Trauma (main): Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
===Primary Survey=== | |||
Evaluate | |||
*Airway | |||
*Breathing | |||
*Circulation | |||
*Disability | |||
*Exposure (completely expose patient, then prevent hypothermia | |||
*Theoretically, if derangement in ABCs found, evaluation should stop until life-threatening dysfunction treated. In multiprovider practices, assessment and management often occur simultaneously | |||
{{Hemorrhagic shock classes}} | {{Hemorrhagic shock classes}} | ||
===Secondary Survey=== | |||
*Head to toe evaluation for additional injuries | |||
==Differential Diagnosis== | ==Differential Diagnosis== |
Revision as of 21:54, 25 August 2019
Background
Initial evaluation objectives
- Rapidly identify life-threatening injuries
- Initiate supportive therapy
- Organize definitive therapy
Locations of Possible Life-Threatening Bleeding
- External
- Internal
- Thoracic cavity
- Peritoneal cavity
- Retroperitoneal space (i.e. pelvic fracture)
- Femur fracture (into muscle/subcutaneous tissue)
Lethal Triad of Major Trauma
Clinical Features
Primary Survey
Evaluate
- Airway
- Breathing
- Circulation
- Disability
- Exposure (completely expose patient, then prevent hypothermia
- Theoretically, if derangement in ABCs found, evaluation should stop until life-threatening dysfunction treated. In multiprovider practices, assessment and management often occur simultaneously
Classes of hemorrhagic shock[1]
Class | I | II | III | IV |
---|---|---|---|---|
Approximate blood loss | <15% | 15-30% | 30-40% | >40% |
Heart rate | ↔ | ↔/↑ | ↑ | ↑↑ |
Blood pressure | ↔ | ↔ | ↔/↓ | ↓ |
Pulse Pressure (mmHg) | ↔ | ↓ | ↓ | ↓ |
Respiratory Rate (per min) | ↔ | ↔ | ↔/↑ | ↑ |
Urine Output (mL/hr) | ↔ | ↔ | ↓ | ↓↓ |
Glasgow coma scale score | ↔ | ↔ | ↓ | ↓ |
Base deficit^ | 0 to -2 mEq/L | -2 to -6 mEq/L | -6 to -10 mEq/L | -10 or less mEq/L |
Need for blood products | Monitor | Possible | Yes | Massive transfusion protocol |
^Base excess is the quantity of base (HCO3-, in mEq/L) that is above or below the normal range in the body. A negative number is called a base deficit and indicates metabolic acidosis.
Secondary Survey
- Head to toe evaluation for additional injuries
Differential Diagnosis
Head trauma
- Traumatic brain injury
- Orbital trauma
- Maxillofacial trauma
- Scalp laceration
- Skull fracture
- Pediatric head trauma
Neck Trauma
- Penetrating neck trauma
- Blunt neck trauma
- Cervical injury
- Neurogenic shock
- Spinal cord injury
Torso Trauma
Extremity trauma
Pediatric trauma
Evaluation
- Consider FAST
- Consider CT
Management
- Address dysfunctions in airway, breathing, circulation, disability
- Massive transfusion protocol
Complications
- Hypothermia
- Acidosis
- (Dilutional) coagulopathy
- Hypocalcemia
Disposition
- Depends on underlying injury
See Also
External Links
References
- ↑ American College of Surgeons Committee on Trauma. Shock: in Advanced Trauma Life Support: Student Course Manual, ed 10. 2018. Ch 3:62-81