304: GI > Trauma > Flashcards

Trauma Flashcards

(18 cards)

Study These Flashcards
1
Q

Trimodal distrubution of death for trauma

A

Death from traumatic injuries is distributed in one of three time periods:

Immediate (50% of cases)

  • Occurs within seconds or minutes
  • Causes: spinal cord/ severe brain injuries, lesions to great vessels

Early (30-35%)

  • within hours
  • Thoracic trauma
  • Liver/ spleen trauma
  • Multiple pelvic fractures

Later (15-20%)

  • Occurs within 203 weeks
  • Causes: sepsis, multi-organ failure
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2
Q

Golden hour in surgery

A

Following a traumatic injury, the time where prompt medical treatment has the highest likelihood to prevent death.

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3
Q

Primary survey and resuscitation of vital functions

A

Team approach to trauma patient in resus.
- Trauma team has been assembled, leader has been allocated

After resus, revaluation. then secondary survey
- Then reevaulated before giving definitive care.

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4
Q

Airway

A

C-spine proteciton
- Until cervical spine injury is excluded

Is airway patent?

Maneuvers to open airway

  • Jaw thrust
  • Chin lift

Adjunct devices

  • Nasopharyngeal/ oropharyngeal airway
  • They can fail, so advance to definitive airway: orotracheal, nasotracheal/ cricothyroidotomy
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5
Q

Breathing and ventilation

A

Assess oxygenation and ventilation

Check for

  • Resp rate
  • Chest movement: expansion and symmetry
  • Percussion and auscultation of chest
  • Tracheal deviation
  • Air entry
  • O2 sats: high flow O2, non-rebreathe

Reassess to see if it’s airway or breathing issue if patient does not improve

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6
Q

Circulation with haemorrhage control

A

Assessing organ perfusion: look for signs of shock

LoC: poor perfusion to brain

Skin colour and temperature

BP: if low, think about source of blood loss (chest, abdomen, retroperitoneum, muscles, open fracture)
- Control external bleeding with pressure

HR and character
- ECG

Urinary catheter

IV access with two 12G cannulae

  • Get blood for crossmatch
  • FBC, clotting, U+Es
  • Restore blood if blood loss significant
  • Ringer’s lactate solution bolus

Consider CXR, CT, US, pelvic scan

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7
Q

Disability

A

Neurological status

GCS

  • Pupils
  • Drugs/ intoxication/ medication
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8
Q

Exposure/ environmental control

A

Prevent hypothermia

  • Warm IV fluids
  • Blankets, warming device.

Checking for missed injuries

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9
Q

Examples of traumatic pulmonary injuries

A

Rib fractures/ flail segment (more than one fracture in 1 rib)

Pulmonary contusions

Pneumothorax

Haemothorax

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10
Q

Triage

A

The process of prioritizing patients according to treatment
needs and the available resources
- Those with life-threatening
conditions and with the greatest chance of survival are treated first

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11
Q

Thoracic injuries

  • Epidemiology
  • Open vs closed injuries
A

Causes 25% of deaths in trauma

  • Those died with multiple injuries, 50% had thoracic
  • Road traffic accidents the most common cause

Open injury
- caused by penetrating trauma (knives, gunshot)

Close injury

  • Blasts
  • Blunt trauma
  • Deceleration
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12
Q

Tension pneumothorax

  • description
  • Presentation
  • Management
A

Pneumothorax caused by penetration in pleura tracheobronchial tree where air cannot escape.
- Due to formation of one way valve.

Presentation

  • Tachycardia
  • Hypotension
  • Respiratory distress: cyanosis, diaphoresis
  • Tracheal deviation
  • Hyperresonant chest, reduced expansion

Management

  • Decompression: 12G cannulae in 2nd IC space, mid-clavicular line
  • Underwater seal chest drain into 5th IC space
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13
Q

Open pneumothorax

  • Description
  • Presentation
  • Management
A

Pneumothorax from open chest wound
- Air enters pleural on inspiration and leaks to exterior on expiration

Presentation

  • Open chest wound
  • Absent breath sounds
  • Hyperresonant chest

Management

  • Three-sided dressing
  • Followed by IC drain
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14
Q

Abdominal trauma

  • epidemiology
  • Types
A

Occurs in 7-10% of trauma patients

Types:
Blunt
- Spleen, liver, retroperiotneal bleed

Penetrating

  • Stab wounds/ gun shots
  • Liver, small bowel, diaphragm, colon
  • High velocity shots: small bowel, colon, liver, vessels.
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15
Q

Indications for resus laparatomy

A

In blunt abdominal trauma where

  • Unresponsive and hypotensive despite adequate resus
  • No other cause of bleeding found
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16
Q

Indications for urgent laparatomy

Study These Flashcards
A

Features of peritonitis

Any gunshot wound or serious knife injury

Blunt trauma with CT features of solid organ injury not suitable for conservative management.

17
Q

Identifying peritoneal cavity as source of significant haemorrhage

Study These Flashcards
A

Four Ps

Morison’s pouch
- Between liver and right kidney

pouch of Douglas
- Retrovaginal/ retrovesicle pouch

Perisplenic

Pericardium

18
Q

Indications for abdo CT

Study These Flashcards
A

In haemodynamically stable patients where no apparent indication for emergency laparotomy

304: GI
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