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. Establishing & securing the airway is always the 1st step in management.
. Altered mental status is the most common indication for intubation in a trauma pt.
. As an unconscious pt can’t maintain his airway.
. The preferred method of securing an airway -> OROTRACHEAL INTUBATION.
. Trauma with cervical spine injury -> FLEXIBLE BRONCHOSCPE.
. Extensive facial trauma & bleeding into airway -> CRICOTHYROIDOTOMY or TRACHEOSTOMY.
. Pts with cervical spine injury should 1st have stabilization of the cervical spine.
. Oro-tracheal intubation with rapid sequence intubation is the preferred way,
. to secure an airway in an apnein pt with a cervical spine injury.
. In burn victims, clinical indicators of thermal inhalation injury to the upper airway,
. or smoke inhalation injury to the lungs include burns on face, singing of eye brows,
. oropharyngeal inflammation & blistering, oropharyngeal carbon deposits,
. carbonaceous sputum, stridor, carboxyhemoglobin level > 10 %.
. H/O of confinement in a burnung buiding.
. The presence of one or more of these indicators warrants early intubation,
. to prevent upper airway obstruction by edema.
. Check oxygen saturation, if SpO2 < 90 %:
-> ++ oxygen concentration & flow rate.
-> Obtain an ABG.
-> Determine the likely cause of hypoxia from H/O.
-> Tension pneumothorax:
. Cause distended neck veins & high central venous pressure.
. Respiratory distress, tracheal deviation, absent breath sounds.
. Hyperresonance to percussion.
. Tx -> immediate placing of a large-bore needle or IV catheter into the pleural space.
. Chest tube placement.
. Never wait for a CXR for diagnosis.
Tiki Taka USMLE notes PDF downlod
. Don’t be distracted by head trauma or dilated pupils in a hypotensive trauma pt.
. Intracranial bleeds are never the cause of hypotensive shock.
. The 1st step in management is to identify & control the site of bleeding.
. Most causes of shock in the setting of trauma are 2ry to hypovolemia from blood loss.
. However, ++ CVP/PCWP or failure of hypotension to resolve after a bolus of IV fluids,
. should suggest an alternative diagnosis.
. Myocardial contusion sh’d be suspected in pts with evidence of injury to anterior chest
. MI can be confirmed with +ve cardiac markers & EKG changes.
. Tension pneumothorax is excluded if there is no tracheal deviation.
. Hypovolemia is excluded if there is failure to respond to an IV fluid bolus.
. High energy blunt trauma to the chest commonly causes aortic injury.
. In most cases of aortic rupture, death is the immediate result.
. Widened mediatinum, large left sided hemothorax & mediastinal deviation to right side.
. Disruption of the normal aortic contour..
. Bilateral COLLAPSED neck veins.
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