approach to trauma

trauma

Trauma patients can be very complex. It can be easy to become distracted by an obvious fracture and miss an abdominal injury, or inadvertently allow the patient to become hypothermic and contribute to their coagulopathy. In the approach to the trauma patient it can helpful to go through the 10 systems of ABCDEFGHIJ:

A

  • c-collar
  • airway

B: CHEST

  • Collapse (pneumothorax)
  • H
  • Effusion (hemothorax)
  • S
  • T

C: CARDIOVASCULAR

  • Cardiac rhythm monitor
  • Around heart: tamponade
  • R
  • Dysfunctional LV: blunt myocardial injury
  • I
  • Outflow dissection: CXR wide mediastinmum
  • V
  • Abdominal bleed on EDE
  • Soft tissue bleed: pelvis, scalp, extemity
  • Child-bearing: consider pregnancy

D: NEURO

  • N
  • E
  • U
  • RBC bleed
  • O

E: ENDO

  • Normothermia: keep warm

F

  • renal injury: hematuria
  • urethral injury
  • consider pregnancy

G: ABDOMINAL

  • A: hepatic: repeat EDE
  • B
  • D:
  • O: splenic: repeat EDE
  • M: mesenteric: CT for abdo pain

H: HEME

  • Hgb: RBC if unstable
  • Early plug: Platelets for massive transfusion protocol
  • Make coagulation factor: FFP for massive transfusion, octaplex to reverse comedian
  • Elevate dimer/decrease fibrin: consider TXA

I: INTOX

  • trauma related to intoxication?

J: ORTHO

  • Open fracture
  • Reduce dislocation
  • Test neurovasc
  • Hand remove ring
  • Other bony/ligament injuries

 

Putting this into practice gives a streamlined approach to the trauma patient.

  • A:  apply c-collar, intubate if not protecting airway
  • B: apply oxygen, listen and look with EDE to r/o pneumo/hemothorax –> needle/chest tube
  • C: RBC if unstable; cardiac/abdo EDE to r/o tamponade/abdominal bleed (then OR); bind pelvis (then angio), suture scalp lac, compress extremity bleed; tilt pregnant patient
  • D: consider CT head
  • E: keep warm (after exposing for complete exam)
  • F: screen for renal injuries, consider CT or RUQ
  • G: repeat EDE, consider CT
  • H: RBC/platelet/FFP/TXA if hemorrhagic shock
  • I: consider intoxications
  • J: screen for ortho injuries, reduce fracture/dislocations, give tetanus/antibiotics

trauma

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