What are the three main specific causes of death after trauma?
***Hypovolemic shock due to acute blood loss
Hypotension: (
What is the primary and secondary survey in the stabilization of trauma patients? Definitive Care?
Primary Survey: ABC’s (+ DE) = Airway, Breathing, Circulation, Disability, Exposure
Secondary Survey: Complete Exam – Head to Toe
Definitive Care: OR vs ICU vs. Transfer
How do you assess the level of consciousness during the Primary Assessment of Neurological Disability?
Level of consciousness: AVPU
1. Alert 2. Response of verbal stimuli 3. Response to pain stimuli 4. Unresponsive
After resuscitation, what is the best and most important predictor of TBI?
GCS = Glasgow Coma Scale
How often do you repeat GCS assessment? What if score increases/decreases?
Assess every 5 minutes & as needed
GCS is obtained by direct patient interaction, not simply patient observation. You must ask direct questions and perform specific actions to obtain GCS score.
Good sign: GCS goes up by 2 points or more
Bad sign: GCS goes down by 2 points or more
Regular re-assessment is important.
Do GCS before intubation.
What is the lowest GCS score a patient can have?
3
What GCS scores indicate TBI Severity (post-trauma)?
GCS 14-15 — MILD
GCS 9-13 — MODERATE
GCS 3-8 — SEVERE
Why is pupillary assessment important?
Can indicate impending cerebral herniation. A fixed and dilated pupil is a warning sign!
What are the indicators of brain herniation?
Bilateral dilated unresponsive pupils OR Asymmetric pupils
AND
Abnormal extension (decerebrate posturing) OR No motor response to painful stimuli
What is the most commonly injured organ in Pediatric abdominal trauma?
Spleen
What is the most common FATAL abdominal injury in pediatric abdominal trauma?
Liver
What diagnostic studies are appropriate if pediatric patient is unstable? stable?
Unstable => ultrasound (don’t do CT), or go straight to OR
Stable => do CT
Severe head injury in children less than one year of age is usually the result of what kind of trauma?
ABUSE => be suspicious!
Where do you place a chest tube in a pediatric patient? Why?
Always place chest tubes lateral and above the nipple (about 5th ICS) to avoid intra-abdominal injury to liver or spleen