Trauma Management Lesson PDF

**Golden hour** = critical hour where immediate death is likely without prompt medical or surgical intervention **Types of Trauma** - **Blunt Trauma**: - Direct impact - Deceleration - Continuous pressure - Shearing - Rotary forces - High energy levels...

**Golden hour** = critical hour where immediate death is likely without prompt medical or surgical intervention **Types of Trauma** - **Blunt Trauma**: - Direct impact - Deceleration - Continuous pressure - Shearing - Rotary forces - High energy levels - **Penetrating Trauma**: - Minor punctures to high-velocity projectiles - Damage factors: - Item causing trauma - Velocity and mass - Characteristics of tissue - Pass-through vs. retained inside **Damage Control** - Stage 0 -- prehospital and early resuscitation - Stage 1 -- lifesaving surgery - Stage 2 -- intensive resuscitation - Stage 3 -- planned reoperation for definitive treatment **Presentation** - Altered mental status (anxiety to comatose) - Blunted sympathetic tone possible - Possible drug or alcohol involvement - All trauma patients are full stomachs - Even if inpatient falls and injuries themselves causing trauma, they are still full stomachs due to sympathetic response and in hospital opioid use - Injuries affecting autoregulation - Severe hypovolemic shock - Assess for hidden injuries - Communicable disease risk Classes of blood loss - Class 1-4 - Replace with blood if pt has lost \>1500mL of blood **Prehospital Care** - Assessment - Oxygen (intubation not always needed) - Bleeding control (tourniquet, pressure, packing) - Controversy over IV fluids in prehospital setting - By administering crystalloids, you are diluting blood and the associated clotting factors - The best thing to give trauma pts is to administer whole blood **Tourniquet Use** **Assessment** - Primary: Identify and manage life-threatening conditions = ABCDE - Secondary: Head-to-toe assessment, history, accident details = head to toe **Airway Management** - Assess for foreign body (teeth, debris) - Evaluate for deformities - Awake patients may maintain airway but may need oxygen - If unconscious, establish airway (intubation, cricothyrotomy, trach) - Minimize C-spine movement -- use the Glidescope **Intubation Considerations** - Preoxygenate - C-spine stabilization (no head tilt) - Cricoid pressure - Medications - Video laryngoscopy **C-Spine Injury** - 2-3% of trauma patients; 6-10% of TBI patients - Risk factors: - Neck pain - Severe distracting pain - Intoxication - LOC - Neurologic symptoms **Breathing Assessment** - Chest movement, wounds, flail chest - Respiratory effort (condensation, ETCO2, cyanosis) - Auscultation for breath sounds - Tracheal position, sub-Q emphysema, rib fractures **Circulatory Assessment** - Radial pulse means SBP\>80 - Femoral pulse means SBP\>70 - Carotid pulse means SBP\>60 **Neurologic Assessment** - Rapid assessment (GCS, AVPU) - CT scan when stable - GCS \60 - Measures to decrease ICP **TBI: ICP Management** - Promote venous drainage - MAP \>70, CPP \>50-60 - EVD for CSF drainage - Mannitol (BBB considerations) - If BBB is disrupted, mannitol will get into the tissue and pull water into the cerebral tissue therefore increasing the volume of the tissues and increasing ICP - We avoid mannitol in TBI for this reason; hypertonic saline is a better option - Anti-seizure meds - Hyperventilation - Sedation (TIVA vs. volatile anesthetics) - Decompressive craniotomy **TBI: Hypoxia** - Maintain SpO2 \>90% - Normocarbia to decrease cerebral edema - Effects of hypoxia and hypercarbia on the brain **Spinal Cord Injury** - Assess spine, neurologic function - CT scan preferred for c-spine clearance, X-ray if necessary - Treat all suspected injuries with full precautions - Document clearance by appropriate provider - **CRNAs cannot clear a patient with spinal cord precautions** **Positioning for Spinal Cord Injury** - C-collar, splints, sandbags, backboard - Log roll with documentation of positioning **Hypothermia in Trauma Patients** - Weather-related risks - Cut-off clothes for assessment, which makes them even colder - Room temperature 30°C (86°F) recommended - Warm fluids, blood, Bair hugger, thermal blankets - 22 degrees C = death **Secondary & Tertiary Surveys** - **Secondary**: Complete after primary survey, stabilization - **Tertiary**: 2-50% of injuries missed in primary/secondary, done within 24 hours - **FAST** exams have increasing popularity to ID injuries **Room Preparation for trauma** - Standardized setups improve safety **PPE Considerations** - Patients may have thermal, chemical, radiation, or biological agents - Possible need for: - Respirators - Isolation - Chemical showers **Hemorrhagic Shock** - Common in trauma - Bleeding must be stopped **Classes of Shock** - Hemorrhage → **Trauma Triad** of hypothermia, coagulopathy, acidosis **Shock Treatment** - Replace volume with fluids or blood - Crystalloids ok in minor injuries, no active bleeding, and \60mmHg - Maintain ICP \