trauma

what is first peak trauma death

within minutes of the trauma, injuries of the brain, upper spinal cord, heart, major blood vessels

second peak trauma death

within two hours, r/t hematomas, hemothorax, ruptured spleen, liver lac, femur fracture

third peak death

days to weeks, sepsis, organ failure

primary survey A

airway, c-sine, suction, assess the need for artificial airway

primary survey B

breathing, look, listen, feel, do the need O2 or assistance

primary survey C

circulation, find pulses, check for bleeding, check skin, get IVs in w/warm LR

primary survey D

disability, neuro exam, pupil response, motor function,

How to test LOC

are they alert, respond to verbal commands, painful stimuli, unresponsive, exposure and evaluation

what is traumatic shock

usually caused by hypovolemia from blood loss

what is exsanguination

initial loss of 40% of blood rapidly

when does the secondary survey begin

after primary assessment is complete and life threatening injuries are treated

things to consider for CT scan

contrast, can further renal damage

things to consider for MRI

metal implants

secondary assessment

vitals, pain meds, hx, identity all injuries, dx scans

what is the trauma diamond

coagulopathy, acidosis, hypothermia, hypocalcemia

why are we worried about hypocalcemia for trauma

blood loss, PRBCs are preserved with citrate which can cause decrease calcium

what do we give for calcium replacement

calcium gluconate

when would you be most worried about calcium levels

after 2-4 units of PRBCs

differences in peds trauma

they have a greater relative body surface area and organs are more anterior and have less subcutaneous fat protecting them

how do peds patients compensate

increasing heart rate and systemic vascular resistance, bp will be maintained until up to 30% blood loss

what injuries are more common in peds

spleen and liver lacs

blood protocol for peds

fresh frozen plasma, PRBCs, and platelets in 1:1:1, use fresh whole blood as an alternative

what is TXA

antifibrinolytic that inhibits the breakdown of blood clots to prevent further bleeding

when is TXA given

within 2-3 hours, given for blood loss, hr greater than 110, bp less than 90