What is the leading cause of death in trauma patients?
#1 hemorrhage shock #2 TBI
What is the “lethal triad” of trauma?
- Acidosis, Hypothermia, coagulopathy
- Each one has negative effect on the other
What is the purpose of a ATLS trauma assessment?
Provides a logical and sequential treatment strategy for rapidly assessing the patient
Basically, it is to ensure a provider does not miss a injury by being distracted by a larger injury (ex. not realizing a patient has a pneumothorax because they arrived with a traumatic leg amputation)
Proper trauma assessment is made up of a primary and secondary survey? Wha is included in the primary survey?
ABCDE
Airway Breathing Circulation Disability Exposure (get the patient trauma naked)
What is the goal of primary survey?
To identify and rapidly manage life-threatening conditions or injuries
What is involved in the secondary survey?
Complete head-to-toe assessment, full set of vitals, medical history and current meds
It is imperative to remain vigilant during a secondary survey to determine if any patient injuries may have been missed during the primary survey
What is historically worse, blunt or penetrating trauma? Why so? Give examples of each
- Blunt, b/c more energy is required to disrupt an organ
Blunt: Falls, Assaults, MVA’s
- Direct impact, deceleration, continuous pressure, shearing, and rotary forces
Penetrating: GSW, stab wounds
What is the standard induction method for trauma patients?
RSI with cricoid pressure
What is associated with the highest overall rate of successful airway management and provides the greatest possibility for rapidly securing the airway?
Muscle relaxation
What is greatest difference between routine induction and RSI?
The use of a muscle relaxant before knowing whether the patient can be mask ventilated
If a trauma patient needs an airway device, what should be used?
- ETT only!!!
- If a patient arrives via EMS with a airway adjunct or supraglottic airway in place, switch it out to an ETT
- If a patient arrives via EMS with a ETT in place, it is imperative to check that it is working properly and in the right location. Confirm with ETCO2, stethoscope, and CXR
What type of trauma is the leading cause of morbidity and mortality among all age groups?
Blunt abdominal trauma
What is major concern with administering induction agents in a trauma patient?
The dose-dependent decrease in BP assoc. with the drug coupled with the already hypotensive trauma patient
The use of apneic ventilation is based on which gas law?
- Boyles
- Gas leaves the facemark, fills the lungs, and exchanges in the lungs based upon the concentration gradient of gases in alveoli
Has fiberoptic intubation proven to be superior to DL in trauma patients?
No
What 2 things are involved in the airway management of an “emergent” cervical spine injury?
Manual In-line Stabilization (MILS)
RSI
What is the most common lung injury ?
Pulmonary contusion
Mostly associated with blunt thoracic trauma
These are injuries to the alveoli without gross disruption to the pulmonary architecture
Initially it is a “bruised” lung, but it typically progresses to much larger swelling and leads to ARDS
How should ARDS be managed?
- Low TV
- Plateau pressures of less than 32 cm H2O
- Permissive hypercapnia
- Conservative fluid strategies
- Prone positioning
- NMB’s
- ECMO
- Do not increase FiO2 to increase low SaO2 levels (can have toxic effects, worsen gas exchange)
Which paralytic is the drug of choice in RSI trauma indications?
Succinylcholine
Caution in patients with neurological injuries or burns. It is safe to administer in the first 24 hours after injury, but can cause lethal hyperkalemia 24-48 hrs after injury
What 3 types of procedures have the highest incidence of recall?
- CABG (#1)
- OB
- Trauma
What are the 5 criteria points for a potential C-spine injury?
- neck pain
- severe distracting pain
- any neurological signs and symptoms
- intoxication (always check for a C-spine injury)
- loss of consciousness at the scene
What is the best way to intubate a trauma patient with c-spine injury?
Manual In-Line Stabilization (MILS)
This is when some elsse secures the c-spine with their hands while you intubate
Be sure to document to that the head was held in neural portion with MILS so you CYA
T/F
Most intubations in a trauma patient happen pre-hospital by EMS
True
What info do you want to obtain if a patient arrives with a c-collar on ?
- Any neurological deficits
- Why was the c-collar placed
- Was a cercival CT scan done and what were the results
