Term
| Indications for intubation |
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Definition
1)patient can't talk/unconscious/intoxicated
2)GCS<8
3)airway compromised/collapsed |
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Term
| if you are worried about C-spine then perform _______________ |
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Definition
| in-line traction when inserting ET tube |
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Term
| if gag reflex is intact then perform______________ |
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Definition
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Term
| nasotracheal intubation is contraindication in (3) |
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Definition
1)children
2)apneic patients
3)cribiform/maxilofacial fractures |
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Term
| if intubation is unsuccessful or massive facial trauma then do _________________ |
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Definition
| emergency cricothyroidotomy |
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Term
| after intubation _______________ |
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Definition
| auscultate all lung lobes for equal breath sounds |
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Term
| B breath sounds confirm ___________________ |
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Definition
| proper tube placement and ventilation |
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Term
| after establishing an airway what do you say? |
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Definition
| "Now that I have established an airway, i would like to assess his breathing by assessing rate and depth" |
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Term
| while checking breathing inspect for: (7) |
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Definition
1)air movement
2)RR
3)cyanosis
4)tracheal deviation
5)JVD
6)asymmetric chest expansion
7)use of accessory muscles |
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Term
| while checking for breathing percuss for: |
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Definition
| hyperresonance or dullness over either lung field |
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Term
| while checking for breathing palpate for: |
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Definition
1)crepitus
2)rib fracture
3)subQ emphysema
4) |
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Term
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Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
1)Run 2L LR wide open
2)no response, run 2 more
3)then give RBCs, O neg
4)type specific in 10 min
5)type/cross in 20-30 min |
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Term
|
Definition
| trauma pt in hypovolemic shock requires 3L of LR for every 1L of blood |
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Term
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Definition
1)alert
2)responds to voice
3)responds to pain
4)unresponsive |
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Term
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Definition
1)AVPU
2)GCS (EVM)
3)pupils
4)motor/sensory |
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Term
|
Definition
1)disrobe pt (visual inspection and digital palpation)
2)keep pt warm
3)log roll pt (check for spine tenderness, lacs, abrasions, step-offs)
4)perform RE (r/o blood at urethral meatus, high riding prostate, hemoccult stool, check sphincter tone) |
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Term
|
Definition
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Term
| if blood at the urethral meatus do a ____________ |
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Definition
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Term
| secondary survey for trauma (5) |
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Definition
1)neuro
2)head to toe exam
3)AMPLE (allergies, meds, PMH, last meal, events surrounding injury)
4)radiology
5)start A-line and get ABG |
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Term
| neuro exam of secondary survery |
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Definition
1)GCS
2)inspect pupils
3)CN
4)tympanic membranes
5)peripheral nerves |
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Term
| head to toe exam of 2ndary survey |
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Definition
1)scalp
2)face
3)neck
4)chest (reassess)
5)abdomen
6)pelvis
7)back
8)extremities |
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Term
| in 2ndary survey check face for: (6) |
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Definition
1)orbital rims
2)zygomas
3)nasal bone
4)septal hematoma
5)maxilla/mandible fx
6)battle sign |
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Term
| in 2ndary survey check scalp for: (3) |
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Definition
1)hematomas
2)lacs
3)skull fx |
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Term
| in 2ndary survey check neck for: (5) |
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Definition
1)tenderness
2)crepitus
3)neck veins
4)wounds
5)hematomas |
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Term
| in 2ndary survey check abdomen for: (5) |
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Definition
1)contusions
2)hematomas
3)scars
4)tenderness
5)BS |
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Term
| in 2ndary survey check pelvis for: (3) |
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Definition
1)check pelvis stability
2)iliac crest and pubis symphisis for fx
3)bimanual pelvic exam for females |
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Term
| in 2ndary survey check back for: (3) |
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Definition
1)spinous tenderness
2)lacs
3)abrasions |
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Term
| in 2ndary survey check extremities for: (4) |
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Definition
1)deformity
2)tenderness
3)crepitus
4)check for compartment syndrome |
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Term
|
Definition
allergies
meds
PMH
last meal
events surrounding injury |
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Term
| radiology for trauma: (4) |
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Definition
1)last C spine (C1 to top of T1)
2)AP chest (r/o PTX or HTX)
3)AP pelvis
4)head CT if LOC |
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Term
| Clinical for tension PTX: (8) |
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Definition
1)dyspnea
2)JVD
3)tachypnea
4)anxiety
5)pleuritic chest pain
6)decreased or absent breath sounds
7)tracheal shift away from affected side
8)hyper-resonance on affected side |
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Term
| Treatment for tension PTX: (2) |
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Definition
1)needle thoracostomy
2)chest tube thoracostomy |
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Term
|
Definition
1)use 14 gauge or larger needle
2)placed in pleural cavity
3)2nd intercostal space
4)MCL |
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Term
|
Definition
1)28 or 36 polyethylene tube placed in pleural cavity
2)5th intercostal space MAL
3)enter pleural space by entering on superior surface of rib to avoid neurovascular bundle
4)place tube in posterior cephalic direction
5)extend tube attached to water seal suction at 20 mmHg max
6)secure with purse string stitch |
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Term
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Definition
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Term
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Definition
1)possible intubation with positive pressure intubation
2)chest tube
3)occlusive dressing (3 sided, 1 way flap valve dressing) |
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Term
|
Definition
1)hypotension
2)decreased or absent breath sounds
3)dullness to percussion |
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Term
| treatment for massive HTX |
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Definition
1)volume replacement (cell saver if available)
2)chest tube
2) |
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Term
| indications for emergent thoracotomy for HTX: |
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Definition
1)>1500 cc of blood on initial placement of CT
2)persistent >200 cc of bleeding via CT per hour x 4 hrs |
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Term
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Definition
| segment of chest moves paradoxically to rest of chest during breaths |
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Term
| flail chest is caused by? |
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Definition
| 2 separate fx in 3+ consecutive ribs |
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Term
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Definition
1)fluids
2)PEEP
3)analgesia |
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Term
| signs symptoms of cardiac tamponade |
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Definition
1)tachycardia/shock
2)becks triad
3)pulsus paradoxus
4)kussmaul's sign |
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Term
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Definition
1)JVD
2)hypotension
3)muffled heart sounds |
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Term
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Definition
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Term
| what is cardiac tamponade: |
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Definition
| bleeding into pericardial sac resulting in constriction of heart, decreasing inflow and decreasing CO |
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Term
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Definition
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Term
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Definition
1)immediate IV fluid bolus
2)U/S guided pericardiocentesis
3)surgical exploration is mandatory |
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Term
|
Definition
1)16-18 gauge needle, 15cm long evero needle cath attached to 30-60cc syringe
2)monitor ECG with precordial lead attached to needle
3)insert 1-2 cm to the L and inf to xiphocostal jxn at 45 angle |
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Term
| site most often injured in cardiac tamponade |
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Definition
| atrial appendage (thin wall) |
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Term
| suspect ___________ with fx of 1st rib, sternum or scapula |
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Definition
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Term
| you will see __________ on CXR with transected aorta |
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Definition
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Term
| confirm transected aorta with: |
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Definition
1)arteriography
2)aortagraphy |
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Term
| in abdominal trauma go ahead and do: (2) |
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Definition
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Term
|
Definition
| decreases risk of vomiting and distension (insert orally if there are facial fx) |
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Term
|
Definition
1)helps decompress bladder
2)helps monitor UOP |
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Term
|
Definition
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|
Term
| if urethral injury is suspected insert _______ |
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Definition
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Term
| approach to blunt abdominal trauma: |
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Definition
1)if there is peritonitis do an ex-lap
2)if no prtnts but tenderness or bleeding then do DPL/FAST
3)if AMS/drunk do DPL/FAST
4)if unstable vitals (hypotensive) do DPL/FAST |
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Term
|
Definition
focused assesment sonography for trauma
1)morrison's pouch (liver)
2)bladder/pelvis (pouch of douglas)
3)spleen
4)pericardial sac |
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Term
| test of choice for eval of unstable pt. with blunt abdominal trauma |
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Definition
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Term
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Definition
cleans abd with antiseptic
1)infiltrate area below umbilicus with 1% lidocaine with epi
2)small vertical incision below umbilicus thru skin to linea alba
(supraumbilical incision if pelic fx)
3)small hole in peritoneum
4)cath advanced into peritoneum and pelvis
4)>10 ml gross blood aspirated then pt goes to OR
5)<10 ml then infuse 10ml/kg LR or NS and lavage fluid via gravity for 5-10
6)send 50 ml sample to lab (microsopic analysis, cell count, bile analysis, amylase analysis) |
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Term
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Definition
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Term
| what constitutes a positive DPL |
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Definition
1) more than 10ml gross blood aspirated
2)RBCs>100,000 in blunt trauma
3)RBCs>1,000 in penetrating trauma
4)WBCs>500
5)amylase>serum amylase
6)bile, bacteria, food particles |
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Term
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Definition
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Term
| stab wound with: peritonitis, shock, eviscerating |
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Definition
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Term
| stab wound without obvious peritonitis, shock eviscertation do |
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Definition
| local wound exploration and check for penetration of anterior fascia, if positive do DPL |
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Term
| normal vital signs with abdominal pain/tenderness |
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Definition
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Term
|
Definition
1)verical/midline incision from xiphoid to pubis
2)4 quad serial packing to tamponade the bleeding
3)remove packs so site of suspected injury is removed last |
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