Mechanisms- Impact
- Fall
- Violent
- Sporting
- Burns
Drowning
- Worry about:
- Hypothermia
- Neck trauma
- Cardiorespiratory arrest
- Why they fell in
- Seizure
- Alcohol
- CPVT (Catecholaminergic Polymorphic Ventricular Tachycardia)
Burns
- Airway obstruction is caused by:
- Bronchospasm initially
- Upper airway oedema later (2-4 hrs) => Intubate early if signs of burning (hoarse voice, soot, singed hair)
Primary survey (what's going to kill them)
- A
- Flail chest (>1 break in >1 ribs)
- => Pain relief, CPAP, Intubation
- B
- Tension pneumothorax
- Haemothorax
- C
- Hypovolaemic shock
- #Femur
- Retroperitoneal bleed
- Aortic dissection
- Can plug with a haematoma, which displaces much later
- D
- GCS
- Pupils
- Limb movement
- GLUCOSE
- E
Intubation
- Indications
- GCS <8
- Predicted clinical course
- RSI
- Suxamethonium (40" on, 5' off, except in slow metabolisers)
- Induction agent (propofol, thiopentone, ketamine)
- Sellick manoeuvre
- BEWARE sudden cardiac arrest, hypotension, anaphylaxis
Notes
- Think LATERALLY and SCEPTICALLY
- Old people can # C-spine from standing => All get a CT
- Ventilation refers to CO2 movement
- FAST is NOT a definitive assessment in trauma
- NOT a rule-out test
- Can easily miss a bleed
- Trismus
- "A firm closing of the jaw due to tonic spasm of the muscles of
mastication from disease of the motor branch of the trigeminal nerve, usually associated with general tetanus."
- May generally refer to all causes of limited mouth opening
- Even with a pulse, start CPR if HR <60 (in a child)
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