Worry about loss of airway when?
- if not speaking in a normal tone of voice
- expanding hematoma or emphysema in neck
When is an airway also needed?
- unconscious or noisy/gurgling breathing
- severe inhalational injury
- secure airway before addressing cervical spine injury
How is an airway inserted?
- orotracheal intubation via laryngoscope with monitoring w/ pulse oxymetry or w/ help of local anesthesia
- nasotracheal intubation w/ fiber optic bronchoscope
When is a fiberoptic bronchscope mandatory?
- if subcutaneous emphysema in the neck
When should you be reluctant to do a cricothyroidotomy?
before the age of 12
What are clinical signs of shock?
- low BP under 90 SBP
- fast feeble pulse
- low UOP
What are the most common causes of shock in trauma?
- bleeding - low CVP
- pericardial tamponade - high CVP
- tension PTX - high CVP
What is the priority of trauma?
- surgical intervention to stop the bleeding and volume replacement afterwards
- this is the opposite of all other settings. usually start w/ 2 L of LR followed by PRBCs
What is the preferred route of fluid resuscitation?
2 peripheral IV lines, 16 gauge, or percutaneous femoral vein cateter
- if under 6 get an IO of proximal tibia
What is the management of pericaridal tamponade?
- based on clinical dx
- prompt evacuation of pericardial sac
What is the management of tension PTX?
- based on clinical dx
- big needle of IV catheter followed by CT connected to underwater seal
Where is the CT placed for tension PTX?
- inserted high in anterior chest wall
What are the causes of intrinsic cardiogenic shock?
- massive MI
- fulminating myocarditis
What is the management of cardiogenic shock?
- circulatory support
- high CVP is found
What is vasomotor shock?
- seen in anaphylactic rxns and high spinal cord transections or high spinal anesthesia.
- CVP is low
How do you treat vasomotor shock?
- restore peripheral resistance so get vasopressors
What to do for a penetrating head trauma?
surgical intervention and repair of damage
What to do for linear skull fractures of the head?
left alone if they are closed. Open fx need wound closue. If comminuted or depressed take to OR
What to do for someone with head trauma who becomes unconscious?
- get a CT to look for ICH.
What are signs of a fracture affecting the base of the skull?
- raccoon eyes, rhinorrhea, otorrhea, ecchymosis
- assess cervical spine integrity with a CT scan
- make sure of avoid nasal ET intubation
What are the 3 components of neurologic damage from trauma?
- initial blow
- subsequent development of a hematoma - do surgery to treat
- increased ICP - give medicine to decrease
What causes acute epidual hematoma?
- modest trauma to side of head w/ classic sequence of trauma, unconsciouness, lucid interval, gradual lapsing into coma, fixed dilated pupil, and contralateral hemiparesis w/ decerebrate posture
What does the CT scan show for an epidural hematoma/
biconvex, lens shaped hematoma
What is the treatment of epidural hematoma?
- emergent craniotomy
