19-20. triage and trauma 1-2

what 3 major body systems are assessed during primary survey?

• respiratory

• cardiovascular

• neurologic

  • (± abdominal / urogenital)

respiratory patterns — upper airway obstruction

stridor, stertor, increased inspiratory effort

respiratory patterns — restrictive

rapid, shallow, asynchronous

respiratory patterns — lower airway disease

increased expiratory effort

respiratory pattern — secondary (non-respiratory)

rapid rate with normal effort & lungs sounds

auscultation of trachea and lungs (what sounds are indicative of different diseases?)

• crackles = fluid within alveoli

• wheezes = narrowed small airways

• muffled = pleural space disease

perfusion parameters (evidence of shock)

• heart-related

  • heart rate: tachycardia (dog), bradycardia (cats)

  • pulse quality: hypo-, hyperdynamic, absent

• gums / mucous membranes

  • mucous membrane color: pale, cyanotic

  • capillary refill time: <1 second, >2 seconds

• temp

  • body temp: less than normal

  • extremity temperature: cool compared to core

• mentation: reduced

primary cardiac abnormalities

• murmur

• arrhythmia

• synchronous or asynchronous pulses

• muffled heart sounds

primary survey — neurologic system

• brain or spinal cord injury?

• seizures?

• altered mentation?

examples of blunt trauma

• motor vehicle accidents

• high-rise syndrome / falls

• other: injured in car, ejected from car, struck by weapon, crushed

examples of penetrating trauma

• bite wounds

• gunshot / ballistic

• lacerations

• other: impalement, quilling

which body systems are most likely to be affected by trauma?

• respiratory

• cardiovascular

• neurologic

• abdominal

• integument

• musculoskeletal

• coagulation

most common respiratory injuries seen with vehicular trauma

• pulmonary contusions

  • hemorrhage into alveoli

  • progress over 24-48h

• pneumothorax

other respiratory injuries seen with vehicular trauma

• hemothorax

• diaphragmatic hernia

• rib fractures

• flail chest

what treatments should be avoided for pulmonary contusions?

• antibiotics

• diuretics

• corticosteroids

• overuse of IV fluids

vehicular trauma — musculoskeletal injuries

• fractures

  • pelvis > femur > forelimb/distal hindlimb

• luxation

  • sacroiliac > elbow

other systems commonly injured by vehicular trauma

• integumentary system

• abdominal

  • hemoabdomen (more common)

  • uroabdomen; gall bladder rupture (rare) — delayed identification

uroabdomen / gall bladder rupture diagnosis

abdominal fluid analysis

• uroabdomen

  • fluid:serum creatinine → 2:1

  • fluid:serum potassium → 1.4:1

• gall bladder rupture

  • fluid bilirubin > serum

vehicular trauma — cardiovascular system

• shock (hypovolemic)

  • abnormal perfusion parameters

  • elevated lactate

  • hypotension

• arrhythmias

vehicular trauma — neurologic system

• perform neurologic exam before analgesia

• traumatic brain injury

• spinal fracture / luxation

  • rule out before significant patient manipulation!

traumatic brain injury — primary vs. secondary injury

• primary: occurs at time of trauma

  • concussion, contusion, laceration, edema, hemorrhage

• secondary: occurs hours to days following trauma due to biochemical injury leading to cell death

signs of elevated intracranial pressure

• progressive loss of consciousness, fixed pupils, anisocoria, abnormal respiratory pattern

• Cushing’s response = elevated blood pressure with bradycardia

vehicular trauma — coagulation system

acute traumatic coagulopathy

• tissue damage + systemic hypoperfusion causes coagulopathy

  • triad of death: coagulopathy, acidosis, hypothermia

• increased transfusion requirements, prolonged hospitalization, increase in mortality

high rise syndrome — triad of injuries

• orofacial trauma

• thoracic injury

• limb fractures

high rise syndrome — common orofacial injuries

• hard palate fracture

• mandibular symphyseal separation

• facial soft tissue injury: tongue injury, lacerations, abrasions

• dental trauma: tooth fractures / luxation, abrasions

high rise syndrome — respiratory injury

• rib fractures

• pulmonary contusions

• pneumothorax

• hemothorax

• diaphragmatic hernia

high rise syndrome — musculoskeletal

• limb fractures

  • single fracture > multiple

  • hindlimb > forelimb

    • tibia > femur > other

• luxation

• pelvic fractures

high rise syndrome — other injuries

• cardiovascular: shock

• neurologic: spinal fractures / luxation, traumatic brain injury

• abdominal: hemoabdomen, uroabdomen, organ avulsion, traumatic pancreatitis / pancreatic rupture

common distribution of bite wounds in dogs vs. cats

• dogs

  • thorax

  • extremeties: head/neck, limbs

• cats

  • back

  • thorax

bite wounds — integumentary injuries

• penetrating injury

  • sharp canine teeth

  • possible penetration into body cavities / vital structures

• shearing / compression injury

  • flat pre-molars / molars

  • tearing / avulsion of underlying tissue

  • devitalization of tissue in 3-5d following trauma

  • bony fracture

• infection risk

bite wounds — common respiratory injuries

• upper airway

  • swelling, hemorrhage → obstruction

  • tracheal puncture / tear / avulsion

• penetrating wounds

bite wounds — abdominal injuries

• penetrating injury

• crushing injury

bite wounds — musculoskeletal system

• severe soft tissue swelling

• fractures

bite wounds — cardiovascular system

• shock

• hemorrhage

  • damage to vital structures

  • cervical bite wounds: carotid, jugular