Penetrating + blunt trauma

What are the benefits of TXA + how does it work?

• Anti-fibrinolytic reducing clot breakdown

• Inhibits plasminogen binding to fibrin, blocking conversion of plasminogen to plasmin that breaks down clots

What are the risks of TXA?

• Nausea / Vomiting / Diarrhoea GI tract irritation

• Hypotension rapid injection causes vasodilation / baroreceptor changes

• Dizziness from hypotension = lack of cerebral perfusion

How can blunt trauma to limbs cause compartment syndrome?

• Injury occurs = blood / fluid accumulate in fixed space

• As fluid increases, ^ internal pressure = venous compression = blood backing up

• This causes fluid to leak out of capillaries = tissue oedema

• Pressure = hypoxia that can lead to necrosis + rhabdo

How does raising legs aid low blood pressure?

Increases blood flow to the heart = bigger preload = bigger CO = higher BP

What are the benefits of oxygen for trauma ?

Blood loss = less haemoglobin = less oxygen delivery

Increasing saturations means haemoglobin that is there can be more effective at transporting to avoid hypoxia and anaerobic metabolism

What are the risks of fluid therapy in trauma?

• Excess fluid can increase haemorrhage:

  • Dislodges clots

  • Dilutes clotting factors

  • Worsens coagulopathy

  • Compartment syndrome - increase of pressure

What are the benefits of fluid in trauma?

• Increases BP: temporary restores circulatory volume which increases venous return, preload, stroke volume and thus cardiac output

  • Reduces risk of ischaemic injury: increases oxygen delivery to vital organs

What are the benefits of entonox in trauma?

• Rapid onset analgesia

• Less patient harm/distress: does not require IV access

• Prevents hypoxia: contains 50% oxygen

What are the risks of entonox in trauma?

• Dizziness: mild CNS depression

• Nausea & vomiting: stimulates chemoreceptor trigger zone in medulla

  • Euphoria: release of dopamine which bind to opioid receptors in the brainh

What are the benefits of IVP in trauma?

• More Rapid onset pain relief: faster acting than oral paracetamol

• BP doesn’t carry as many side effects as stronger opiates such as morphine

What are the risks of IVP in trauma?

Hypotension if administered too quickly: peripheral vasodilation reducing vascular resistance

what is the pathophysiology of hypovolemic shock?

• Volume loss = low BP

• Preload decreases = reduced stroke volume + CO

• Baroreceptors activate to ^CO = blood shunting to brain + heart

• RAAS + ADH = vasoconstriction and volume retention

  • Anaerobic metabolism occurs = metabolic acidosis = effects on brain function, HR + RR

What can a traumatic injury cause?

Penetrating - laceration to organs / tissue / ligaments, nerve injury

Blunt - compartment syndrome, rhabdo

Both - hypovolemic shock, traid of death

What is the triad of death

Coagulopathy, metabolic acidosis, hypothermia

Causes a cycle of worsened bleeding + organ failure