Emergency Flashcards Preview

PPS - trauma > Emergency > Flashcards

Flashcards in Emergency Deck (29)
Loading flashcards...
1
Q

What are examples of pre hospital services important in the treatment of trauma patients?

A

LAS - London Ambulance Services

HEMS - Helicopter Emergency services, in most critical cases

BASICS - British Association for Intermediate Care, volunteer

Good samaritan

2
Q

What are the key things to do on the scene of an accident?

A
  1. Ensure personal safety - key is to be fast and thorough in short period of time
  2. Rapid systematic patient assessment - idea of injuries needed to be treated
  3. Treat life threatening injuries to prevent deterioration of the patient
  4. Keep warm - helps with blood clotting
  5. Scoop and run - monitor for deterioration and get to the nearest trauma center
  6. Call ahead - to give pre-alert that trauma patient is arriving and prepare unit
3
Q

What are potential life threatening injuries that need to be treated on scene?

A

Stop external catastrophic haemorrhage

Stabilise potential injuries - neck bones can have effect on nerves

4
Q

Examples of on-site treatments that can be done on trauma patients?

A

Analgesia - drugs, splints

Make sure the patient is comfortable to prevent them from moving

5
Q

What is an estimate of the number of trauma patients in London per year?

A

20 000 cases of major trauma/year

Estimated that around 5400 deaths

6
Q

How many major trauma centers are there in London?

A

4

Network spreads across London to centralise the services

Certain trauma patients only accept patients from certain hospitals

7
Q

What are the 4 major trauma centers in London?

A

St Mary’s Hospital

King’s College Hospital

St George’s Hospital

Royal London Hospital

8
Q

What are the requirements of trauma centers?

A

24/7 consultant available on site to lead the trauma team

Trauma team should be appropriately trained and competent to deliver their role

Trauma team present 24 hours a day for immediate reception of the patient

Ability to undertake resuscitative thoracotomy in the emergency department

A massive haemorrhage protocol in place for patients with severe blood loss

24/7 immediate availability of fully staffed operating theatres

Need all the specialties within 30 minutes of the patient arriving into the hospital

9
Q

What is a resuscitative thoracotomy?

A

Open chest to have direct access of the heart

10
Q

What is involved with haemorrhage control?

A

Administration of tranexamic acid within 3 hours of injury

Transfusion specialist advice should be avaliable 24 hours a day

Blood given to patients

11
Q

What is tranexamic acid?

A

Antifibtolytic

Competitively inhibits the activation of plasminogen to plasmin

By binding to specific sites of both plasminogen and plasmin

12
Q

Which specialities may be needed by a trauma patient?

A

Neurosurgery

Spinal and spinal cord surgery

Vascular surgery

General surgery

Trauma and orthopaedic surgery

Cardiothoracic surgery

Plastic surgery

Maxiolllofacial surgery

Ear, nose and throat surgery

Anaesthetics

Interventional raiology

Intensive care

13
Q

What is a primary survey?

A

How to manage patient when they arrive at A&E

First thing to do

  • Evaluates physiological parameters
  • Identifies specific life-threatening conditions which can be treated in the A&E to prevent the patient from deteriorating
14
Q

What approach is used in the primary survey?

A

ABCDE approach

Structured and easy to remember

15
Q

What does the primary survey consist of?

A

A - airway

B - breathing

C - circulation and haemorrhage control

D - disability

E - entire patient and make sure didn’t miss wound

16
Q

B

A

Injuries which may affect the patient’s ability to breathe properly

Like blood or air

Tube to drain air or blood

Keep a record of patients saturation and respiratory rate

17
Q

C

A

Know pulse and BP and how they feel

Look for any signs the patient is bleeding in chest, abdomen, pelvis, bones or external wound

Not always evident where blood is from

IV fluids and blood or medications to help with clotting

18
Q

D

A

Recorded by looking at GCS

Pupils to determine brain function

19
Q

Who conducts the primary survey?

A

Different members of the trauma team conduct different parts of the survey

20
Q

What happens following the primary survey when the treatment has been instigated?

A

Review the patient and start again through primary survey

Look at patient again to see if the patient has

  • changed
  • improved
  • deteriorated
21
Q

What can be used to obtain more information during the primary survey?

A

Fast scan - US in chest and stomach to see if there is blood

22
Q

What is the secondary survey?

A

Evaluates anatomy of the patient

More of an in depth top to toe assessment to look for any anatomical dysfunction that is not life threatening but still important

Important to look at back of the patient - may hide big anatomical injuries

Done so via log roll

23
Q

When is the secondary survey conducted?

A

Once happy with the primary survey

24
Q

What is the difference between the primary and secondary survey?

A

Secondary survey looks more at anatomical problems rather than physiological problems like primary survey

25
Q

What are examples of anatomical problems observed during secondary survey?

A

Skull fractures

Bowel perforation

Urethral injuries

Dislocations

26
Q

What are the three time periods in which trauma patients die?

A

50% of deaths happen in the first few minutes

30% of deaths happen in the first few hours

20% of deaths happen in days/weeks/months after injury

27
Q

What is the golden hour?

A

Have one hour to properly take care of patient

Clock starts at time of injury

28
Q

In which occasions are triage important ?

A

When there are multiple patients

29
Q

Who came of with the idea of trauma teams?

A

James Styner

Taught how to have structured approach to treat trauma patients