Principles of Trauma Management

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Describe a primary survey.

rapid assessment for life threatening problems

target critical organs by priority

2 minutes or less

How long should a primary survey take?

2 minutes or less

What should you be looking for/assessing during a primary survey?

level of consciousness, attitude, behavior

unusual acivity

unusual body or limb postures

positions that suggest bone fractures, joint dislocations

traumatic injuries

unusual breathing sounds or sounds suggesting airway obstruction

look for any obvious blood, wounds, or other gross abnormalities

What was the old method of performing an initial assessment?

ABC —> airway, breathing, circulation, neurologic, wounds

What is defined as the natural process of old cells dying and being replaced by new ones?

apoptosis

What is defined as cell death due to toxins, radiation, heat, trauma, or lack of oxygen due to the interruption of blood flow?

necrosis

What do A, B, and C in ABC have in common?

red blood cells and oxygen

If there are not sufficient red blood cells to transport enough oxygen to keep the cells alive, then what becomes irrelevant?

Airway, Breathing, Circulation

What is compressible hemorrhage?

hemorrhage that you can put your hand on and stop it

What is non-compressible hemorrhage?

hemorrhage that you cannot put your hand on and stop

What is M2ARCH2E?

massive hemorrhage and muzzle

airway

respiration

circulation

head injury and hypothermia

evacuate/pain management/antibiotics

Arterial hemorrhage is described as what?

bright red and squirting

Venous hemorrhage is described as what?

dark red and oozing or flowing

What hemostatic bandages can assist with massive hemorrhage?

combat gauze (kaolin product)

Chitogauze (chitosan impregnated)

Hemcon

Should you restrain the jaw of a dog even if it is unconscious?

Yes but examine and clear the oral cavity first

How do you check for a patent airway?

visible observation for barking, panting, or lack of sounds

is patient unconscious? —> observe and position airway placement

observation for bleeding oral cavity, burns, and external evidence of blockage or facial damage

What sounds may be associated with something blocking the airway?

labored and noisy breathing

How do you examine the airway?

open the mouth and examine the inside as far back into the throat area as possible for masses, foreign objects, swelling, and deformities that may cause airway obstruction

How can we clear airway obstructions when deemed possible?

“2 finger sweep” technique

If a patient has a bleeding oral cavity, burns, and external evidence of blockage or facial damage, what should you prioritize after massive hemorrhage and muzzle?

airway protection

What can be done to protect the airway in a dog?

intubation or tracheotomy

Explain how to place a tube trachemotomy.

make a transverse incision through the annular ligament between the third and fourth OR fourth and fifth tracheal cartilages

facilitate tube placement by depressing the proximal cartilages with a hemostat

elevate distal cartilages with an encircling suture then insert a tracheostomy tube that does not completely fill the lumen

appose the sternohyoid muscles, subcutaneous tissue, and skin cranial and caudal to the tube

secure the tube by tying it with gauze or umbilical tape around the neck

If a tracheostomy tube is unavailable, what can be used instead?

an endotracheal tube so long as you don’t go past biurfication

When making the transverse incision in the annular ligament, what is the limit to how far you can extend the incision?

do not extend the incision around more than half the circumference of the trachea

How do we check for breathing?

observe chest and abdomen, inspect and palpate as fur may hinder observation

If a canine is wearing a vest, what should you do?

remove it but do NOT cut it off

Why do we not cut vests off of canines?

you may be able to use it to hold pressure on potential hemorrhage

What type of breathing suggests lung trauma or problems, such as pulmonary contusion?

deep, labored breathing

What type of breathing suggests that air, blood, or some other fluid is in spaces of the lungs that don’t normally contain air, blood, or fluids?

shallow, rapid breathing

If the dog is not breathing, he is in what?

respiratory arrest (emergency)

What type of breathing may indicate brain injury?

irregular breathing

Other than observation of breathing, what else can give us clues to the dogs respiratory status?

look at the gums —> blue is bad

feel the chest/body for signs of wounds, fractures, or other signs of trauma

At what point in M2ARCH2E do we initiate IVs and IO devices if needed?

circulation

If fractures are suspected, what do you do and when?

in the circulation step

immobilize the joint above and below, secure splint immediately above and below site of injury

What should you be considering when checking a pulse?

rate

character —> strong or weak, rhythm

Normal mucous membrane color is what?

pink

Pale grey or white gums indicate what?

anemic/blood loss

Blue gums indicate what?

cyanotic

Yellow gums indicate what?

icterus —> liver issue

“Brick red” gums indicate what?

cyanide

CRT is an indicator of what?

blood flow to tissues

What is a normal CRT?

<2 seconds

What is an abnormal CRT?

>2 seconds

Rapid heart rate or pulse with prolonged capillary refill time suggest what?

shock, major trauma, or a serious medical problem

How do we assess a dog’s level of consciousness?

ability to follow verbal commands, gait or how he stand, visual observation of head, is he unresponsive

What are we assessing when determining if there is a head injury?

assess level of consciousness

observe equality between pupils

What should you assess after completing M2ARCH2E?

the rest of the dog for wounds, fractures, evidence of trauma elsewhere (spinal column, abdominal region, flank, limbs)

What is the mechanism behind an open pneumothorax?

air can get in and out, it is a “sucking chest wound”

What is the mechanism behind a tension pneumothorax?

dog breaths in, air goes in, air can’t get back out, pressure builds around lungs —> lungs collapse

What type of pneumothorax requires needle decompression?

tension pneumothorax

What size needle should be used to alleviate a tension pneumothorax?

the biggest one available

What are the landmarks for needle decompression of a tension pneumothorax?

7th to 10th intercostal space

How can we alleviate an open pneumothorax?

cover the wound