lethal triad
What are the 4 parts of the lethal diamond
hypothermia
coagluopathy
acidosis
hypocalcemia
If we have an aortic rupture how would we treat it differently in a trauma scenario vs a mass casualty situation?
in trauma we would give all our resources to treat them since they are the most life threatening. In a mass casualty these patients would be tagged as black since we would not have the resources to treat them effectively and they have a high chance of death.
how can you tell if a bone is broken or sprained?
loss of strength or function
deformity
crepitus, erythema, edema, bruising
muscle spass
neurological impairment
What is compartment syndrome?
When the compartment aka the tissue on an extremity because too full of swelling causes and increase of pressure inside the extremity. This cuts off blood supply.
What is a fat embolism and what are the most likely type of bones would this occur in?
A fat embolism is when a fat globule travels through the body and get stuck in tissues and organs. they occur most in long bones like ribs, tibia, pelvis, etc
what will happen if patients get all 3 parts of the lethal triad
They are at a high risk of death
What type of fracture has the most blood loss and why?
Pelvic fractures because of the femoral arteries run through them. Typical blood loss is 1/2 L
1. Immobilize
2. Neurovascular assessment
3. Imaging
4. Splint and wait or surgery
how soon can compartment syndrome happen after a broken bone?
within 4-8 hours
when is the time frame for when a fat embolism will occur????? and what are some signs and symptoms?
24-72 hours after the injury
respiratory and neurological symptoms
- Hypoxemia
-hypoxia (SOB, tachypnea, chest pain, cyanosis)
-Neuro (Confusion, comatosed)
- Impending doom
-petechiae
Why is hypothermia included in the triad and how can we treat it?
When we face trauma that body is no longer able to regulate temperature this can be from blood loss, being wet, trauma etc.
We treat hypothermia from the inside out
- cut off wet clothes
- warm the room
- warm blankets
- warm fluids
what is the difference between a primary and a secondary survey
Primary survey is ABCDE and we must secure each before moving on to the next. Used in life threatening traumas
Secondary survey is used after the patient is stabilized and it is a more comprehensive head to toe approach.
What are the 6 Ps. What do we do if a patient is showing any of the signs of a P?
paresthesia, pulselessness, pallor, pain, paralysis, pressure
we must notify the doctor and perform an intervention
how do we assess for compartment syndrome?
neurovascular checks
the 6 ps: pressure, pulselessness, pain, paresthesia, pallor, paralysis
what is the fat embolism triad? Will this occur in all the people?
Petechiae, hypoxemia, neuro. NO! Petechiae can only occur in 20-25% of people and can take 24-48 hours to develop.
what causes acidosis in the body in the lethal triad?
A. Increased CO2
B. Lactic acid
C. Hypercalcemia
D. Increased Ph
Lactic acid is released in the case of trauma. It causes the PH to be more acidic which causes the body to go acidic.
What is flail chest and how serious would you rate it? what's one sign and symptom you can use to describe it
flail chest is when the ribs are detached on both sides and are just floating. Flail chest can be devastating to breathing and therefore is life threatening. You can tell this by see saw breathing
where are 3 things we should assess with traction and what are 2 things we should never do with these patients.
Do:
1. maintain proper body alignment
2. pulleys should move freely
3. check ropes for frays
4. make sure there are knots in the rope
DONT
1. never move weights or lift weights
2. weights should never touch the floor
What is the treatment for compartment syndrome?
a faschiotomy by the provider to relieve the pressure
How do we prevent fat embolisms?
2. do not move them after they have been stabilized
3. look for signs and symptoms of a fat embolism especially in the 24-72 hour mark
Why do we have decreased coagulopathy and hypocalcemia in the lethal diamond?
Due to blood loss we no longer have effective clotting in the body. In this case, we typically get blood transfusions. The blood from the blood bags are kept fresh with citrate. Citrate binds to calcium when we give transfusions. In massive transfusion protocol seen in trauma, the excessive citrate binds to calcium causing hypocalcemia
name 2 -3 complications of pelvic fractures
1. soft tissue injuries
2. blood loss
3. shock
4. sepsis
5. ARDS
What should we do when we encounter a patient with an open fracture
immediately cover with a sterile dressing
immobilize
give abx and tetanus shot
Should we elevate the affected limb above the heart or apply ice to the limb? why or why not will this help?
No
since the blood vessels are cut off elevating will not decrease inflammation
Ice will cause vasoconstriction and we are already cut off.
What are some interventions for treating a fat embolism?
1. coughing and deep breathing
2. O2
3. intubation or positive pressure ventilation
4. frequent ABGs
5. Vasopressors, steroids, fluids