CSB337 TRAUMA tree of knowledge

MOI

Head and spinal/Autonomic dysreflexia

Chest and facial

Pain, shock and crush

Ballistics and bomb

Abdo and pelvic

Special populations

Environmental and drowning

FAST

Dysbarism

Burns, electricity and taser

RCR

Trauma

epidemiology

scoring

prevention

primary and secondary survey

kinematics

injury patterns

blunt

penetrating

head

spinal

autonomic dysreflexia

maxilofacial

pneumo

tension

open

types

terminology

management

injuries

meninges

brain stem

leaking CSF

scalp and skull

brain perfusion and metabolism

lobes of brain

MOI

coup/contracoup

DAI

concussion

intracranial haematomas

assessment

primary vs secondary

Cushing's triad

assessment

management

assessment

management

analgesics

fentanyl

morphine

methoxyflurane

ketamine

paracetamol

ibuprofen

shock

types

drugs

TxA

IV fluids

triad of death

crush

COAST score

physics

types of rounds

damage pathways

types of blasts

blast injuries

management

wound packing

emergency banadage

tourniquets

IV fluids

TxA

pain

pelvic

classfication of # and bleeding

management

binder

pain

abdo and genitourinary

solid and hollow organs

elderly physiology

paediatric

pain assessment

paediatric assessment triangle

obstetric

thermoregulation

hypothermia

severity

management

hyperthermia

heat loading

management

drowning

principles

MOI

patho

assessment

treatment

terminology

scan planes

diving

altitude

gas laws

assessment

management

assessment

management

burns

classifications

  • extent - surface area?

estimation

Lund and Bowder - more accurate

critical burns

complications

management

electrical

taser

Boyle's
PV=k

Gay Lussac's
pressure of gas varies with temperature, when volume is constant

Henry's
mass of gas dissolved in liquid is proportional to pressure

Dalton's
Ptotal=p1+p2

symptoms occured at

descent

depth

ascent

rapid

long/deep

nitrogen narcosis

barotrauma

barotrauma

DCS

middle ear

teeth

GI

PO

signs

  • pain
  • numbness
  • dizziness
  • motor weakness

CAGE (cerebral arterial gas embolism) -> seizures

  • check pneumo
  • O2 to reduce cerebral edema and increase perfusion. Dalton's law, increase O2/N2 gradient to wash N2
  • seizure management
  • supine or lateral, no trendelenberg
  • IV fluids
  • hypothermia,
  • Hx - depth, time, presentation., air supply, dive type, decompression stops. dive computer or buddy
  • retrieval service
  • hyperbaric chamber

acute mountain sickness - caused by rapid exporsure to low O2 conc

PO (HAPE)

cerebral oedema (HACE)

  • rest fluids
  • mild analgesics
  • acetazolamide - prevents alkylosis

management

  • hyperbaric chmaber
  • o2
  • dexamethosone

management

  • hyperbaric
  • o2
  • nifedipine (Ca2+ blocker to reduce pulmonary artery pressure)

patho

  • caused by pulmonary venous constriction in response to hypoxaemia, causing capillary leak

signs

  • ataxia, ALOC, retinal haemorrhage

patho

caused by vasodilation in response to hypoxaemia

click to edit

  • depth - how many layers?

rule of 9s

  • faster, not accurate for children or obese
  • superficial - epidermis
    • partial - dermis
    • full - underlying structures

rule of palm - palmer surface=1% of TBSA in all age groups

trauma bypasss

  • burns over 20% or 10% in adults or children respectively, to the hand, face, genitals, airway or respiratory tract

A - swelling -> intubation
B - smoke inhalation, chest burns restrict expansion
C - shock, IV fluids 15ml/hr x TBSA (nearest 10%) additional 200ml/hr if over 100kg (consult for paeds)
physical - rapid estimation, remove bands, cool with running water, prevent hypothermia with cling wrap, cover with dry sheets. burn aid dressing if less than 10% or 5% in adults or paed

paeds - thin skin, large SA/weight, poor immune response, small airways and lungs

geri - thin skin, poor circulation, underlysing disease

key issues

upper airway - neck, face, singing of hairs

lower airway - LOC, closed space, tachypnoea, carbonaceous sputum

drugs

hydroxycobalamin - smoke inhalation

carbon monoxide - binds to haemoglobin 250x stronger than o2, headache, ataxic, confusion, tachycardic

factors

types of current

dc

ac - 3x more dangerous, produces tetanic cotnraction, 50hz, muscular tissue is sensitive to 50-150hz, potential for VF

voltage - 1000V is high

resistance

current path

contact duration

clinical features

  • heart
  • nervous system
  • high tension vs flash

lightning

facts

mechanism

management

danger - AC hot stick

mechanism

management

  • BGL
  • 12 lead
  • consider - EEA, removal of probes (not if in eyes, genitals, face or neck), manage 2nd injuries
  • appearance
  • work of breathing
  • skin

wong-baker

  • hypothermia -> coagulopathy -> metabolic acidosis

high order

low order

IED

primary (shock wave), secondary (shrapnel), tertiary (fall), quatenary (burns,crush, toxic dust)

soft lead

full metal jacket

hollow point

shot

bean bag

rubber bullets

bone

lungs

transport is the best treatment!

velocity and shape of bullet

Jackson's wound model

  • zone of coagulation, stasis and hyperaemia