Primary survery- Vitals
- ABG
- Pulse Ox
- ETCO2
- Catheters
- Urine o/p
- ECG
AMPLE
- Allergies
- Medications
- PMH
- Last meal
- Event / Environment
Guedel airway - Hard-to-hard
- Soft-to-soft
- Put it in upside down + turn
Nasopharyngel airway - Size of their little finger
- Length = Tip of nose to tragus
- Put in the right side
Shock
- Blood loss is like tennis:
- 15%
- 750 ml
- Unlikely even to notice
- 30%
- 1.5 litres
- Tachy but normotensive
- This is the dangerous one!
- 40%
- 2 litres (e.g. femur/pelvis fracture)
- Start to become hypotensive
- Game (>40%)
- Bradycardia
- Catastrophic hypotension
Danger areas in assessing shock
- The 30%-ers
- Athletes
- 80 bpm may be very tachy.
- Beta blockers
Rib fractures
- 1-3
- Need SEVERE force
- Check for associated injuries
- Brachial plexus
- C. spine
- Vessels
- 4-9
- Risk of pulmonary contusion + pneumothorax
- 10-12
- Look for abdo injury (spleen etc)
6 killers in thoracic trauma
- Laryngeotracheal injury
- Rare
- Horseness
- Subcut emphysaema
- Tension pneumothorax
- Resp. distress
- Shock (from VENOUS compression)
- Distended neck veins (may be hidden by c. spine collar)
- Cyanosis is a LATE sign
- Open pneumothorax
- Seal 3 sides => Valve to let air out
- Flail chest / Pulmonary contusion
- Multiple ribs broken in multiple places
- => Sections sucked in on inspiration
- => Contusion underneath => Blood in lung
- Big ventilation problems appear in a few hours
- Massive haemothorax
- Requires a BIG vessel
- Stage 3 shock
- No breath sounds
- Dull percussion
- Fluid level on CXR but only if upright
- Cardiac tamponade
- PEA
- Muffled heart sounds
- Hypotension
- Distended neck veins
Other serious thoracic traumas
- Tracheobronchial tree injury
- Causes a persistent pneumothorax (still bubbling after an hour)
- Blunt cardiac injury
- Oesophageal rupture
- Pain + shock out of proportion to injury
- Patriculate matter comes out of chest tube
- Check with contrast swallow
- Simple pneumothorax
- Beware pressure changes (ventilation, air transfer)
- Pulmonary contusion
- May look like a haemothorax on CXR
- Traumatic aortic disruption
Notes- SBP >80 to feel peripheral pulse
- Careful with fluid resuscitation - Can dislodge clot
- FAST scan for free fluid
- Focused Assessment with Sonography for Trauma
- Diagnostic peritoneal lavage - Only in resource-poor settings these days
- Seesaw respiration => Obstructed airway
- Women tend to be chest-breathers (to prepare for pregnancy?)
- Pelvis = Polo mint => Look for secondary break
- Abdo injury = Nipples to groin (trauma can be very high up!)
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