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