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)