Most common mechanism of injury - ANS Falls
Forms of energy - ANS -mechanical
-gravitational
-thermal
-chemical
Types of trauma - ANS
... [Show More] -blunt
-penetrating
-burn
-other
Blunt trauma - ANS accounts most injuries sustained
frontal impact
-aortic & cardiac injury, rib fxs, liver & spleen
-dash board posterior hip fx/dislocation, femur, knee injury
lateral impact
-head/facial, c spine, clavicle, pelvic, liver/spleen
rear end
-low velocity, neck hyperextension/hyperflexn
rollover
-DAI
ejection
-risk of death 4x greater
pedestrian vs car
-tib/fib fx, truncal, head injury
bicycle
-head and abdominal injury from handlebar
falls
-4 stories 50% will die
-calcaneous, pelvis, spine, arm fx
Penetrating Trauma - ANS lower incidence higher mortality
GSW
Stab: low velocity higher direct damage to organs
Burn: thermal or inhalation
Other: Hanging, strangulation , suffocation, drowning
Waddell's Triad - ANS -femoral shaft fx
-intrathoracic and abdominal injury
-contralateral head injury
Newton's three laws of motion - ANS 1. object at rest will stay at rest, object in motion will stay
in motion
2. Force: F=ma applying force produces acceleration (think seatbelt sign)
3. Action & Rxn: Every action there is an equal and opposite reaction
ABCDE "do your job" Primary Survey - ANS Airway obstruction is major cause of preventable
trauma deaths
Hemorrhage is the most common cause of mortality in trauma
Airway-get definitive airway
Circulation-IV access and IVF
Disability-assess LOC GCS scale
Exposure-get your pt naked! temperature control
-hypothermia=acidosis, coagulopathy, low O2
Hemorrhage Control-STOP THE BLEED replace volume loss, use tourniquet-note tourniquet
time
-<6yo IO access preferred over central line
MTP
-1:1:1 pRBC:plasma:platelet
-pt receiving >10 units pRBC w/in 24 hrs admit
When is a definitive airway needed? - ANS Edema, hemorrhage, fracture to obstruct airway and
an ET/NT cannot be placed
-closed head injury w/ GCS <8
-unresponsive
-neuromuscular paralysis
-apnea
-sustained seizure activity
-inability to protect lower airway from blood/secretion
Breathing Assessment - ANS -rate
-depth
-effort
-symmetry
-watch for tension pneumothorax!!
Open pneumothorax dressing - ANS 3 sided dressing
Confirm airway placement - ANS -cords visualized
-chest rise and fall
-auscultate
-CO2 detector
-pulse ox
-CXR
Adult IVF bolus - ANS 1-2 liters if no contraindication
Pediatric IVF bolus - ANS 20ml/kg [Show Less]