

3 considerations in prehospital trauma by-pass

Answer 1

• Mechanism of Injury
• Pattern of Injury
• Vital signs

Question 2

Trauma bypass vital sign criteria

Answer 2

Question 3

Injury pattern criteria

Answer 3

Question 4

Trauma bypass guideline

Answer 4

If any of the vital sign or pattern of injury criteria are present, the patient should be transported to a major trauma service if there is one within 45 minutes road transport time - IF NOT - should be taken to regional trauma service if within 45 minute road transport time - IF NOT - take to closest available hospital and notify comms to organise areomedical retreival at hospital

Question 5

Facility choice in traumatic cardiac arrest

Answer 5

• Take to major trauma centre only if within 15 minutes of scene - otherwise closest available facility

Question 6

Cushings triad

Answer 6

• Bradycardia
• Hypertension
• Irregular respirator pattern
  
  • Indicates raised ICP and imminent herniation

Question 7

TBI management

Answer 7

Question 8

Goals in prehospital care of TBI

Answer 8

• Reduce secondary hypoxic injury
• Reduce acidocis
• Prevent hypotension

Question 9

Neurogenic versus spinal shock

Answer 9

SPINAL SHOCK - transient condition following acute cord injury charecterised by flaccid paralysis below lesion. It will often resolve over months and reflexes will return to normal in most instances

NEUROGENIC SHOCK - Loss of vasomotor tone, resultant in hypotension and bradycardia. Usually in injuries T5 and above (site of sympathetic outflow)

Question 10

NEXUS C-spine criteria

Answer 10

• No posterior midline c-spin tenderness
• No evidence of intoxication
• No ALOC
• No distracting injuries
• No focal neurological deficit

Question 11

Chest Injuries - general management

Answer 11

Question 12

Grey Turner’s, Kehr’s and Cullen’s sign

Answer 12

GREY TURNERS - bruising of the flanks which indicates retroperitoneal bleeding

CULLEN’s - superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus. Indicates retroperitoneal and intra-abdominal bleeding

(Cullen’s and Grey Turner’s sign are often late indicators of bleeding)

KEHR’S SIGN - left shoulder tip pain associated with peritoneal irritation (often bleeding)

Question 13

Fluid therapy in abdominal trauma

Answer 13

• SBP of >90 mmHg or minimum amount required to maintain radial pulse

Question 14

Abdominal injuries - management

Answer 14

Question 15

General management principals in eye injuries

Answer 15

• Irrigation with saline for chemical or biological fluid exposure, foreign body or burns
  
  • Flush from medial aspect with injured eye facing down
• Protect eye with shield
• Antiemetic administration (vomiting causes raised intraoccular pressure)
• Position patient head up
• Significant eye injury may be present despite normal vision and minimal symptoms

Question 16

Assessment of eye injuries

Answer 16

• One eye at a time
• Count fingers and if successful:
  
  • Motion and light perception
• Do not delay standard cares

Question 17

Crush injury, compartment syndrome and crush syndrome

Answer 17

Crush Injury - localised tissue injuryt from compressive force

Compartment Syndrome - compromised perfusion to tissues within an anatomical compartment due to increased pressure. Can lead to necrosis, parmenant impairment and crush syndrome

Crush syndrome - systemic resonse from application of a compressive force of significant force and duration to cause widespread ischemia and necrosis of soft tissue. This leads to increased permeability of membranes and the release of potassium, enzymes and myoglobin into systemic circulation occurs. It is characterised by rhabdomyolysis, lactic acidosis, hyperkalemia, shock, dysrythmias and death

Question 18

Compartment syndrome characteristics

Answer 18

• Palpable tension or swelling of an anatomical compartment
• Pain disproprtionate to the injury
• Pain on passive stretching of muscles within a compartment
• Parasthesia of skin and paresis of muscles
• Pallor of skin over compartment
• Diminishing distal pulses

Question 19

Risk assessment in crush injury

Answer 19

• Anticipate crush syndrome on removsal of compressive force
• Anticipate hypovolemic shock on removal of compressive force
• Chest involvment means immediate release of compressive force

Question 20

Contraindications for probe removal in Taser incidents

Answer 20

• Eyes
• Face
• Neck
• Genitals

Question 21

Transport indications in Taser incidents

Answer 21

• Probes cannot be removed
• Patient requries psychiatric evaluation
• Other injuries
• Patient effected by substance other than alcohol

Question 22

Taser incident general management

Answer 22

Question 23

Secondary injuries from muscle contractions during Taser use

Answer 23

• Fractures
• Spinal injuries
• Head injuries
• Other soft tissue injuries
• Hyperthermia

Question 24

Contraindicatons for cervical collar use

Answer 24

• Surgical airway
• Penetrating neck trauma

Question 25

Contraindications for pelvic binder use

Answer 25

* Suspected isolated NOF * Suspected traumatic hip dislocation

Question 26

Methoxyflurane (Indications)

Answer 26

* Pain

Question 27

Methoxyflurane (Contraindications)

Answer 27

* Patients \<2 * KSAR or hypersensitivity * Significant liver or kidney disease * Hx of malignant hyperthermia

Question 28

Methoxyflurane (Precautions)

Answer 28

* ALOC * Intoxication or drug affected patients

Question 29

Methoxyflurane (Side effects)

Answer 29

* ALOC * Cough * Renal/hepatic failure

Question 30

Naloxone (Indications)

Answer 30

* Respiratory depression (secondary to administration of narcotic drugs)

Question 31

Naloxone (Contraindications)

Answer 31

* KSAR or hypersensitivity to Naloxone

Question 32

Naloxone (Precautions)

Answer 32

* Use with caution on patients with pre-existing cardiac disease

Question 33

Naloxone (Side effects)

Answer 33

* Combativeness, vomiting, sweating, tachycardia and hypertension * May prodice withdrawal convulsions in chronic narcotic users * Pulmonary oedema