Created by: Sanford Health - Fargo, ND Trauma Services - May
2014
Slide 2
Vital Signs mean what? HR >140 (adult) Systolic BP
TRUE or FALSE? An obese trauma patient needs intraosseous IV
access. You are using the EZ IO for insertion. Would you use a blue
needle? Pink 3-39kg Blue > 39 kg Yellow >39 kg, excessive
tissue: edema, large musculature, obesity
Slide 4
What criteria must be met to clear the Adult Cervical Spine
without imaging? Not Intoxicated Not Intoxicated Normal Mentation
Normal Mentation No Neurologic Deficit No Neurologic Deficit No
Midline Neck Pain No Midline Neck Pain No Distracting Injuries No
Distracting Injuries
Slide 5
A significant cause of death- the combination of three common
complications in patients with traumatic injuries and when they
occur together is called: HypothermiaAcidosisCoagulopathy
Slide 6
TRUE or FALSE? Care done in the field and ED may contribute to
this problem. Consider: Consider: Prevention Identification
Treatment
Slide 7
When does this start? - immediately after injury - immediately
after injury
Slide 8
Control hemorrhage !! Warm: room; patient; fluids Oxygenation
& Ventilation Perfusion Limit crystaloids Blood products / MTP
Consider TXA (if < 3hrs from time of injury)
Slide 9
Fluid resuscitation limit to 1-2 liters of crystaloids (NS/LR)
Crystalloids are not benign Crystalloids are not benign Associated
with prolonged mechanical ventilation Associated with prolonged
mechanical ventilation Normal saline causes metabolic acidosis
Normal saline causes metabolic acidosis Associated with multiple
organ failure and systematic inflammatory response syndrome (SIRS)
Associated with multiple organ failure and systematic inflammatory
response syndrome (SIRS)
Slide 10
Logroll 4-6 inches to left side and support with something (?
pillows, bath blankets, etc.), thus maintaining spinal precautions
and decompressing the vena cava. What side should a pregnant
patient lie when immobilized supine on a spine board?
Slide 11
What drug has shown significantly reduced mortality rates from
bleeding in trauma patients? Binds to a receptor on fibrin and
plasmin, thus blocking the binding of plasmin to fibrin. Net effect
is fibrin is not broken down. Clots are stabilized. No effect on
platelets, coagulation factors.
Slide 12
TXA should be given as early as possible to bleeding trauma
patients, but should not be given if > 3 hours from time of
injury! Contraindications (in FDA labeled population)
Hypersensitivity to TXA Active intravascular clotting Active
thromboembolic disease Subarachnoid hemorrhage
Slide 13
What % of Spinal Injuries occur in each region? Approximately
10% of patients with a cervical spine fracture have a second,
noncontiguous vertebral column fracture.
Slide 14
C-spine injury in what pediatric age group is extremely rare,
occurring in < 1% of injuries in this age group? Nearly all
injuries in this age group occur above C3 Nearly all injuries in
this age group occur above C3 Factors associated with c-spine
injuries in children < 3 yrs of age: Factors associated with
c-spine injuries in children < 3 yrs of age: GCS < 14 GCS Eye
Score = 1 MVC mechanism of injury May be higher incident of injury
between 2 & 3 years of age
Slide 15
Factors associated with c-spine injuries in children < 3 yrs
of age: Factors associated with c-spine injuries in children < 3
yrs of age: GCS < 14 GCS Eye Score = 1 15
Slide 16
TRUE or FALSE? Secondary brain injury is caused by hypotension
& hypoxia A ABCDE dminister oxygen M Maintain adequate
ventilation aintain blood pressure (systolic > 90 mm Hg) D Do
not resuscitation with multiple liters of crystaloids
Slide 17
What is a quick, simple way to assess a patient in 10 seconds?
A quick assessment of the A, B, C, & D in a trauma patient can
be conducted by identifying oneself, asking the patient for his or
her name, and asking what happened.
Slide 18
An intoxicated person lay sprawled across three seats in a
fancy Theater. When the usher noticed this, he whispered to the
person, "Sorry, sir, but you're only allowed one seat. The person
groaned but didn't budge. The usher became more impatient: "Sir, if
you don't get up from there I'm going to have to call the manager.
Once again, the person just groaned. The usher marched back up the
aisle, and he returned with the manager. Together the two of them
tried repeatedly to move the person, but with no success. Finally,
they summoned the police. The police officer surveyed the situation
briefly, then asked, "All right buddy, what's your name?" "Fred,"
the person moaned. "Where ya from, Fred? asked the police officer.
With terrible pain in his voice, and without moving a muscle, Fred
replied,......
Slide 19
TRUE or FALSE? Children often sustain significant injury to the
intra-thoracic structures without evidence of thoracic skeletal
trauma High index of suspicion is necessary! High index of
suspicion is necessary! Consider mechanism of injury Consider
mechanism of injury Identification of skull or rib fractures in a
child suggests the transfer of a massive amount of energy
Identification of skull or rib fractures in a child suggests the
transfer of a massive amount of energy Rib fractures in children
are uncommon, but pulmonary contusion is not. Rib fractures in
children are uncommon, but pulmonary contusion is not.
Slide 20
A patient presents to your ED after a bar fight. Family members
report the patient passed out earlier, after the fight. He then
went home, where they had a hard time waking him up. The family now
brings the patient to your ED, and you determine his GCS is 11.
Based on the report, what might you suspect your patients injury
may be? A lucid (awake) interval between time of injury and
neurologic deterioration is the classic presentation of an epidural
hematoma.
Slide 21
Choosing the correct size of a King LT airway is based on what?
Yellow (#3) 4-5 feet tall Yellow (#3) 4-5 feet tall Red (#4) 5-6
feet tall Red (#4) 5-6 feet tall Purple (#5) >6 feet tall Purple
(#5) >6 feet tall
Slide 22
Frostbite Management Treat hypothermia first (LIFE OVER LIMB)
Treat hypothermia first (LIFE OVER LIMB) Lightly wrap frostbit
areas with Kerlex / gauze and protect from mechanical trauma
Lightly wrap frostbit areas with Kerlex / gauze and protect from
mechanical trauma Allow passive re-warming of frostbite during
transport Allow passive re-warming of frostbite during transport
Administer pain medications Administer pain medications Massage or
manipulate the tissue Massage or manipulate the tissue
Slide 23
What is the most common type of Pelvic Fracture ? 4. Vertical
Shear 1. Anterior - Posterior Open Book 2. Acetabulum 3. Lateral
Compression Closed Open Book
Slide 24
When safety belts are worn incorrectly, they can cause what
types of injuries?
Slide 25
Using the Rule of Nines, estimate the BSA burned of a 2 y/o old
who pulled a pan of boiling liquid off from the stove and burned
his entire head (front and back) and the anterior portion of his
chest: 28% 27% 64% 36% The childs palm represents 1% of his or her
body.
Slide 26
What do raccoon eyes & battle signs indicate in a trauma
patient? Picture below : base of skull depicting where the blood
would pool and cause ecchymosis of the mastoid process area by the
temporal bone, and the periorbital ecchymosis.
Slide 27
What oral anticoagulant, which is marketed as a Coumadin
replacement, has come under great scrutiny over reports of
irreversible bleeding and other serious side effects? Irreversible
GI bleed Irreversible GI bleed Cerebral bleed Cerebral bleed Other
Oral Anticoagulants.. Eliquis (apixaban) Xarelto (rivaroxaban)