EM - Care of Trauma Patients

What is the leading cause of death from ages 1-44?

trauma (accidental/non-accidental)

What are the peaks in the trimodal death distribution?

- 1st: seconds to minutes of the injury

- 2nd: minutes to hours of the injury

- 3rd: several days to weeks after injury

What are the peaks of the bimodal death distribution?

- 1st: seconds to minutes after injury

- 2nd: several days to weeks after injury

What is the ABCDE's of basic trauma care?

A: airway/arterial breathing

B: breathing

C: circulation

D: disability

E: exposure/environment/eFAST

Which type of needle should be used for a tension pneumothorax decompression?

3.25 inch 14 gauge angiocath

Which sites are acceptable for a pneumothorax decompression?

- 2nd intercostal midclavicular

- 5th intercostal midaxillary

What are the recommended treatments for compressible hemorrhages?

- direct pressure

- elevation

- tourniquet

Tourniquets are designed for exsanguinating hemorrhages that cannot be controlled with ___

direct pressure

What are some physiologic changes related to hypothermia?

- increased oxygen consumption

- worsens acidosis

- inhibits coagulation cascade

What are some reasons the decision to terminate a surgical procedure may be made?

- coagulopathies

- major venous injuries

- poor response to resuscitation

- serious extra-abdominal injuries

What are some reasons you may opt to bring a patient back to the operating room for a second operation sooner rather than later?

- significant continued hemorrhage

- worsening acidosis

- abdominal compartment syndrome

Compensation mechanisms for shock?

- insufficient oxygen supplemented by increased CO

- O2 extracted from hemoglobin increases

- anaerobic metabolism creates lactic acidosis

What are some physiologic signs of shock?

- systemic hypotension (SBP<90)

- tachycardia (HR>130)

- ABG base deficit >6mEq/L

- hypo/hyperthermia

- skin pillow, diaphoresis, decreased cap refill

What volume of blood loss constitutes a class I hemorrhage

750cc, 15%

What volume of blood loss constitutes a class II hemorrhage

750-1500cc, 15-30%

What volume of blood loss constitutes a class III hemorrhage

>1500cc, >30%

What volume of blood loss constitutes a class IV hemorrhage

2000cc, >40%

What are some patient responses to IVF?

- responder: becomes hemodynamically stable

- transient responder: gets better, then worse

- non-responder: no response

What are some different kinds of burns?

- flame/fire: inhalation, CO poisoning, cyanide poisoning

- hot liquids: water, grease

- electrical injuries: CV complications, compartment syndrome

- chemical burns: acids/alkali, dry powder/liquids

What are the 4__ burn depth classifications?

- superficial

- superficial partial

- deep partial

- full thickness

___ burns are limited to the epidermis and are characterized by redness, hypersensitivity, and pain

Superficial

___ burns involve the epidermis and a variable portion of the dermis with red, blistered, wet and weepy skin

Superficial partial

___ bruns have.a reticular dermis that is pale in color due to damages blood vessels

Deep partial thickness

___ burns destroy the entire thickness of the epidermis, dermis, fat, fascia, muscle, and bone

Full thickness

All burns ___ with time

mature/worsen

What are some items to consider in the secondary survey of a burn patient?

- vital signs

- pertinent hx

- head to toe exam

- determine TBSA

- perform necessary labs, diagnostics, txs

- analgesia/resuscitation

- reassurance and psych support

- wound care

- patient disposition

Which burns should be included in TBSA calculation?

only partial and full thickness

At what TBSA should resuscitation be done?

greater than 20%

How to calculate resuscitation volume for an adult with thermal/chemical burns?

2mL LR x patients weight (kg) x % TBSA

How to calculate resuscitation volume for a child with burns?

3mL LR x child's weight (kg) x % TBSA

How to calculate resuscitation volume for an adult with high voltage electrical burns?

4mL LR x patient's weight (kg) x % TBSA

What is the time schedule for fluid resuscitation in a burn patient?

- first 8 hours: 1/2 of fluid given

- 2nd 8 hours: 1/4 of fluid given

- 3rd 8 hours: 1/4 of fluid given

Which burn patients should be referred to a burn center?

- chemical burns

- inhalation burns

- pre-existing medical disorders

- concomitant trauma

What are some standard steps taken in inhalation injuries?

- perform ABCDEs

- debridement as needed

- airway watch

- bronchoscopy for airway visualization

If there is a burn present on the hands what additional steps should be taken?

occupational therapy