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