• Vitals
• ABG
• Pulse Ox
• ETCO2
• Catheters
• Urine
• Gastric
• Urine o/p
• ECG

AMPLE

• Allergies
• Medications
• PMH
• Last meal
• Event / Environment

Guedel airway

• Hard-to-hard
• Incisors to angle of jaw
• Soft-to-soft
• Side of mouth to tragus
• 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
• Still normotensive
• 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
• Walking on snow
• 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
• Bruising => Dysrhythmia
  
• 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

• 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!)