WHat are the immediate complications of trauma?
Airway, haemorrhage
What are the early complications of trauma?
infection
WHat are the delayed complications of trauma?
deformity and functional problems
What are the principles to dealing with trauma?
Primary suvery: ABCDE
secondary survery: top to toe
How can we maintain the airway?
Clear oropharynx of debris chin lift jaw thrust oropharyngeal airway (Guedel) nasopharynfeal arway tongue stitch
What are the issues with nasophayrngeal airway?
risk of nasal hameorrgahe
WHat are the options for definitive airway?
Orotrachael
nasotracheal
Surgical: cricothyoridotomy/tracheotmy
When is a definitive airway indicated?
to protect the airway:
- unconscious patient,
- Severe fractures,
- risk of aspiration eg bleding or vomit, risk of obstructiongross tissue swelling, laryngeal injuries
to factiltate ventitlation:
- inadequate respiratory effort, tachponea, hypoxia, hypercarbia, cyanosis
- apnoea: unconscious and NM paralysis
- severe closed head injuries with the needs for hyperventilation
How do you perform a cricothyrotomy?
incision placed in the cricothyroid membrane
What should you do with fractures before prescribing analgesics?
should immobilise fractures as these are very painful
What are the type of tissue injuriees?
hard and soft
What percentage of c spine injuries are associated with injuries above the clavicles?
3-5%
And ATLS quotes 15%
What is the classifcation of injuries related to speed?
high velocity
low velocity
blast/explosion
WHat is the classification of injuries related to depth of tissue damage?
blunt
penetrating
Which bronchus, R or L do things from the oropharynx more likely enter?
R
What are the indications for a surgical airway?
- doubt re continued patency of the airway with or without 2. supervision esp during evacuation
- wounds of the jaw associated with layrngel injuries
- IMF fixation with any degree of resporatory obstruction
- gross tissue loss associated with severe sweling
What is a flail mandible?
Bilateral subcondylar fracture
can cause involuntary posterior movement of the tongue with subsequent obstruction of the upper airway
When is haemorrgahe more of a risk?
not usually with lower facial third trauma but neck trauma due to rpesence of great vessels
How do you manage heamorrgahe?
direct pressure and prompt operative intervention
WHat are the first aid measures following ABCDE?
wound debridement
antibiotics and analgesics
WHat do you carry out in wound debridement?
irrigation
removal of any foriegn bodies and nectroic tissues and then dress with saline or antispetic soaked gauze
What is the purpose of post up wound dressings?
to protect the delicate healing tissues to prevent haematoma to prevent bacteria/organisms infecting the wound to absorb exudate to maintain wound in moist environment
How do you carry out surgery nvolving infected tissues?
thoroigh cleaning or material and excise any non viable tissue
loose open oacking and then inspect the wound under anasethsia with delayed primary closure
What type of bacteria are likely to have colonised a site following trauam?
anaerobic and thus need broad spectrum ab
