- ATLS Assessment: (
General Approach to Trauma)
-
airway protection:
-
virtual anesthesia textbook /
intubation menu
-
anesthesia consideration for spine patients:
-
Emergency Airway Management
-
breathing and ventilation:
-
pneumothorax
-
pulmonary contussion:
-
management of respiratory failure
-
circulation:
-
cardiac contussion:
-
ACLS
-
fluid resusitation, pRBC transfusion:
-
subclavian vein approach /
internal jugular approach for central line placement
- disability (
head trauma /
glasgow)
- exposure / environmental control:
-
Adjunctive Studies:
- portable lateral cervical spine, chest radiograph, and AP pelvis;
- baseline labs:
CBC,
UA,
electrolytes,
blood gases,
clotting studies, and type & crossmatch;
- foley for urinary output: (caution with
urinary and rectal injuries from pelvic frx)
-
General Survey Exam
-
cranio-maxillo-facial
- cardiovascular:
-
vascular trauma
-
Orthopaedic Assessment:
-
spine;
-
management of the spine injured patient
-
cervical radiographic clearance:
- high index of suspcion for cervical spine injury with multitrauma, altered mentation, and/or blunt injury above the clavicle;
-
pediatric cervical spine
- cervical spine immobilization:
- patients should be transported to the ER with the neck immobilized in C-collar and head taped between two sandbags (or equivalent);
- without exception, trauma patients need to be taken off the trauma board ASAP to prevent decubiti;
- while moving one assistant controls the head while others help turn, check the scalp and back for lacerations and deformities, and then help to
transfer to a padded mattress;
-
children are immobilized so that shoulders are raised on a folded sheet (which counteracts tendency for the C-spine to be flexed on the trauma board,
due to the child's larger head size;
- Pediatric cervical spine immobilization: achieving neutral position? C Curran et al. J. Trauma. Vol 39(4). 1995. p 729-732.
- references:
-
Lumbartransverse process fractures: A sentinel marker of abdominal organ injuries.
-
Skeletal fracture demographics in spinal cord-injured patients
-
ER transport and positioning of young children who have an injury of the C spine. The standard backboard may be haazardous.
-
Falls from height: spine, spine, spine!
- pelvic fractures
-
radiographs:
AP view will help diagnose
open book pelvic injuries,
femoral neck frx, or
verticle shear injuries;
-
extremities:
-
fractures
-
dislocations
-
compartment syndromes
-
vascular injury note: it is difficult to assess for vascular injuries when the SBP is less than 90 mm Hg;
-
mangled extremity severity score generalized assessment:
- Trauma Work Up
-
surgical timing for femoral neck fracture
-
surgical timing in patients with head injury
- references:
-
Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopedic surgery
-
Damage control orthopedics in patients with multiple injuries is effective, time saving, and safe.
- Outside links:
- Iowa
- Family Practice Handbook
- A History of Resusitation
- ACLS
- Iowa Family Practice Handbook
- AHCPR Guidelines
- eMedicine Online Text
