The following are quick summary notes created during the 2013 Assessment and Treatment of Trauma course. It is intended as a means to create study bullets for those to view without having to read entire paragraphs of material. Images and other things will be added later. This is a 'Hit it and quit it' bullet-point-style list to the testable portions of the course! Forgive the grammar and lack of beauty, and enjoy!

 

ASSESSMENT OVERVIEW

 

ALL TRAUMA PATIENTS GET O2
MORE DISTAL ARTERIES WITH A PULSE DEMONSTRATE HIGHER SYSTOLIC

CAROTID - 60 SYS

BRACHIAL - 70 SYS

RADIAL - 80 SYS

 

GCS ASSESSMENT

PINCH TRAPEZIUS MUSCLE TO TEST IF PT IS RESPONSIVE TO PN

IF RESPONSIVE, ASK THEM TO WIGGLE THEIR TOES OR MOVE FEET

 

DETERMINE BEST WAY TO MOVE PT - RAPID OR ADDITIONAL CARE

 

EARLY VITAL SIGNS ARE IMPORTANT TO ESTABLISH TRENDS

 

IF PATIENT IS UNSTABLE, MOVE TOWARD TRAUMA CENTER ASAP

DETAILED TRAUMA EXAM SHOULD BE PERFORMED QUICKLY

ANY CLOTHING THAT IS IN THE WAY SHOULD BE REMOVED

ADD BLANKETS TO ENSURE HEAT AND PRIVACY

 

ASSESSMENT

SCENE SAFETY IS NUMBER 1 JOB

EVEN WHEN VIOLENT SCENES APPEAR CALM, IT COULD EASILY REIGNITE

ASSURE PD IS ON SCENE

 

GET AIRWAY CLUES FROM PT SPEECH. ASSESS BREATH SOUNDS.

PNEUMOTHORAX IS LIFE THREATENING AND MUST BE TREATED IMMEDIATELY.

ANY NON-LIFE THREATENING TREATMENTS SHOULD BE PERFORMED EN ROUTE.

 

NO IVS ON SCENE. START THEM ON TRUCK. #1 GOAL IS TO GET THEM TO SURGERY. GET IVS EN ROUTE TO TRAUMA CENTER.

 

ATT AIRWAY MANAGEMENT

 

AIRWAY CARE BEGINS BEFORE TOUCHING PATIENT

MOI WILL DETERMINE NEED FOR SPINAL IMMOBILIZATION

TALKING TO PT PROVIDES CLUES

WHEN PTS ARE SPEAKING CLEARLY, YOU CAN ASSUME AIRWAY IS OPEN AND PATENT. IF STRIDOROUS, ASSUME OBSTRUCTION. JUDGE MENTATION.

 

REASSESS AIRWAY q 5MIN

 

HANDS ON -

TRAUMA JAW THRUST

TRAUMA CHIN LIFT

HEAD TILT CHIN LIFT

 

POSITION

SUPINE/NEUTRAL

LOG ROLL TO CLEAR AIRWAY - USEFUL WHEN PT IS VOMITING

 

AIRWAY ADJUNCTS

ORAL, NASAL, SUCTIONING

INT - KING AIRWAYS

ADVANCED - TRACHEAL INTUBATION, SURGICAL AIRWAY

KINGS DO A GOOD JOB, AND YOU CAN USE ETCO2 TO VERIFY GOOD AIR MOVEMENT, BUT DO NOT ENSURE PATENT AIRWAY. ET TUBE IS THE MOST SECURE.

IF USING SURGICAL AIRWAY, USE SCALPEL AND 6.0 ET TUBE

NEEDLE CRIC - USE 14G IV CATH (SUSTAINABLE FOR 45 MINUTES MAX)

RSI

PREMEDICATION AGENTS

LOAD

LIDOCAINE, OPIATES, ATROPINE, DEFASCICULATING DOSE

*ATROPINE USED IN PEDS TO PREVENT BRADYCARDIA

 

INDUCTION AGENTS - RAPID LOSS OF CONSCIOUSNESS

NEUROMUSCULAR BLOCKING AGENTS - PARALYTICS

 

CORRECT BVM TECHNIQUE IS VITAL

USE BVM TO BAG AT 10-12 TIMES A MINUTE SUFFICIENT TO MAKE CHEST RISE. APPROX 6-10 ML /KG. MAKE SURE YOU HAVE REALLY GOOD MASK SEAL. DROP NG TUBE TO REMOVE AIR FROM BELLY - IT RELIEVES UPWARD PRESSURE ON THE DIAPHRAGM AND ENSURES THE GREATEST AMOUNT OF LUNG COMPLIANCE. USE AS MANY EXTRA PEOPLE AS YOU CAN. ENSURING MASK SEAL IS SUPER HELPFUL. NASAL AIRWAY IS LEAST OBSTRUCTIVE.

 

COMPRESSIONS SHOULD LOOK LIKE VTACH

 

MONITORING

OXYGENATION - PULSE OXIMETRY

ETCO2 - NORMAL ETCO2 IS 30-40MM HG

CAPNOGRAPHY WAVEFORMS MAY HELP DIAGNOSE PROBLEMS

DIFFICULT AIRWAYS - BOUGIE - USE AS INTRODUCER OR STYLET. FEEL IT SLIDE ALONG THE CRICOID RING. USE 2 HANDS ON BOUGIE. ESPECIALLY USEFUL FOR ANTERIOR AIRWAYS. SLIDE ET TUBE OVER BOUGIE.

 

HEAD INJURY

FOCUS ON PREVENTION OF SECONDARY INJURIES LIKE HYPOXIA AND INCREASED ICP

 

SEVERE MAXILLARY FACIAL TRAUMA

CLEAR THE AIRWAY - SUCTION, POSITION, BLEEDING CONTROL

 

IF PT IS KNOWN ALCOHOLIC, IT MIGHT BE BETTER TO BAG WITH BVM INSTEAD OF INTUBATING BECAUSE OF POSSIBLE TRAUMA AND RUPTURE OF VARICES.

 

INJURY TO LARYNX OR TRACHEA

RECOGNIZE EARLY - SWELLING, STRIDOR, EXTERNAL WOUNDS, FREE AIR

INTBUATION MAY REQUIRE SMALL ett, IF RESISTANCE IS MET, ABORT ATTEMPT

MAY REQUIRE SURGICAL AIRWAY.

 

SCALPEL TO CUT SKIN TO SEE MEMBRANE

INSERT CRIC NEEDLE AT 45 DEGREE ANGLE DOWNWARD TOWARD FEET

 

IF A PATIENT IS ALLERGIC TO SHELLFISH, SHE IS LIKELY ALLERGIC TO IODINE.

 

EMERGENCY MOVE REQUIREMENTS:

 

PATIENTS WHO FAIL PRIMARY SURVEY SHOULD BE MOVED TO AREA THAT GIVES YOU FULL ACCESS.

IF PATIENT IS BLOCKING ACCESS TO MORE INJURED PATIENT.

IF PATIENT IS IN HAZARDOUS AREA.

 

IF THERES A HELMET AS IN MOTORCYCLE CRASH,, HOLD CPSINE, UNLOCK CHIN STRAP, THEN HOLD MANDIBLE WHILE OTHER PERSON HOLDS EITHER SIDE OF THE HELMET, PULLS APART SLIGHTLY THEN OFF WITHOUT LIFTING THE C-SPINE. IMMEDIATELY APPLY C-COLLAR.

 

TYPES OF SHOCK

neurogenic - cardiogenic - hypovolemic - OBSTRUCTIVE - DISTRIBUTIVE

NEUROGENIC SHOCK IS DISTINGUISHABLE BECAUSE THERE IS NO INCREASE IN HR. NORMAL BP AND IRREGULAR RESPIRATORY RATE.

 

IMPORTANT DERMATOMES - T 10 = NAVEL T4 = NIPPLE LINE

 

COLD IV FLUIDS INHIBIT CLOTTING CASCADE - YOU’RE ALMOST INDUCING HYPOTHERMIA. THEN, THE BODY USES ALL ITS ATTENTION AND ENERGY TO RAISING THE BODY TEMPERATURE INSTEAD OF STOPPING POSSIBLE BLEEDING. 72 HOURS LATER, THE PATIENT MAY DIE IN ICU. PUT FLUIDS ON DASH EN ROUTE TO CALL FOR TRAUMA PATIENTS.

 

WITH ABDOMINAL TRAUMA THAT INVOLVES INTERNAL BLEEDING, YOU MAY NOT HAVE DISTENTION OR BRUISING IN THE FRONT, EVEN IF ITS A SPLENIC INJURY. BLOOD TENDS TO POOL IN THE RETROPERITONEAL SPACE BECAUSE THERE ARE NO ORGANS IN THAT SPACE.

 

INTRACRANIAL BLEEDS

EPIDURAL BLEED - SUDDEN ONSET USUALLY ACCOMPANIED BY SERIOUS HEADACHE

SUBDURAL BLEED - TYPICALLY ELDERLY PATIENTS WITH SLIGHTLY ALTERED MENTATION.

SECONDARY BRAIN INJURY

INJURY CAN OCCUR FROM WITHIN MINUTES TO DAYS

ACCOMPANIED BY SBP < 90HG, INCREASED ICP (NORMAL 10-15 MMHG), DECREASED MAP AND CPP

CPP = MAP - ICP (AS ICP RISES, CPP WILL DECREASE IF BP DOES NOT RISE)

HYPOXIA - SPO2 < 90% - EXCESS CO2 CAUSES THE BRAIN TO SPELL

 

DO NOT HYPERVENTILATE YOUR PATIENT

IF YOU OVEROXYGENATE YOUR PATIENTS, YOUR BRAIN VASOCONSTRICTS AND STARTS TO SWELL.

 

INTUBATING TBI PATIENTS, WHEN YOU TOUCH THE GAG REFLEX, BP AND ICP GOES UP.

WHEN YOU HAVE A PATIENT WITH TRANSIENT CONSCIOUSNESS WITH HEAD INJURY

EARLY SIGNS OF INCREASED ICP

VOMITING

HEADACHE

DIZZINESS

AMNESIA

VISUAL DISTURBANCES

ALTERED LOC

SEIZURES

LATE SIGNS OF INCREASED ICP

CUSHING TRIAD - HTN WITH WIDENING PULSE PRESSURES, BRADYCARDIA AND IRREGULAR RESPIRATIONS.

PUPIL CHANGES

COMA

POSTURING

 

IN BLEEDS, USE FLUIDS TO MAINTAIN BP ABOVE 90 MM HG ABOVE ALL COSTS.

TRANSPORT BLEEDS SITTING UP, IE. SEMI FOWLERS.

REDUCE STIMULI - KEEP QUIET AND DARK AS MUCH AS POSSIBLE

 

IN MANAGEMENT OF CEREBRAL HERNIATION, KEEP ETCO2 BETWEEN 30 AND 35

CO2 IS A VASODILATOR

CO2 MAKES BLOOD VESSELS IN THE HEAD EXPAND AND SWELL.

 

DIURETICS, MANNITOL MAY TAKE 15 TO 30 MIN. LASIX MAY NOT REDUCE FLUID IN BRAIN.

SEIZURES - BENZOS (INCREMENTS OF 2. WATCH BP.

STEROIDS SHOULD NOT BE USED.

HYPOTENSION AND HYPOXIA WILL KILL YOUR TBI PATIENT

OBESE PATIENTS DESATURATE AT TWICE THE NORMAL RATE BECAUSE THE INCREASED ADIPOSE TISSUE STORES MORE NITROGEN.

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