Trauma

Question 1

What are the priorities for ATLS (Advanced Trauma Life Support)?

Answer 1

• A - Airway (with cervical spine control)
• B - Breathing
• C - Circulation (with haemorrhagic control)
• D - Disability (neurological)
• E - Exposure and Environment

Question 2

How do you assess Airway (with cervical spine control) in ATLS?

Answer 2

(Cervical spine immobilised)
- talking?
- obstruction? (stridor)
- reduced conscious state (GCS <8)
- aspiration (suction if needed)
(high flow oxygen for all patients initially)

Question 3

What is the GCS?

Answer 3

• Glasgow Coma Scale

Question 4

How do you assess Breathing in ATLS?

Answer 4

• resp. effort
• resp. rate
• oxygen sats

Question 5

How do you assess Circulation (with haemorrhagic control) in ATLS?

Answer 5

• pulse (rate, character)
• blood pressure
• capillary refill time (centrally at sternum or peripheral at nail bed)
• pallor
• any obvious external bleeding (apply pressure)
• group and save for blood if needed

Question 6

How do you assess Disability (neurological) in ATLS?

Answer 6

• GCS / AVPU
• check blood glucose lvls
• head injuries?

Question 7

How do you assess Exposure and Environment in ATLS?

Answer 7

• assess the rest of patient
• obvious open fractures
• any other bruising

Question 8

What does AVPU stand for (measures consciousness level)?

Answer 8

• Alert
• Verbal (responds to verbal stimuli)
• Pain (responds to pain)
• Unresponsive

Question 9

What is the management for an open fracture?

Answer 9

• wound should be photographed then irrigated and dressed with saline-soaked swabs
• splint the limb and start IV antibiotics asap (within 3 hrs)
• give tetanus prophylaxis
• wound should be debrided in theatre to minimise bacterial infection of the fracture
• fracture can then be stabilised with a suitable method of internal or external fixation
• also check neurovascular status (sensation/weakness, pulses/cap. refill)

Question 10

What investigations (imaging) should be done for a spinal injury?

Answer 10

• X-rays
• MRI (to look for ligament and spinal damage)

Question 11

How should stable spinal injuries be managed, and how should unstable spinal injuries be managed?

Answer 11

• Stable: mobilisation straight away
• Unstable: immobilisation (eg. halo vest), bracing, or possibly internal fixation

Question 12

What are the 3 ways in which the pelvis can be fractured?

Answer 12

• Anteroposterior compression (blow from the front)
• Lateral compression (side impact)
• Vertical shear forces (usually fall from height)

(or a combo of all 3)

Question 13

How should pelvic fractures be managed?

Answer 13

• stabilise the pelvis if there is bleeding (pelvic binder)
• Stable fractures: analgesia and mobilisation
• Unstable fractures: surgical fixation