indicates center with greatest resources available most immediately. Ex: Trauma surgeon available within minutes

Airway The primary Survey

Airway maintenance with c-spine control. Position, Foreign bodies, fractures, hypoxia/hypoventilation, GCS

Indications for Intubation, mechanical ventilation

unable to oxygenate/ventilate, major head trauma of GCS<8, Agitation/intoxication

How do you know if they have c-spine injury?

Imaging, and clinical assessment. NEXUS: no posterior midline tenderness, no evidence of intoxication, alert mental status, no focal neurological deficits, no painful distracting injuries

Radiology alone can never clear a

c-spine. Can be cleared just clinically.

Are they oxgenating and ventilating? Neck (tracheal deviation with tension pneumothorax), chest(flail chest), abdomen (paradoxical breathing, accessory muscles used)

tx of tension pneumothorax

14 guage needle decompression immediately, followed by chest tube once stable. want to immediately get BP down with needle decompression

positive pressure ventilation. Intubate!

Tx for sucking chest wound

1 way valve flap to cover wound

Hemorrhagic shock, control hemorrhage, Large bore IV access, Fluid replacement (Crystalloid!), blood productes

abbreviated neuro exam; GCS, pupils, moving all extremities, rectal tone

Nexus II: evdience of significant skull fx, altered level of alertness, neurological deficit, persisten vomiting, presence of scalp hematoma, abnl behavior, coagulopathy, age 65 years or older

as you age, your brain

shrinks, injury puts tension on suspension bands

E, F on primary survey

Exposure, Fingers/foleys (family and friends)

Imaging for Primary Survey

FAST scan US, X-ray (chest, CTLS Spine), CT Scan

MOI: blunt, Penetrating. Head to toe exam, identify any injury, plan imaging in conjuction with trauma surgery, arrange disposition

Skills and Procedures in trauma

chest tube, central venous access, nasogastric tube, foley catheterization

Special Considerations

Pediatrics, Elderly, Penetrating Trauma

In gunshot wounds, you must

match the number of holes to the number of bullets. It can embolize, go through and through...

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EM Trauma

Em Approach to Trauma

Question	Answer
Number 1 leading cause of death in ages 1-34	Trauma
Level I	indicates center with greatest resources available most immediately. Ex: Trauma surgeon available within minutes
Airway The primary Survey	Airway maintenance with c-spine control. Position, Foreign bodies, fractures, hypoxia/hypoventilation, GCS
GCS of ____ or less may warrant intubation	8
Indications for Intubation, mechanical ventilation	unable to oxygenate/ventilate, major head trauma of GCS<8, Agitation/intoxication
How do you know if they have c-spine injury?	Imaging, and clinical assessment. NEXUS: no posterior midline tenderness, no evidence of intoxication, alert mental status, no focal neurological deficits, no painful distracting injuries
Radiology alone can never clear a	c-spine. Can be cleared just clinically.
Breathing Survey	Are they oxgenating and ventilating? Neck (tracheal deviation with tension pneumothorax), chest(flail chest), abdomen (paradoxical breathing, accessory muscles used)
tx of tension pneumothorax	14 guage needle decompression immediately, followed by chest tube once stable. want to immediately get BP down with needle decompression
Tx for flail chest	positive pressure ventilation. Intubate!
Tx for sucking chest wound	1 way valve flap to cover wound
Circulation	Hemorrhagic shock, control hemorrhage, Large bore IV access, Fluid replacement (Crystalloid!), blood productes
Disability	abbreviated neuro exam; GCS, pupils, moving all extremities, rectal tone
Who needs a CT?	Nexus II: evdience of significant skull fx, altered level of alertness, neurological deficit, persisten vomiting, presence of scalp hematoma, abnl behavior, coagulopathy, age 65 years or older
scalp hematoma	indicative of skull fx
as you age, your brain	shrinks, injury puts tension on suspension bands
E, F on primary survey	Exposure, Fingers/foleys (family and friends)
Imaging for Primary Survey	FAST scan US, X-ray (chest, CTLS Spine), CT Scan
FAST scan US on the belly is used to answer one question	is there blood in the belly?
Secondary Survey	MOI: blunt, Penetrating. Head to toe exam, identify any injury, plan imaging in conjuction with trauma surgery, arrange disposition
best test in trauma	CT
Skills and Procedures in trauma	chest tube, central venous access, nasogastric tube, foley catheterization
Imaging needed to evaluate the actual spinal cord	MRI
Special Considerations	Pediatrics, Elderly, Penetrating Trauma
In gunshot wounds, you must	match the number of holes to the number of bullets. It can embolize, go through and through...

Created by: ltm12

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