Final year‎ > ‎

14.01.07 Trauma

Mechanisms
  • Impact
  • Fall
  • Violent
    • Penetrating
    • Blunt
  • Sporting
    • Horses
    • Rugby
  • 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
      • "I'm going to die"
    • 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
    • FULL exposure
    • Environment
      • Temp => Clotting => DIC


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)

Comments