Trauma

By Lauren Young FY1 Trauma & Orthopaedics

Trauma

• Leading cause of death in UK in 1-40 year olds

• Trimodal deaths:– 50% immediate (secs to mins), CNS or large

vessel injuries– 30% early (mins to hours), uncontrolled blood

loss or secondary CNS injury, ‘golden hour’– 20% late (days to weeks), sepsis or multi-

organ failure

‘Trauma call A&E resus’

• Can be daunting

• GO! Put on aprons, gloves and goggles

• You are useful

• Talk to paramedics

YOU WILL NEVER BE ALONE!

A.T.L.S

• Advanced Trauma Life Support

• Developed in 1976 by Dr Jim Styner

• Multi-disciplinary and evidence-based

• Common language, common approach

Brief history

• A – allergies• M – medications (given & regular)• P – past medical history• L – last meal• E – events inc. change in condition

(fall >3ft, high velocity, bullseyed windscreen, LOC, children, elderly)

PRIMARY SURVEY - Airway

Look for:

• Foreign bodies• Blood• Facial trauma• Battle’s sign• ‘Racoon’ eyes• Singed nose hairs

Airway

Listen:

Talking / stridor ?

Airway adjuncts:

Oropharygeal

Nasopharyngeal

Endotracheal tube

Extra Glottic Devices

Surgical airway

C - spine

Secure with 3 point technique:

1. Correctly sized rigid collar

2. Head blocks

3. Tape to bed

C - spine

• ‘Clear this patient’s C-spine please’

• Ask about pain

• Examine for tenderness

• Neurological exam

• Adequate lateral c-spine plain radiograph

• Cannot exclude if distracting injury, intoxication, altered mental state, dangerous mechanism of injury

Breathing

• Look – accessory muscle use, oxygen should be present

• Feel – trachea position, expansion, percussion

• Listen – bilateral air entry, added sounds

• Measure – respiratory rate, sats

Life-threatening chest conditions

• A – airway obstruction

• T – tension pneumothorax

• O – open pneumothorax

• M – massive haemothorax

• F – flail chest

• C – cardiac tamponade

Circulation

• Look – colour, blood loss, including floor

• Feel – warmth, clammy, pulse, cap refill

• Listen – heart sounds

• Measure – pulse, BP, urine output, BM

• Catheterise, cannulate and take bloods, ABG

Bloods in trauma cases

• FBC, U&Es, LFT, crossmatch and group & save, DEFG…..

• DON’T EVER FORGET GLUCOSE• Cross match – 1 hour• Type specific – 10 mins• Universal donor – immediate, O neg,

‘flying squad’• Always give Rhesus negative to women of

childbearing age

Access problems

• Femoral access

• Intraosseous, especially in children

• Sternal access

• Drugs can sometimes be given via endotracheal tube

Disability

• A – alert

• V – voice

• P – pain

• U – unresponsive

Glasgow Coma Scale

SECONDARY SURVEY

• Completely expose

• Log roll

• Trauma series of radiographs– C-spine, chest, pelvis

• Damage limitation surgery

• Inform family

• Thank your team

Further resources

• www.pre-hospitalcare.co.uk

• www.trauma.org

• RUMS Surgical Society

• Wilderness Medicine Society, UCL

• Volunteer as ATLS helper, patient, observer

• Arrange paramedic observer shifts