Trauma For Med Students
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Transcript of Trauma For Med Students
Trauma
By Lauren Young FY1 Trauma & Orthopaedics
Trauma
• Leading cause of death in UK in 1-40 year olds
• Trimodal deaths:– 50% immediate (secs to mins), CNS or large
vessel injuries– 30% early (mins to hours), uncontrolled blood
loss or secondary CNS injury, ‘golden hour’– 20% late (days to weeks), sepsis or multi-
organ failure
‘Trauma call A&E resus’
• Can be daunting
• GO! Put on aprons, gloves and goggles
• You are useful
• Talk to paramedics
YOU WILL NEVER BE ALONE!
A.T.L.S
• Advanced Trauma Life Support
• Developed in 1976 by Dr Jim Styner
• Multi-disciplinary and evidence-based
• Common language, common approach
Brief history
• A – allergies• M – medications (given & regular)• P – past medical history• L – last meal• E – events inc. change in condition
(fall >3ft, high velocity, bullseyed windscreen, LOC, children, elderly)
PRIMARY SURVEY - Airway
Look for:
• Foreign bodies• Blood• Facial trauma• Battle’s sign• ‘Racoon’ eyes• Singed nose hairs
Airway
Listen:
Talking / stridor ?
Airway adjuncts:
Oropharygeal
Nasopharyngeal
Endotracheal tube
Extra Glottic Devices
Surgical airway
C - spine
Secure with 3 point technique:
1. Correctly sized rigid collar
2. Head blocks
3. Tape to bed
C - spine
• ‘Clear this patient’s C-spine please’
• Ask about pain
• Examine for tenderness
• Neurological exam
• Adequate lateral c-spine plain radiograph
• Cannot exclude if distracting injury, intoxication, altered mental state, dangerous mechanism of injury
Breathing
• Look – accessory muscle use, oxygen should be present
• Feel – trachea position, expansion, percussion
• Listen – bilateral air entry, added sounds
• Measure – respiratory rate, sats
Life-threatening chest conditions
• A – airway obstruction
• T – tension pneumothorax
• O – open pneumothorax
• M – massive haemothorax
• F – flail chest
• C – cardiac tamponade
Circulation
• Look – colour, blood loss, including floor
• Feel – warmth, clammy, pulse, cap refill
• Listen – heart sounds
• Measure – pulse, BP, urine output, BM
• Catheterise, cannulate and take bloods, ABG
Bloods in trauma cases
• FBC, U&Es, LFT, crossmatch and group & save, DEFG…..
• DON’T EVER FORGET GLUCOSE• Cross match – 1 hour• Type specific – 10 mins• Universal donor – immediate, O neg,
‘flying squad’• Always give Rhesus negative to women of
childbearing age
Access problems
• Femoral access
• Intraosseous, especially in children
• Sternal access
• Drugs can sometimes be given via endotracheal tube
Disability
• A – alert
• V – voice
• P – pain
• U – unresponsive
Glasgow Coma Scale
SECONDARY SURVEY
• Completely expose
• Log roll
• Trauma series of radiographs– C-spine, chest, pelvis
• Damage limitation surgery
• Inform family
• Thank your team
Further resources
• www.pre-hospitalcare.co.uk
• www.trauma.org
• RUMS Surgical Society
• Wilderness Medicine Society, UCL
• Volunteer as ATLS helper, patient, observer
• Arrange paramedic observer shifts