TRAUMA - ADULT
ABDO/PELVIS - PENETRATING
Prompt2 most important radiological investigations in unstable penetrating trauma patient
ResponseCXR – lung edge with pneumothorax, mediastinal shift with tension haemo or pneumo, veiling hemithorax with haemothorax
FAST scan – free fluid peritoneum with abdominal visceral injury, pericardial fluid with heart injury/tamponade
FAST scan – free fluid peritoneum with abdominal visceral injury, pericardial fluid with heart injury/tamponade
PromptPrinciples of your fluid resuscitation strategy
ResponseNo crystalloid
Blood product use – begin packed cells
Goal – cerebral perfusion/radial pulse / systolic 80mmHg
Blood product ratios 1:1 – 1:2 FFP/platelets:packed cells
Massive transfusion protocol (not an extra mark in addition to ratios and blood product use)
Blood product use – begin packed cells
Goal – cerebral perfusion/radial pulse / systolic 80mmHg
Blood product ratios 1:1 – 1:2 FFP/platelets:packed cells
Massive transfusion protocol (not an extra mark in addition to ratios and blood product use)
PromptIndications for urgent thoracotomy in OT
ResponsePericardial blood / tamponade
Large ongoing air leak
Large ongoing ICC blood losses (some number given will be needed eg >1500ml and 200mL/hr but hard to mark anything as “wrong”)
Large ongoing air leak
Large ongoing ICC blood losses (some number given will be needed eg >1500ml and 200mL/hr but hard to mark anything as “wrong”)
Promptindications for intubating unstable penetrating abdo trauma patient in the ED
ResponseAgitation interfering with management / facilitate management
Refractory shock with decreased consiousness
Deteriorating hypoxia
To expedite surgical management also acceptable
Refractory shock with decreased consiousness
Deteriorating hypoxia
To expedite surgical management also acceptable
PromptList causes of high airway pressures in intubated penetrating abdo trauma patient
ResponseTension pneumothorax (critical answer)
Tension haemothorax
Blocked ETT – blood/sputum
Misplaced ETT – right main bronchus
Ventilator dys-synchrony (includes not sedated)
Inappropriate ventilator settings eg too large volume
Bronchospasm
Tension haemothorax
Blocked ETT – blood/sputum
Misplaced ETT – right main bronchus
Ventilator dys-synchrony (includes not sedated)
Inappropriate ventilator settings eg too large volume
Bronchospasm