Trauma pt 1
Trauma triad of death
Traumatic injury--> -Bleeding-->coagulopathy -Exposure-->hypothermia -Hypoperfusion-->acidosis Coagulopathy, hypothermia, and acidosis=triad of death
Airway examination
airway noises position of head foreign body fluid, secretions edema
ocular irrigation contraindication
alkali exposure require>irrigation eye pH 7-7.3 needs to return to normal
activated charcoal
binds to reduce absorption within 60 mins of ingestion
Decontamination agents
cathartics activated charcoal gastric lavage whole bowel irrigation ocular irrigation dermal irrigation
gastric lavage contraindication
consider 25G charcoal to absorb first
contraindication of whole bowel irrigation
contraindication GI disease* may cause NV, abdominal cramping, electrolyte imbalance
activated charcoal contraindications
do not use with caustic or corrosive substance
Pre-hospital trauma care
golden hour
ocular irrigation
irrigate eye with copious amounts NS or LR
treatment for tension pneumothorax
needle thoracostomy
contraindication of cathartics
no bowel sounds renal failure cardiac failure
whole bowel irrigation
nonabsorbable evacuant solution GI tract flush via NGT or OGT
interventions for airway
open suction secure oxygen
needle gauges and colors
orange- 14 gray- 16 green- 18 pink- 20 blue- 22 yellow- 24 violet- 26
dermal irrigation
remove contaminated clothing wash whole body with tepid water
hospital tauma care
stabilization ABCDE triage assessments (primary and secondary survey) intervention
gastric lavage
tap water via OGT/NGT remove tablet fragments
Hospital personnel and role
trauma team: -identify injuries -initiate definitive treatment -know role and function
dermal irrigations contraindication
wear PPE
Antidepressants (TCA) poisoning symptoms
•"Red as a beet" •"Dry as a bone" •"Hot as a hare" •"Blind as a bat" •"Mad as a hatter" •Urinary retention •Tachycardia •Cardiac-QTc prolongation
treatment of acetaminophen poisoning
•Acetaminophen levels, LFT's, coags •Activated charcoal •N-acetylcysteine -An amino active to minimize hepatoxocity
Beta Blocker Poisoning symptoms
•Bradycardia •Hypotension •Arrhythmias •Hypothermia •Hypoglycemia •Seizures •Cardiogenic Shock
Sedatives/hypnotics poisoning symptoms
•CNS depression •Slurred speech •Ataxia •Altered mental status •Respiratory depression
Antidepressants (TCA) poisoning treatment
•EKG, glucose, gastric lavage •IVF •Activated charcoal/Gastric lavage •Sodium bicarb-blood pH goal 7.5 •Benzodiazepines for seizures •Antiarrhythmics •Supportive care: ABC, monitoring, IV
Risk factors for trauma
•Gender Males/risky behavior •Race & socioeconomic background •Alcohol •Urban areas
treatment of salicylate poisoning
•IVF •Activated charcoal •Sodium bicarb •Hemodialysis •Urine pH therapy •ABG •Labs: salicylate level, glucose, lactate, coags
Alcohol Poisoning treatment
•Labs: alcohol and glucose •IVF with thiamine, folic acid •Benzodiazepines for alcohol withdrawal •CIWA-Ar scale
Beta Blocker poisoning treatment
•Labs: electrolytes, glucose, cardiac enzymes, ABG, CXR, EKG •Activated charcoal •Glucagon •D50 •Benzodiazepine for seizures •Hemodialysis •Supportive care
sedatives/hypnotics poisoning treatments
•Med levels, glucose, drug screen, ABG •Flumazenil •Activated charcoal •Hemodialysis •Supportive: airway, IV access, monitoring
Alcohol Poisoning symptoms
•Slurred speech •Euphoria •Impaired balance •Ataxia •Flushed face •Vomiting •Erratic behavior
Complications of trauma
-hemorrhage -airway compromise -sepsis -hypothermia
other symptoms/thermomanagement interventions
-identified cause therapy -thermomanagment -trauma treatment -insertion of NGT, IUC
Breathing (sufficient oxygenation and ventilation) examination
-look, listen, feel approach -resp rate and effort -breath sounds -subcutaneous emphysema -symmetry of chest movement -tracheal deviation -JVD -cyanosis
breathing interventions
-oxygen according to SpO2 -pneumothorax therapy -inhalation therapy -ventilation
What is the leading cause of unintentional injuries
MVC
Cathartic ex
Mag sulfate mag citrate sorbitol w/ charcoal
Neurological state examination
-AVPU/GCS -reactivity and symmetry of pupils -blood glucose level -basic neurological exam -posture -toxicological exam
Field personnel and roles
EMT and Paramedics: -determine severity of injury -mechanism of injury -activate trauma team
symptoms of salicylate poisoning
Early (<30 mg/dL): •N/V, diaphoresis, tinnitus, vertigo, tachypnea, tachycardia, abdominal pain Toxicity (30-70 mg/dL): •Agitation, delirium, hallucinations, convulsions, lethargy Severe Toxicity (> 70 mg/dL): •Rhabdomyolysis, ARF, respiratory failure
circulation examination
-HR -BP -cap refill -bleeding -skin color -blood smaples -diuresis
circulation interventions
-IV/IO access control of bleeding -hemorrhage protocol -fluids -drugs -transfusion
Blunt thoracic trauma ex and what they cause
-blunt cardiac injury-->myocardial contusion to cardiac rupture -Shearing Injury-->traumatic aneurysm, Exsanguination -Rib Fractures-->flail chest, Free floating sternum -Other pulmonary Injuries-->Pulmonary contusion, Pneumothorax, Hemothorax
Blunt Abdominal Traum examples and what they cause
-compression-->Traumatic diaphragm rupture -Shearing-->liver laceration -Pelvic fractures-->Unstable pelvic fractures
types of forces (esp during MVA)
-deceleration -acceleration -compression -shearing
Neuro interventions
-glucose -antidotes
Penetrating Trauma ex and what it causes
-gunshot wound-->Cavity creation by tumble and yaw of bullet -stabbing-->damage based on scope movement and density tissue affected
other symptoms and thermomanagement exam
-head to toe examination -medical history -temperature -injuries -edema -scars -signs of drug abuse -skin changes -signs of infection/sepsis
damage control surgery for trauma
1)Stop hemorrhage 2)Correct physiologic abnormalities in ICU 1)Fluid resuscitation 2)Warm 3)Correct coagulopathies 3)Definitive operation
Tauma levels 1-4
1- highest level of care, open 24 hours a day, and offer teaching and research components 2- no research or surgical residency like 1, on-call specialists 24/7 3-have resources for emergency surgery and intensive care, but might need to transfer the pt 4-initial evaluation, stabilization, and diagnostic capabilities, but will likely have to transfer pt if needed
acetaminophen poisoning symptoms
Depletes glutathione •Allows NAPQI to accumulate •Hepatocellular necrosis •Gastroenteritis within hours Hepatotoxicity 1-3 days after ingestion Phase 1--> Phase IV