Primary assessment
A
airway maintenance and cervical spine
what do we do if a patient has organs falling out?
put sterile water and gauze on it while we stabilize them and get them to the OR
if bleeding is not the biggest issue with hollow organ damage, what is?
infection due to spilled gastric contents
what are 2 things that we worry about in patients with fractures
infection (give updated tetanus shot)
disrupted blood supply distal to the injury
DCAP
deformities
contusions
abrasions
punctures
B
breathing and ventilation
What type of organs are most commonly injured with blunt trauma?
solid organs
halo sign
cerebrospinal fluid leaking out with blood
noticeable on sheets
what do we worry about with pelvic fractures
blood loss; patients can lose up to 4 liters with this fracture and bleed up to 2 liters into the pelvic cavity
BTLS
burns
tenderness
lacerations
swelling
C
circulation; control any hemorrhaging
What type of organs are most commonly injured during penetrating traumas?
hollow organs
what to do if the pelvis is unstable
put on a pelvic binder to help keep the bones together and minimize bleeding until they can get to the OR
battle sign
bruises behind the ear
indicates basilar skull fracture
things to note about pregnant traumas
they are already hypervolemic, so they will have to lose more blood (1200-1500 ml) before they show symptoms
their abdominal organs are somewhat protected since they are misplaced
position them on the left to relieve pressure off the vena cava
D
disability (neurological status)
why is damage to the liver or spleen significant?
they are extremely vascular organs, so patients can loose a lot of blood
how to check for pelvic stability
push in and down on the iliac crests. if that is stable, you can push down on the symphysis pubis
blood loss with different fractures (humerus, tibia, femur, pelvis)
humerus: 0.5-1.5 liters
tibia: 0.5-2.5 liters
femur: 1-2.5 liters
pelvis: 1-4 liters
trauma diamond of death
hypothermia
coagulopathy
hypocalcemia
acidosis
E
exposure/environmental control
Signs of injury to the spleen
Kehr's sign
left upper quadrant
abdominal rigidity, spasm, and guarding
signs of renal/urinary damage
gray turner's sign
flank/abdominal tenderness when palpating
hematuria
suprapubic pain
feels the urge, but can't pee
blood at urethral meatus
symptoms of a femur fracture
unable to bear weight
affected leg is shorter
leg is rotated
edema/deformity of the thigh
signs of hypovolemia
Glasgow coma scale
3-8 = severe
9-12 = moderate
13-15 = mild