Trauma

Primary Survey and Secondary Survey
 
AIRWAY: look, listen and feel

  • C-spine precautions
  • Definitive airway for GCS </= 8, blood, shock, inhalation injury, burns
  • Chin lift, jaw thrust, oropharyngeal airway, nasopharyngeal airway

BREATHING

  • O2 non rebreather mask @ 15 L/min
  • O2 Sat, Resp rate and rhythm
  • Percussion
  • Breath sounds
  • CT for pneumothorax

CIRCULATION

  • HR, BP, O2 Sat, pulses
  • Shock @ 1500 cc blood loss, fatal @ 2000 – 2500cc
  • U/S, CT abdomen
  • Differential Diagnosis
    • Cardiogenic
    • Hypovolemic
    • Distributive (neurogenic, septic, anaphylactic, addisonian)
    • Obstructive (Pulmonary embolism, tamponade, pneumo)
  • Signs and Symptoms of shock
    •  Narrow pulse pressure in early hypovolemic
    • Decreased LOC
    • Decreased U/O (Normall is 0.5cc/kg/hr, 1cc/kg/hr in kids, 2cc/kg/hr in infants)
    • Tachycardia
    • Hypertension
    • Cold clammy in hypovolemic
    • Warm pink in neurogenic
    • Tachypnic
  • Sources of Blood loss
    • Pelvis and retroperitoneum (check for stability)
    • Long bones (2L/femur, 1.5L/tibia)
    • Abdomen
    • External
    • Chest
  • Treatment
    • Direct pressure
    • Vascular access
    • Volume Resuscitation
    • Find Source
    • Control bleeding

DISABILITY/ENVIRONMENT/EXPOSURE

  • GCS
  • Pupils
  • Examine all surfaces
  • Exposue adequately
  • Prevent hypothermia with warmed fluid, blankets

Adjucts

  • EKG
  • Pulse Oximetry
  • ABG
  • NG/OG
  • Foley catheter
  • Chest x-ray
  • Pelvic x-ray
  • 2 large bore IVs

Life threatening chest injuries

  • Pneumothorax
  • Hemothorax
  • Open chest wound (sucking – requires 3 sided seal with chest tube)
  • Flail chest (2 or more rib # in 2 or more places)
  • Aortic arch injury (sudden deceleration, fixed at ligamentum arteriosum)
  • Pulmonary contusion
  • Cardiac tamponade
  • Diaphragmatic rupture (spleen injury)

Management

  • IVs – 2 large bores
  • Monitors (O2, EKG, BP)
  • Foley
  • Investigations
  • NG tube
  • X-rays (CXR, lat C spine, pelvic)

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