Trauma

Question 1

What is the assessment of a trauma patient?

Answer 1

• AMPLE history (allergies, medication, past illness/pregnancy, last meal and events leading to injury)
• A-E assessment and resus
• Secondary survey (log roll to view back)
• Trauma series (chest and pelvic X ray)
• FAST Scan,
• Trauma CT if stable enough,
• Theater or intensive care

Question 2

What are the 6 major areas of blood loss in trauma?

Answer 2

• Chest,
• Abdomen
• Long bones,
• Retroperitoneal
• Floor (ambulance floor/ scene)

Question 3

What are the signs of hypovolaemia?

Answer 3

• Pallor/grey,
• Cold sweat,
• Rapid, thready pulse,
• Increased resp rate,
• Thirsty/dry mouth,
• Peripherally cold,
• Low BP,
• Reduced urine output

Question 4

What are the investigations for hypovolaemia?

Answer 4

• Blood gas (VBG/ABG) to see Hb,
• G&S and crossmatch
• Identify bleeding source

Question 5

What is the initial management for hypovolaemia?

Answer 5

• Direct pressure +/- adrenaline soaked gauze,
• Splint long bones and pelvic binder,
• Tourniquet
• Big sutures,
• Tamponade,
• Tie off vessels
• 1L of warmed saline STAT,
• Blood product replacement 2:1:1 (RBCs, Platelets and FFP)
• TXA and coag testing

Question 6

What are some different signs of head trauma?

Answer 6

• Racoon eyes and CFS leaking from nose (anterior cranial fossa #)
• Battle sign and CSF leaking from ears/haemotympanum and CN signs ( petrous temporal bone #)
• Blood on head CT (WHITE)
• Reduced GCS,
• Headaches/vomiting,
• Stiff neck,
• Seizures/amnesia,
• Pupil size and reactivity,
• Posturing
• Cushing’s reflex

Question 7

What are the investigations for head trauma?

Answer 7

• Full neuro exam,
• GCS every 30-60mins,
• Blood gas,
• CT scan,
• MRI
• EEG

Question 8

Explain the initial management of head trauma

Answer 8

• Resus,
• CT scan,
• Stop/ reverse blood thinners,
• Neurology review
• Surgical management = Burr hole decompression or trauma crainectomy

Question 9

What are the complications of head trauma?

Answer 9

• Traumatic brain injury,
• CNS infection,
• Disability,
• Herniation,
• Death

Question 10

What are the clinical signs of chest trauma?

Answer 10

• Haematoma,
• Respiratory distress,
• Decreased/absent breath sounds,
• Dull/hyper-resonant percussion,
• Hypovolaemia,
• Obstructive shock,
• Surgical emphysema

Question 11

What are the signs of a tension pneumothorax?

Answer 11

• Respiratory distress,
• Deviated trachea,
• Distended neck veins (due to compressed SVC),
• Absent breath sounds,
• Hyper-resonant
• Minimal chest movement

Question 12

What is the management of a tension pneumothorax?

Answer 12

• Oxygen,
• Decompression with grey venflon in second intercostal space mid-clavicular line

Question 13

What is the management of a haemothorax?

Answer 13

Chest drain and trauma CT to localize bleeding

Question 14

Describe features of a cardiac tamponade

Answer 14

• It is accumulation of pericardial fluid/ blood/ pus/ air in pericardial space which causes a restriction of cardiac fulling and decreases cardiac output.
• Presents with tachycardia, hypotension, muffled heart sounds, distended neck veins, pulsus paradoxus
• Managed with pericardiocentesis or thoracotomy

Question 15

What are the investigations for chest trauma?

Answer 15

• Blood gas,
• ECG,
• Trauma series,
• Monitor blood loss in trauma,
• FAST scan,
• Trauma CT

Question 16

What are the complications of chest trauma?

Answer 16

• Cardiac arrest,
• Hypoxic arrest,
• Haemorrhagic shock,
• Obstructive shock,
• Empyema,
• Death

Question 17

What are the clinical signs for abdominal trauma?

Answer 17

• Haematoma,
• Abdominal pain/ guarding/ rigid,
• Shoulder tip pain,
• Signs of hypovolaemia,
• Haematuria

Question 18

What are the investigations for abdominal trauma?

Answer 18

• Blood gas,
• Trauma,
• Fast scan,
• Trauma CT scan
• Urine dip

Question 19

What is the management for abdominal trauma?

Answer 19

• Resus,
• CT if stable,
• Interventional radiologist embolisation,
• Trauma damage control laparotomy (stop bleeding, contamination control, abdo packing and temporary closure device

Question 20

What are the complications of abdominal trauma?

Answer 20

• Re-bleeding,
• Abdominal compartment syndrome,
• Ischaemic organs,
• Intra-abdominal sepsis,
• Pseudoaneurysms,
• Urinoma,
• Death

Question 21

What are the clinical signs of pelvic trauma?

Answer 21

• Haematoma,
  -Signs of hypovolaemia,
• Pain/unable to mobilise
• High riding prostate on PR,
• Neurological complaints

Question 22

What are the investigations for pelvic trauma?

Answer 22

• Blood gas for Hb,
• Trauma series,
• CT scan
• CTA pelvis,
• CT Cystogram if bladder injury is suspected

Question 23

What is the management of pelvic trauma?

Answer 23

• Resusitation,
• Pelvic binder,
• Orthopaedic/urology review,
• If Intraperitoneal bladder rupture then laparotomy,
• If bleeding then IR embolization,
• Pelvic fixation

Question 24

What are the complications of pelvic trauma?

Answer 24

• Hypovolaemic shock,
• GU injuries,
• Neurovascular injuries,
• PE,
• Disability,
• Death