-10b- Trauma

September-15-08 10:51 AM

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Epidemiology * Trauma is the leading cause of death under age 40 years Common Pitfalls * Inadequate airway maintenance * Inadequate protection of Cervical Spine * Airway obstruction by foreign matter (e.g. blood) * Airway obstruction by Tongue or epiglottis * Inadequate fluid Resuscitation * Failure to recognize and treat internal hemorrhage Primary Survey Protocol * Airway maintenance with C-Spine Control * Breathing and Ventilation * Circulation with Hemorrhage control * Neurological Status * Exposure and Environmental Control * Trauma Diagnostic Testing Other Primary Survey measures * Foley Catheter * Nasogastric tube Secondary Survey * Obtain Trauma History * Secondary Survey Detailed Neurological and Physical Assessment Indications for Fluid Therapy: Signs of shock * Mottled or pale color * Cool skin * Diminished peripheral pulses * Delayed capillary pulses despite normal Ambient temp * Mental status changes * Oliguria * Shock may be present despite normal Blood Pressure Fluid Distribution in 70 kg male Total-Body Water (TBW) : 60% body wt. = 42 Ls Intracellular Fluid (ICF) : 66% TBW = 28 Ls Extracellular Fluid (ECF) : 34 % TBW = 14 Ls Intravascular Fluid (IF) : 25% ECF = 3.5 Ls Available Fluids for Volume Expansion * Crystalloid Isotonic Solution Normal Saline (.9% NACL) or Lactated Ringers Solution: * One liter of Lactated Ringer's Solution contains: * 130 mEq of sodium ion = 130 mmol/L. * 109 mEq of chloride ion = 109 mmol/L. * 28 mEq of lactate = 28 mmol/L. * 4 mEq of potassium ion = 4 mmol/L. * 3 mEq of calcium ion = 1.5 mmol/L . Blood Packed Red Blood Cells (pRBC) * Contains 200-250 ml per unit * Increases Hematocrit 3% per unit * Increases Hemoglobin 1 gram/dl per unit * Indication * Hypovolemic shock despite 40 ml/kg crystalloid * Coagulopathy Crystalloids dont respond, then add blood, if they dont respond to Crystalloids blood then continue to give fluids and blood but now add pressers * D5W- 5g/dl dextose * NS NaCl- 154mMol/L of Na and Cl * Others: 1/4NS NaCl, 1/2NS NaCl, D10W, D50W, 3% NaCl, 5% NaCl Colloids * Hespan- hetastarch, 6g/dl * Salt Poor Albumin ( SPA )- Albumin, 5.0g/dl

Make sure the airways are open Until you clear the Cspine they have to be in a column

Urine output to assess the fluid output generally you want to see >30cc

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