Em Approach to Trauma
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| Number 1 leading cause of death in ages 1-34 | Trauma
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| Level I | indicates center with greatest resources available most immediately. Ex: Trauma surgeon available within minutes
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| Airway The primary Survey | Airway maintenance with c-spine control. Position, Foreign bodies, fractures, hypoxia/hypoventilation, GCS
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| GCS of ____ or less may warrant intubation | 8
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| Indications for Intubation, mechanical ventilation | unable to oxygenate/ventilate, major head trauma of GCS<8, Agitation/intoxication
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| 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
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| Radiology alone can never clear a | c-spine. Can be cleared just clinically.
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| Breathing Survey | Are they oxgenating and ventilating? Neck (tracheal deviation with tension pneumothorax), chest(flail chest), abdomen (paradoxical breathing, accessory muscles used)
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| tx of tension pneumothorax | 14 guage needle decompression immediately, followed by chest tube once stable. want to immediately get BP down with needle decompression
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| Tx for flail chest | positive pressure ventilation. Intubate!
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| Tx for sucking chest wound | 1 way valve flap to cover wound
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| Circulation | Hemorrhagic shock, control hemorrhage, Large bore IV access, Fluid replacement (Crystalloid!), blood productes
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| Disability | abbreviated neuro exam; GCS, pupils, moving all extremities, rectal tone
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| 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
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| scalp hematoma | indicative of skull fx
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| as you age, your brain | shrinks, injury puts tension on suspension bands
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| E, F on primary survey | Exposure, Fingers/foleys (family and friends)
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| Imaging for Primary Survey | FAST scan US, X-ray (chest, CTLS Spine), CT Scan
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| FAST scan US on the belly is used to answer one question | is there blood in the belly?
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| Secondary Survey | MOI: blunt, Penetrating. Head to toe exam, identify any injury, plan imaging in conjuction with trauma surgery, arrange disposition
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| best test in trauma | CT
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| Skills and Procedures in trauma | chest tube, central venous access, nasogastric tube, foley catheterization
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| Imaging needed to evaluate the actual spinal cord | MRI
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| Special Considerations | Pediatrics, Elderly, Penetrating Trauma
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| 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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Created by:
ltm12