Primary survey

ABCDE with resuscitation adjuncts FG

What does ABCDE/FG stand for

A airway/alertness/w simultaneous cervical spinal stabilization
B-breathing/ventilation
C-circ/control of hemorrhage
D-disability (neuro status)
E-exposure/environment control
F-full VS/family
G-get resuscitation adjunct
L-lab- ABG,TYPE N CROSS MATCH
M-monitor heart rhythm,rate
N-NGT/OG
O-o2/vent analysis' pulse ox/ETCO2
P-pain/manage
H-hx/head to toe
I-inspect posterior surfaces

Describe Newton's First Law of Motion

A body at rest will remain at rest, and a body in motion will stay in motion unless acted upon by an
outside force (energy)

Describe Newton's Second Law of Motion

(F)orce = (m)ass x (a)cceleration;
It takes more force to move a heavy object

Describe Newton's Third Law of Motion

For every action, there is an equal and opposite reaction resulting from the transfer of energy

Describe the Law of Conservation of Energy

Energy can neither be created nor destroyed, but it can change form

What are the five forms in which energy exist?

- Mechanical: direct impact of an object
- Thermal
- Chemical
- Electrical
- Radiant
The consequences of mechanical energy are directly related to __________ energy
Kinetic

Kinetic Energy (KE) is equal to

1/2 the mass multiplied by the velocity squared
In other words: when mass is doubled, energy is doubled; when velocity is doubled, energy is
quadrupled

Kinetic Energy formula

KE=1/2mv^2

Differentiate between internal and external forces of energy transfer in the context or
trauma.
External forces are how energy can impact the body (e.g., deceleration, acceleration, compression).
Internal forces represent the ability of the body to withstand external forces.

How do internal forces protect the body from injury?

- Compression strength: ability of tissue to resist crush injury or force

- Tensile strength: ability to resist being pulled apart when stretched

- Shear strength: ability to resist a force applied parallel to the tissue

List four main types of traumatic injury

- Blunt trauma
- Penetrating trauma
- Thermal trauma
- Blast trauma

Primary survey begins

Immediately upon pt arrival at overall stability and id any uncontrolled ext hemorrhage wh is the major
cause of preventable death after injury. Rearrange order of ABC if needed.

Alignment of cervical spine

2 ways- manual stabilization- 2 hands holding the pats head n neck in alignment
Immobilization- correct size- semi rigid collar securely fastened.

When removing helmet coordinate w 2 ppl

1 person maintains manual inline stabilization of the head/neck while 2 removes the helmet
AVPU stands for
Quickly assessing level of alertness
A-alert able to maintain airway
V-responds to verbal stim ? If air adjunct is needed to keep tongue from obstructing airway.
P-pain ? May not b able to maintain airway. May need airway adjunct while further assessment is made
to determine the need for intubation.
U-unresponsive-announce for pulse to b check while assessing cause might b problem w airway.
Reprioritize the ABCs if needed

If pt unconscious, unable to open mouth r responds only to pain

Use jaw thrust to open airway- assess for obstruction 2 ppl to perform if CSI. Inspect for tongue
obstruction, loose/missing teeth/foreign objects. Blood, vomitus, secretions, edema, burns or evident of
inhalations

Auscultation (part of A of primary survey)

Includes listening for snoring, gurgling, stridor
Palpate for maxillofacial bony deformity, sub q emphysema

INSPECT AIRWAY FOR

tongue obstructing airway
loose or missing teeth
foreign objects,
blood, vomitus, or secretions
edema
burns or evidence of inhalation injury

AUSCULT AIRWAY
OBST AIRWAYS SOUNDS SUCH AS SNORINGM, GURGLING, OR STRIDOR

PALPATE AIRWAY
FOR POSSIBLE OCCLUSIVE MAXILLOFACIAL BONY DEFORMITY
SUBQ EMPHYSEMA

WHEN TO CONSIDER DEFINITIVE AIRWAY

APNEA, GCS OF 8 OR LESS, SEVERE MAXILLOFACIAL FX, INHALATION INJURY/FACIAL BURNS,
LARYNGEAL OR TRACHEAL INJURY OR NECK HEMATOMA, HI RISK OF ASPIRATION AND THE PT
INABILITY TO PROTECT THE AIRWAY
COMPROMISED OR INEFFECTIVE VENT
ANTICIPATE DETERIORATION OF NEURO STATUS WHERE INABILITY TO MAINTAIN OR
PROTECT THE AIRWAY.
SPONT BREATHING, SYMMETRICAL RISE AND FALL OF CHEST, DEPTH PATTERN AND RATE OF
RESPIRATIONS, SX OF RESP DIFF- USE OF ACCESSORY MUSCULES OR DIAPHRAGMATIC BREATHING

UNDERLYING INJURIES
SKIN COLOR, CONTUSIONS, ABRASIONS, OR DEFORMITIES

OPEN PHNEUMOTHORACES
-SUCKING CHEST WOUNDS,JVD DISTENTION, POSTION OF TRACHE= TENSION PNEUMO IF DEVIATED,
SIGN OF INHALATION= SINGED NASAL HAIR, CARBONACEOUS SPUTUM.

DIFF AIRWAY/BREATHING/VENT /AUSCUL

BREATH SOUNDS 2 INTERCOSTAL SPACE MIDCLAVICULAR LINE AND THE BASE AT THE 5TH
INTERCOSTAL SPACE AT THE ANT AXILLARY LINE

DIFF AIRWAY/PALPATE
FX RIBS, SUB Q EMPH= PNEUMOTHORAX, SOFT TISS INJUR, JUGULAR VENOUS PULSATION AT THE
SUPRASTERNAL NOTCH OR IN THE SUPRA CLAVICULAR AREA.

INTERVENTION/AIRWAY/VENT/
ADM 02 AT 15 L, INABILITY TO MAINTAIN ADEQUATE 02 = HYPOXEMIA= ANAEROBIC METABOLISM
AND ACIDOSIS.
TRAUMA PT NEED EARLY O2, NEED TO TITRATE TO AVOID HYPEROXIA

HOW DO YOU DETERMINE IF VENTILATION IS EFFECTIVE

ETCO2 NORM 35-45 MM HG. ABOVE 50 = DEPRESSED VENT. O2 SAT GREATER THAN 94% IS ASSOC W
EFFECT VENT

IF ASSISTED VENT IS INEFFECTIVE

GIVE O2 AT 15L 10-12 BPM (5-6 BP PER SEC)

NAME 4 PULM INJURIES

OPEN PHEUMOTHORAX, TENSION PHEUMOTHORAX, FLAIL CHEST, HEMOTHORAX

C- CIRC AND CONTROL HEMORRHAGE INSPECT

INSPECT FOR UNCONTROLLED EXT BLEEDING, SKIN COLOR

C- CIRC AND CONTROL HEMORRHAGE- AUSCULTATE

MUFFLED HEART SOUNDS COULD = PERICARDIAL TAMPONADE
C- CIRC/ CONTROL HEMORHHAGE- PALPATED
PRESENCE OF CAROTID/FEMORAL (CENTRAL PULSES) FOR RATE RHYTYM AND STRENGTH.
SKIN TEMP AND MOISTURE- COOL/DIAPHORETIC OR WARM/DRY

C- CIRC/CONT HEMORRHAGE
- IF PULSE ABSENT

START LIFE SUPPORT/ CPR

ASSESS FOR SIGNS OF UNCONTROLLED INTERNAL BLEEDING, CONSIDER AND ASSESS FOR THE
FOLLOWING: A PENETRATING WOUND TO THE HEART, PERICARDIAL TAMPONADE, RUPTURE OF
GREAT VESSELS, ABDOMINAL HEMORRHAGE.

COMMON SITES FOR HEMORRHAGE

CHEST, ABDOMEN, PELVIS, LONG BONES AND EXTERNAL BLEEDING FROM WOUNDS AND
AMPUTATION.

WHT COULD A RAPID THREADY PULSE INDICATE

HYPOVOLEMIA, IRREGULAR PULSE MAY WARN OF CARDIAC DYSFUNCTION

IF PULSES ARE PRESENT, BUT CIRC IS INEFFECTIVE WHTS WRONG???

LOOK FOR SSX OF UNCONTROLLED INTERNAL BLEEDING, SUCH AS FROM CHEST, ABD, OR PELVIS

CIRC/CONTROL HEMORRHAGE- INTERVENTIONS

CONTROL AND TREAT UNCONTROLLED EXT BLEEDING BY: APPLYING DIRECT PRESSURE OVER THE
SITE, ELEVATE A BLEEDING EXTREMITY, APPLY A PRESSURE OVER ARTERIAL SITES, CONSIDER A
PELVIC BINDER, CONSIDER THE USE OF A TOURNIQUET. GET BP FOR BASELINE AND TREND.

CIRC/CONTROL HEMORRHAGE INTERVENTIONS

INTERVENTIONS CONT- GET 2 LG BORE IV, USE IO, GET BLD SAMPLE FOR TCXM, INITIATE INFUSION
OF WARMED ISOTONIC CYYSTALLOID SOLUTION. USE BLD TUBING/NS,

CIRC/CONTROL HEMORRHAGE INTERVENTIONS CONT

VOL RESUSCITATION- BE CAUTION ABOUT LG VOL AMT OF FLUIDS, BC W ELEVATED BP MAY
DISLODGE THE BODY'S FORMATION OF CLOTS AND PROMOTE FURTHER BLEEDING. MAY LEAD TO
DILUTIONAL COAGULOPATHY WHICH WORSENS METABOLIC ACIDOSIS AND MAY CAUSE
HYPOTHERMIA. NOW TX IS BALANCED APPROACHED TO WITH RBC, PLASMA AND PLTS.

D-DISABILITY NEURO STATUS ASSESSMENT

PUPILS =, SHAPE, AND REACTIVITY (PERRL), CT, DECREASE LOC, MAY BE AN INDICATOR OF
DECREASED CEREBRAL PERFUSION, HYPOVENTILATION, OR ACID- BASE IMBALANCE
E- EXPOSURE/ENV/ CONTROL
WAYS TO MAINTAIN BODY HEAT
COVER THE PT WITH WARM BLANKETS
KEEPT THE AMBIENT TEMPERATURE WARM
ADM WARM IVF
USE FORCED AIR WARMERS
USE RADIANT WARMING LIGHTS

HYPOTHERMIA+ HYPOTENSION+ ACIDOSIS

= LETHAL COMBO IN THE INJURED PT. TX LOSS OF HEAT.

LACTIC ACID
REFLECTION OF TISSUE PERFUSION
HI LEVELS ASSOCIATED WITH HYPOPERFUSION
LACTIC ACID BETWEEN 2-4 MMOL/L = POOR OUTCOMES

ABGS
PROVIDE VALUES OF O2, CO2, BE WH ARE REFECTIVE OF ENDPOINT MEASUREMENTS OF THE
EFFECTIVENESS OF CELLULAR PERFUSION, ADEQUACY OF VENT AND THE SUCCESS OF THE
RESUSCITATION.

ABN BE DEFICIT MAY INDICATE

POOR PERFUSION AND TISSUE HYPOXIA, WHICH RESULTS IN GENERATIONS OF H IONS AND
METABOLIC ACIDOSIS
BE -6 IS ASSOC WITH POOR OUTCOMES

M MONITOR CARDIAC RATE AND RHYTHM

COMPARE THE PT PULSE TO THE MONITOR RHYTHM. DYSRHYTHMIAS- PVCs, AT FIB, S-T SEG
CHANGES- MAY INDICATE BLUNT CARDIAC TRAUMA.
PEA- POINTS TO CARDIAC TAMPONADE, TENSION PNEUMOTHORAX OR PROFOUND HYPOVOLEMIA

NGT/OGT CONSIDERATION
EVAC STOMACH CONTENTS AND RELIEF OF GASTRIC DISTENTION. HELP TO OPTIMIZE INFLATION OF
THE LUNGS. IF MID FACE FX OR HEAD INJURY ARE SUSPECTED, THE ORAL RT IS PERFERRED.
MAINTAIN CERVICAL SPINAL IMMOBILZATION AND ENSURE THAT SUCTION EQUIOPMENT IS READILY
AVAIL

OXIMETRY
MEASURES O2 SAT AND NOT EVIDENCES OF VENT.
ABOVE 94% IS EFFECTIVE VENT.
ETCO2 PROVIDES
INSTANT INFO ABOUT VENT, PERFUSION, AND METABOLISM OF CO2. NORM 35-45
ABOVE 50 = DEPRESSED VENTILATION

PAIN ASSESS AND MGMT-

GIVE COMFORT TO PT WHILE AVOIDING RESP DEPRESSION

CXR AND PELVIC XR CAN REVEAL

PNEUMOTHORAX AND PELVIC FX WITH UNCONTROLLED INTERNAL HEMORRAGE.AND PLACEMENT OF
OET/NGT.

HISTORY-
MIST-
MOI-
INJURIES SUSTAINED
SSX- IN THE FIELD
TX - IN THE FIELD

SAMPLE GETS HIGHLIGHTS OF IMPORT PT HX

SAMPLE
S-SX WITH INJURIES
A-LLERGIES AND TETANUS STATUS
M-EDS INCLUDING ANTICOAGULANT
P-AST MED HX
L-AST ORAL INTAKE
E-VENTS AND ENVIRONMENT FACTORS R/T INJURY

H- HEAD TO TOE ASSESS

OBS FOR STIFFNESS, RIGIDITY OR FLACCIDITY OF EXT. ODORS- GAS ALCOHOL, SHORTENING OF LEG,
ROTATION OF LEG, INSPECT SKIN- CONTUSIONS, EDEMA, ECCHYMOSIS. PALPATE TENDERNESS, STEP-
OFF, CREPITUS, DEPRESSION, ANGULATION,
EYES- HOLD UP FINGERS, GLASSES? MOVE FINGER- GET THEM TO FOLLOW WITH EYES.

EARS
INSPECT- DRAINAGE- CLEAR OR BLOODY
DON'T PACK IT/ MIGHT BE CSF. TEST IT FOR BETA- TRANSFERRIN- GOLD STANDARD FOR ID CSF
OTORRHEA OR RHINORRHEA.
ECCHYMOSIS BEHIND THE EAR(BATTLE SIGN- USUALLY LATER DEVELOPMENT)
EAR AVULSION OR LACERATION- REQUIRES PLASTIC SURG.
DRAINAGE? CK FOR CSF. +, DON'T INSERT A NGT.
NOT THE POSITION OF THE NASAL SEPTUM
NECK AND CERVICAL SPINE
PRESUME PT WITH MAXILLOFACIAL/HEAD TRAUMA MAY ALSO HAVE AN UNSTABLE CSI. IMMOBILIZE
THE CERVICAL SPINE.

NECK AND CERVICAL SPINE INSPECTION

LOOK FOR IMPALED OBJECTS, CONTUSIONS, EDEMA OR OPEN WOUNDS
POSITION OF TRACHEA AND APPEARANCE OF JUGUALR VEINS

NECK AND CERVICAL SPINE PALPATE

CERVICAL TENDERNESS OR DEFORMITIES, TRACHEAL DEVIATION, SUB Q AND AREAS OF TENDERNESS

CHEST--- INSPECTION
PRESENCE OF SPONT BREATHING, RATE, DEPTH AND DEGREE OF EFFORT, USE OF ACCESSORY OR
ABD MUSCLE AND ANY PARADOXICAL CHEST MOVEMENT

CHEST- PALPATE
BONY CREPITUS OR DEFORMITIES
SUBCUT EMPHYSEMA

ABD/FLANK INSPECTS
LACERATION, PUNCT WOUND, ABRASIONS, CONTUSIONS, AVULSIONS, ECCHYMOSES, EDEMA,
EVISCERATION, DISTENTION
AUSCULTATE-? BOWEL SOUND
PALPATE- RIGIDITY, GUARDING, MASSESS, AND AREAS OF TENDERNESS IN ALL 4 QUADS. BEGIN
LIGHT PALPATION IN AN AREA WHERE THERE IS NO COMPLAINT OF PAIN OR OBVIOUS INJURY

PELVIS/PERI INSPECT
LAC, PUNCT, ABRASION, CONTUSION, ETC,
BONY DEFORMITY, EXPOSED BONE, BLOOD AT THE URETHRAL MEATUS, PRIAPISM (ERECTION CONST)
PAIN ON URGE TO VOID, BUT CAN'T
SCR0TAL/LABIA HEMTOMA

PELVIS/PERI/ PALPATE
INSTABILITY OF THE PELVIS BY APPLYING GENTLY PRESSURE OVER THE ILIAC WINGS DOWNWARD
AND MEDIALLY
INSTABILITY OF THE PELVIS BY PLACING GENTLY PRESSURE ON PUBIS.

URINARY OUTPUT
IS END ORGAN PERFUSION AND CONSIDERED A SENSITIVE INDICATOR OF THE PTS VOLUME STATUS.
INDICATIONS FOR FOLEY
OBSTRUCTION OR RETENTION
ALTERATION IN BP OR VOL STATUS
THE NEED TO DETERMINE ACCURATE INPUT AND OUTPUT AND THE PT IS UNABLE TO USE A URINAL
OR
BEDPAN
EMERGENCY SURGEY OR MAJOR TRAUMA
UROLOGIC PROCEDURES OR BLADDER IRRIGATION
COMFORT CARE FOR TERMINALLY ILL.
CONTRAINDICATED IF URETHRAL TRANSECTION IS SUSPECTED.

URETHRAL INJURY INCLUDES

BLOOD AT THE URETHRAL MEATUS, PERINEAL ECCHYMOSIS, SCROTAL ECCHYMOSIS, HI RIDING OR
NON PALPABLE PROSTATE, SUSPECTED PELVIC FX

EXTREMITIES
- EVAL THE NEUROVASCULAR WITH CIRC, MOTOR FUNCTION AND SENSATION
INSPECT FOR SOFT TISS INJURIES- BLEEDING, LAC, ABRASION, CONTUSIONS, AVULSIONS, PUNCTURE
WOUNDS, IMPALED OBJ, ECCHYMOSES, EDEMA, DEFORMITY, OPENED WOUND,

EXTREMITIES
- EVAL THE NEUROVASCULAR WITH CIRC MOTOR FUNCTION AND SENSATION
BONY INJ- ANGULATION, DEFORMITY, OPEN WOUNDS, EDEMA, PALPATE- CIRC, SKIN TEMP,
MOISTURE, PULSES- COMPARE BOTH SIDES
CREPITUS, DEFORMITY- AREA OF TENDERNESS
SENSATION- 4 EXT ABILITY TO SENSE TOUCH

I- INSPECT- POST SURFACES

MAINTAIN CERVICAL SPINAL PROTECTION, SUPPORT EXT, LOGROLL, ROLL AWAY FROM EXAMINER,
LOOK AT BK, FLANKS, BUTTOCKS AND THIGHS.

RECTAL EXAM
DRE- DIGITAL RECTAL EXAM- MD, APN=- ASK PT TO SQUEEZE BUTTOCKS.
RECTAL TONE?
HI RIDING PROSTATE GLAND= SIGN PELVIC FX

UPPER AIRWAY IS COMPOSED OF WHT

NOSE, MOUTH, PHARYNX, LARYNX, EPIGLOTTIS AND TRACHE

LOWER AIRWAY CONSISTS OF WHT

BRONCHI AND LUNGS
FUNCTIONAL UNIT OF PULM. SYS IS WHT
ALVEOLUS

NOSE IS PRIMARY PASSAGEWAY FOR AIR INTO THE LUNG AND IS COMPOSE OF MOSTLY
CARTILAGE.
NAME ITS FUNCTION
WARMS/MOISTENS INHALED AIR
SENSE OF SMELL VIA OLFACTORY NERVE (CN 1)

WHERE DOES THE BLD FROM FROM THE NOSE ORIGINATED

INTERNAL AND EXTERNAL CAROTID ART
MOUTH IS 2ND PASSAGEWAY FOR INHALED AIR.

WHT MAY COMPROMISE UPPER AIRWAY PATENCY AND PREVENT ADEQUATE VENT
PRESENCE OF SWELLING, BLOOD, FOREIGN OBJ, OR TONGUE ESP IN UNCONSC PT.

NASO AND OROPHARYNX MEET AT THE BASE OF SKULL AND EXTEND TO THE LOWER
BORDER OF THE CRICOID CARTILAGE. SERVE AS A GUIDE FOR WHT
TO LOCATE THE TRACHE ESP DURING INTUBATION

EPIGLOTTIS SERVES WHT PURPOSE

ROUTE AIR TO LUNGS/ FOOD AND LIQ TO ESOPHAGUS. SITS ON TOP OF LARYNX.

LARYNX INFO
CONNECTS OROPHARYNX TO TRACHEA. FNX TO ALLOW AIR INTO TRACHEA. THE MOST HEAVILY
INNERVATED SENSORY STRUCTURE IN BODY. VAGUS NERVE

VAGUS NERVE (CN X) DOES WHT

SERVES AS PRIMARY PARASYMPATHETIC NERVE. STIM. OF THE LARYNX DURING INTUBATION CAN
ACTIVTE THE PARASYMPATHETIC NS, CAUSING BRADYCARDIA, BRONCIAL VC, AND INCREASED ICP,

TRACHE IS INNERVATED BY WHICH NERVE

VAGUS (CN X)

WHT IN MEDIASTINUM
HEART, THORACIC AORTA, VAGUS NERVE, PHRENIC NERVE, INFERIOR AND SUPERIOR VENA CAVA
AND OTHER VASCULAR STRUCTURES.

PROCESS FOR AIR TO LUNGS TO BLOODSTREAM

VENTILATION- MOVE AIR IN AND OUT OF LUNGS
DIFFUSION- PASSIVE MOVE. OF GASES FROM AREA OF HI CONC TO AREA OF LO CONC
PERFUSION- MOVE BLD TO AND FROM LUNGS AS A DELIVERY MEDIUM OF O2 TO THE ENTIRE BOD.
PERFUSION DEPENDS ON ADEQUACY OF THE FOLLOWING
AIRWAY PATENCY, VENT EFFORT, GAS EXCHANGE IN THE ALVEOLI, HGB TO CARRY O2, BP, A
FUNCTION OF BOTH VASC VOL AND CARDICA CONTRACTILITY IN THE CIRC SYS TO TRANSPORT
BLOOD TO THE CELLS.

PATHO ASSESS FINDINGS

AIRWAY OBS
TONGUE CAUSES OBSTRUCTION IF NOT ALERT.
UNDER INFLUENCE OF SUBSTENCE MAY HAVE ALTERED LOC,
MAXILLOFACIAL TRAUMA MAY HAVE EDEMA, INCREASED SECRETIONS, BLEEDING OR
DISLODGED TEETH, VOMITING
-OBSTRUCT, INJURTY TO NECK AND LARYNX= SWELLING AND HEMORRHAGE.

SA02
% OF HGB SAT WITH O2 DETERMINED BY ABG

SP02
PULSE OX READING OF ARTERIAL 02 SAT (SA02) MEASURED IN %

PA02
PARTIAL PRESSURE OF 02 DISSOLVED IN ART BLOOD IS MEASURED IN MM/HG. REFLECTIVE OF TISS
OXYGENATION

FI02
INSPIRED CONC OF 02 MEASURED FRACTIONS, BUT MORE COMMONLY IT IS REFERRED TO IN
CLINICAL PRRACTICE AS %

RM AIR
21%

HYPOXEMIA
O2 DEFICIENCY WITHIN ART BLD IS MEASURED BY SP02, SA02, PA02

HYPOXIA
DEFICIENCY IN O2 PERFUSION OF TISS. NOT DIRECTLY MEASURED BUT IS CONSIDERED TO BE
PRESENT IN DECREASED PA02.

INEFFECTIVE VENT; SUPPORT OXYGENATION

AMS, , LOC, INCREASED ICP, HYPOXIA, MED SUBSTANCE OR ALCHOL, TRAUMA IN HIGH CERVICAL
SPINE WITH DISRUPTION OF THE SYPATHETIC PATHWAYS, SCI INVOLV OF PHRENIC NERVE
RESULTING IN HYPOVENT. BLUNT THORACIC TRUMA WITH RIB FX AND CHEST WALL INSTABILITY,
PENTRATING THORACIC TRAUMA
-HEMOTHORAX OR PNEUMO THORAX, HX OF RESP DX, OLD AGE, WITH DEC PUL RESERVE, TACHYPNEA

PRIMARY SURVEY A AIRWAY/ ALERTNESS

AVPU
USE JAW THRUST IF UNABLE TO OPEN MOUTH OR RESPONDS ONLY TO PAIN.

ONCE AIRWAY IS OPEN, CONT WITH AIRWAY ASSESS.

LOOK FOR PREVIOUS LISTED THINGS,
LISTEN FOR SNORING, GURGLING, OR STRIDOR
PALPATE FOR MAXILLOFACIAL BONY DEFORMITY AND/SUBQ EMP.

PRIM SURVEY - B-
INSPECT FOR SPONT BREATHING. RISE AND FALL OF CHEST, WORK OF BREATHING, SKIN COLOR,
JVD, POSITION OF TRACHE (TRACHIAL DEVIATION AND JVD ARE LATE SIGNS = TENSION
PNEUMOTHORAX
OPEN PNEUMOTHORACES (SUCKING CHEST WOUNDS)

SX OF PNEUMOTHORAX
DIMINISHED OR ABSENT BREATH SOUNDS, SUBQ, HYPERRESONANCE (AIR IN PLEURAL SPACE)

HEMOTHORAX
PERCUSS MAY BE DULL- BLOOD OR FLUID IN PLEURAL SPACE.

BREATHING INTERVETIONS PG 61
IF ABSENT... OPEN AIRWAY, INSERT AIRWAY, USE BAG MASK CONNECTED TO 02 AT 10-12 L, GIVE 1
BREATH Q 5-6 SEC.

IF AIRWAY NOT PATENT

SX AIRWAY, CAREFUL TO AVOID STIMULATING GAG
IF BLD OR VOMITUS NOTED, USE RIGID SX DEVICE. IF FOREIGN BODY, REMOVE CAREFULLY WITH
FORCEP OR LIKE.

IF SX DIDN'T OPEN AIRWAY WHTS NXT OPTION

TONGUE MAYB CAUSE OF OBSTRUCTION. INSERT AIRWAY. USE JAW THRUST MANEUVER TO OPEN
AIRWAY WHILE STABILIZING HEAD/NECK. A NASOPHARYNGEAL AIRWAY CAN BE USED IN PT WHO ARE
CONSC OR UNCONSC. AN OROPHARYNGEAL AIRWAY ONLY IN PPL WITHOUT A GAG.

WHEN TO CONSIDER DEFINITIVE AIRWAY: OETT

APNEA, GCS 8, SEVERE MAXILLOFACIAL FX, EVIDENCE OF INHALATION INJURY (FACIAL BURNS),
LARYNGEAL OR TRACHEAL INJURY OR NECK HEMATOMA, HI RISK OF ASPIRATION AND OR PT
INABILITY TO PROTECT AIRWAY.
COMPROMISED OR INEFFECT VENT, ANTICIPATED OR DETERIORATION NEUROLOGIC STATUS IN WH
AIRWAY IS UNPROTECTED
VENT DEFINED
MOVEMENT OF AIR IN AND OUT OF LUNGS

DIFFUSION
PASSIVE MOVEMENT OF GASES FROM AN AREA OF HIGHER CONC TO LOWER CONC.

PERFUSION
MOVEMENT OF BLOOD TO AND FROM LUNGS AS A DELIVERY MEDIUM OF O2 TO THE ENTIRE BODY.
DEPENDS ON AIRWAY PATENCY, VENT EFFORT, GAS EX IN THE AVEOLI, HGB TO CARRY O2, BP

1ST PRIORITY FOR TRAUMA PT

EST AN OPEN, PROTECTED, UNOBSTRUCTED AIRWAY AND ENSURE EFFECTIVE VENT TO PX
HYPOXEMIA AND ITS HARMFUL EFFECTS.

MAXIOLLOFACIAL TRAUMA
MAY CAUSE EDEMA, INC SECRESTIONS, BLEEDING OR DISLODGE TEETH WITHIN ORAL CAVITY.

INEFFECTIVE VENTILATION
NEXT PRIORITY PROMOTE ADEQUATE VENTILATION
ALS, LOC, INC ICP, HYPOXIA, MED OR SUBSTANCE ABUSE, TRAUMA, INCREASE IN AGE (NO RESERVE)
INC RESP CONPENSATION FOR DIMINISHED O2 AND PERFUSION.

PNEUMOTHORAX
DIMINISHED BS, SUBQ EMPHYSEMA, HYPERRESONANCE

HEMOTHORAX
DIMINSIHED BS, PALPATE DULLNESS

NASOPHARYNGEAL AIRWAY (TRUMPET)

CAN BE USED IN RESPONSIVE/UNRESPONSIVE PT BUT CONTRAINDICATED IN PT WITH FACIAL
TRAUMA OR SUSPECTED BASILAR SKULL FX. MEASURE FROM NOSE TO EARLOBE . START WITH RT
NARE,
USE LARGEST SIZE, BEVEL OPENING FACING SEPTUM,
DIRECT AIRWAY POSTERIORLY SLIGHLY ROTATING TOWARDS EAR. IF USE LEFT NARE TURN AIRWAY
UPSIDE DOWN TO ASSURE AIRWAY IS FACING SEPTUM.

AIRWAY ADJUNCTS
NASOPHARYNGEAL AIRWAY, OROPHARYNGEAL AIRWAY

DEFINITIVE AIRWAYS
ETT, SURGICAL AIRWAYS
AFTER INTUBATION-
ATTACH CO2 MONITOR, WATCH FOR RISE AND FALL OF CHEST, LISTEN FOR GURGULING OVER
EPIGASTRIUM(+ TUBE IN ESOPHAGUS) NXT LISTEN FOR BS AT MIDAXILLARY AND MIDCLAVICUL
LINES, AFTER 5-6 BREATHS, CK FOR COLOR CHANGE IN ETCO2 DEVICE.
NOTE PLACEMENT AT LIPS. GET CXR.

LAB
ABG, BE --MEASUREMENT OF ADEQUACY OF CELLULAR PERFUSION AND PREDICTS THE SUCCESS OF
RESUSCITATION. BE LESS THAN 6 MEQ/L POOR OUTCOMES.'
LACTIC ACID INCREASES BC OF TISSUE HYPOXIA
2-4 + POOR OUTCOMES.

WHEN WILL OUT GET POOR O2 SAT READINGS?

POOR PERIPHERAL PERFUSION CAUSED BY VC, HYPOTENSION, OR HYPOTHERMIA. BP CUFF INFLATED,
CARBON MONOXIDE POISONING, METHEMOGLOBINEMIA, SEVER DEHYDRATION.

OXYHEMOGLOBIN- DISSOC CURVE

SHIFT TO RIGHT
INC CO2
INC TEMP
INC 2,3 DIPHOSPHOGLYCERATE SUBS IN THE BLOOD THAT HELPS O2 MOVE FROM HGB TO THE TISS
DEC pH (ACIDEMIA)

OXYHEMOGLOBIN- DISSOC CURVE

SHIFT TO LEFT
DEC CO2
DEC TEMP
DEC 2,3 DIPHOSPHOGYCERATE
ELEVATED ph alkalosis

carbon monoxide and methemoglobinemia

goal is to maintain normothermia and normocarbia
which dec hypothermia, acidosis or coagulopathy

RSI DRUGS
LIDOCAINE- BLUNT THE COUGH REFLEX AND BRONCOSPASM. MITIGATE THE INCREASE ICP DURING
INTUBATION.
ATROPINE - THOUGHT TO REDUCE THE CHANCES OF DEC HR.
OPIOID- THOUGHT TO REDUCE INCREASES IN ICP, INTRAOCULAR PRESSURE, MEAN ART PRESSURE,
MYOCARDIAL O2 CONS, AND PA PRESSURE.
LOAD
LIDOCARE, OPIOIDS, ATROPINE, ADN DEFASCICULATING DOSE OF NEUROMUSCUALR BLOCKING
AGENTS.

7 P OF RSI
1. PREPARATION--GATHER ALL SUPPLIES, CK PATENCY OF IV, MONITOR, PREPARE FOR FAIL
INTUBATION
2. PRE02-- PLACE HEAD UP POSITION, REV TREND IF BARACTRIC, MAINTAIN AIRWAY PATENCY WITH
AIRWAY ADJUNCT, USE POSITIVE PRESS VENT FOR PT UNABLE TO ACHIEVE SP02 AT 94% OR HIGHER
3. PRETREAT-- ADM DRUGS LOAD- TO PRODUCE DEEP SEDATION AND MUSCULAR RELAX QUICKLY.
ETOMIDATE, KETAMINE, VERSED, PROPOFOL, SUCCINYCHOLINE, (WATCH ELEVATED K, LOWER HR, )
NONDEPOLARING AGENTS RECURONIUM. VECURONIUM- LONGER ACTING, FEW SE THAN SUCC,
MUST HAVE AIRWAY,
4. PROTECT- AIRWAY FROM ASP AND MANUAL VENT
MONITORY VENT AND O2 STATUS, BAG IF NEEDED,
5. POSITION- ONCE INTUB IN A TRAUMA SETTING IT IS A 2 PERSON PROCEDURE TO TURN.
6. PLACEMENT WITH PROOF-INFLATE CUFF AND SECURE TUBE
7. POST INTUBATION MANAGEMENT- SECURE THE ETT WITH TAPE/TIES/ETC. CXR

HYPOVOLEMIC SHOCK
LEADING CAUSE OF PREVENTABLE DEATH IN TRAUMA PT.

4 TYPES OF SHOCK
1. HYPOVOLEMIC- FROM HEMORRHAGE/ DECREASE AMT OF CIRC BLD VOL. CAN BE FROM VOMITING
OR DIARRHEA. BURNS- PLASMA AND PROTEIN LEAKAGE.. GOAL- REPLACING THE TYPE OF VOL THE PT
HAS LOST IN ORDER TO RESTORE PHYSIOLOGIC HOMESTATIS.
2. OBSTRUCTIVE,- HYPOPERFUSION OF THE TISSUE DUE TO AN OBSTRUCTION IN EITHER THE
VASCULARTURE OR HEART . GOAL IS AIMED AT RELIEVING THE OBSTRUCTION AND IMPROVING
PERFUSION. EX TENSION PNEUMO, CARDIAC TAMPONADE. WITH TP- INC INTRATHROACIC PRESSURE
LEADS TO DISPLACEMENT OF VENA CAVA, OBSTRUCT TO ATRIAL FILL, AND DEC PRELOAD AND DEC
CO. CARDIC TAMP. ACCUMULATION OF GLUIDS WITHIN THE P. SAC, IMPEDEDS DIASTOLIC
EXPANSION AND FILLING WH IN TURNS LEADS TO A DEC IN PRELOAD, STROKE VOL, CO, AND ULT EN
ORD PERFUSION. CAN B ON RT SIDE OF HEART.
3. CARDIOGENIC, - PUMP FAILURE WITH ADEQUATE VOL, SO THERE IS LACK OF CO AND END ORGAN
PERFUSION 2 TO DEC IN MYOCARDIAL CONTRACT AND OR VASVULAR INSUFF (CHRONIC OR ACUTE.
GOAL- INOTROPIC SUPPORT ANTIDYSRHYTHMIC, CORRECT OR TX OF CAUSE.
4. DISTRIBUTIVE= MALDISTRIBUTION OF ADEQ CIRC BLD VOL. WITH LOSS OF VASCULAR TONE OR
INC PERM. - ANAPHYLACTIC SHOCK, SEPTIC , NEUROGENIC SHOCK-
GOAL CONTROL VOL REPLACEMENT AND INC SVR

SYMPATHETIC NERVOUS SYSTEM STIMULATION

INC FORCE OF CONTRACTION, +INOTROPY
INC HR, VC PERIPHERAL VESSESLS, INC SEC, PUPILS DILATION, INC SECRETIONS OF SWEAT GLANDS,
INC CORTICAL AND MEDULLARY SECRETION- ADRENAL GLANDS, BRONCHI- DILATION, KIDNEYS-
RENIN SECRETIONS INC, LIVER- GLYCOGENOLYSIS (BREAKDOWN OF STORED OF GLYCOGEN)

THE SCALP CONSISTS OF 5 LAYERS OF TISSUE

SCALP- SKIN CONNECTIVE TISSUE, APONEUROSIS, LOOSE AREOLAR TISSUE AND PERICRANIUM.

SKULL FORMED BY CRANIAL BONES AND FACIAL BONES TO PROTECT THE CONTENTS OF
THE CRANIAL VAULT
BONES OF SKULL= FRONTAL, ETHMOID, SPHENOID, OCCIPITAL PARIETAL AND TEMPORAL

MENINGES CONSISTS OF 3 LAYERS OF PROTECTIVE COVERINGS

PAD, ----PIA MATER, ARACHNOID MEMBRANE, DURA MATER THE PAD THE BRAIN AND THE SPINAL
CORD.

CSF IS PRODUCES WHERE

CHOROID PLEXUS IN THE LATERAL AND 3 VENT
CSF CUSHIONS AND PROTECTS THE BRAIN AND SPINAL CORD.

tentorium divides the cranium into 2 compartments

supratentorial/infratentorial. supra= central hemi in ant and midd fossa.
infra=lower part of brainstem (pons and medulla) and the cerebellum in post fossa
the upper part of the brainstem (midbrain) and oculomotr N (CN3) PASS THRU A GAP IN THE TENT.
injury or edema near the tentorium gap may cause compression and shifting of the brainstem structure
and the oculomotor

BRAIN- 2 HEMI= 4 LOBES

FRONTAL, PARIETAL, TEMPORAL AND OCCIPITAL
lobes are responsible for judgement, reasoning, social restraint and vol motor function(frontal), sensory
function and spatial orient. (parietal) speech, auditory and memory function (temporal) and vision
(occipital)

diencephalon connects the 2 cerebral hemi with midbrain including thalamus, hypothalamus,
sub thalamus and epithalamus
play role in hormonal reg and metabolic function incl temp reg. release of hormones from pit glad
and adrenal cortex, emotional behavior such as fear rage and pleasure and activates sympathetic and
parasympathetic NS

2 DIVISIONS OF BRAINSTEM
MIDBRAIN, PNS AND MEDULLA= RESPON FOR WAKEFULNESS OR CONSC WHILE THE MEDULLA AND
PONS ARE RESP FOR VITAL FUNCTIONS SUCH AS CV FUNCTION AND RESP.
INJURY TO BRAIN STREM = CHANG IN CONS AND IMPAIRED INVITAL FUNCTION, ESP BP AND HR, R.
CEREBELLUM LOCATED POSS FOSSA AND BEHIND BRAINSTEM AND BENEATH THE
CEREBRAL HEMI
HAS EXTENSIVE NEURAL CONNECTIONS WITH SPINAL CORD, MIDBRAIN, AND CEREBRAL HEMI.
PRIMARY FUNCT INCL VOL AND INVOL MUSCLE COORDINATION MOVEMENT, BALANCE AND POSTURE.

12 CRANIAL NERVES
OLFACTORY CN1, OPTIC CN2, BRAINSTEM IS PT OF ORIGIN FOR CN3- 10 AND 12, THEY ALL LEAV THE
CRANIAL VAULT THRU THE BASE OF THE LOWER BRAIN. PROBLEM WITH ONE=ALL ACCESSORY NERVE
CN 11 HAV BOTH CRANIAL AND SPINAL COMPONENT.

FACE DIVIDED FUNCTIONAL 3RDS

UPPER 3RD- LOWER PT OF FRONTAL BONE
MIDDLE 3RD- (MIDFACE)- ORBITS, MAX SINUSES, NASAL BONE, ZYGOMATIC BONES, TEMPORAL
BONES AND BASAL BONE OF MAXILLA.
LOWER 3RD= BASAL BONE OF MANDIBLE AND THE TEETH BEARING BONE OF THE MAXILLA AND
MANDIBLE.

BRAIN
- VASCULAR

RT/LT CAROTID
- (INT CAROTID- FACE) (EXT CAROTID- NECK), RT/LT VERTEBRAL ARTERIES
VENOUS BLOOD DRAINS VIA THE JUGULAR VEINS

BRAIN USES 20% BODYS TOTAL O2 SUPPLY HEAVILY DEPEND UPON GLUCOSE
METABOLISM FOR ENERGY.
NO WAY TO STORE, DEPEND ON CONT SUPPLY

CO2 PRIMARY REGULATOR OF BLD FLOW TO BRAIN AND STRONG VD.

INC PACO2 = CEREBRAL VD THUS INC CEREBRAL BLD VOL AND PERFUSION
DEC PACO2= CEREBRAL VC, REDUCING BLD VOL AND PERFUSION, DEC ICP,
WITH HYPOXEMIA= 02 IS EXTRACTED FROM BLD. WHEN HYPOXIA BECOME ACUTE PA02 LESS THAN
50 MMHG CEREBRAL VD OCCURS AND BLD FLOWS INCREASES

ICP NORM 0-15. FIX AMT OF FLD

ABN IS GREATER THAN 20 SUSTAINED

CPP NORM 60-100 (50-70)

CPP= MAP-ICP

BRAIN INJURY CLASSIFIED AS PRIMARY OR SECONDARY INJURY

PRIMARY=SKULL AND CRANIOFACIAL FX, INTRACRAINAL LESIONS, LAC
SECONDARY= HYPOTENSION, HYPOXEMIA, HYPERCARBIA, CEREBRAL EDEMA, INC/DEC ICP,
CEREBRAL ISCHEMIA
GOAL OF CARING FOR PPL WITH HEAD TRAUMA IS PX OR LIMIT SECONDARY INJURY AND
CATASTROPHIC CASCADE OF EVENTS

HYPOTENSION AND CEREBRAL BRAIN FLOW (CBF)

IF INJURY CAUSES MAP, ICP (ETC)OUTSIDE OF NORM RANGE, BRAIN LOSES ABILITY TO AUTO
REGULATE. HYPOPERFUSED BRAIN BC ISCHEMIC AND SUFFERS IRREVERSIBLE DAMAGE SSX
CONFUSED, UNRESPONSIVE, AND COMATOSE. SINGLE EPISODE OF BP LESS THAN 90 CAN BE
HARMFUL.
MAP ELEVATED, EDEMA CAN RESULT.

HYPERCARBIA AND HYPOXIA

CO2 = VD= POWERFUL BUT REVERSIBLE EFFECT OF CBF.
HYPERCAPNIA CAUSES SIGNIFICAN DILATION OF CEREBRAL ART VASCULATURE AND INC BLD FLOW.
HYPOCAPNIA CAUSES VC AND DEC BLD FLOW.

HYPERVENTILATION
REDUCES THE PACO2 CAUSING CEREBRAL VC AND HYPOPERFUSION AND MAY RESULT IN CEREBRAL
ISCHEMIA.
HYPERCARBIA PACO2 GREATER THAN 45 PROMOTES VD AND INC ICP, SO IT SHOULD ALSO BE
AVOIDED.

EARLY SIGNS IF INC ICP

(CPP IS DECREASING) RESULTS IN CEREBRAL ISCHEMIA, HYPOXEMIA, LETHAL 2 INSULT
HA, NV, AMNESIA, BEHAVIOR CHANGES, ALTER LOC

LATE SIGNS OF ICP

DILATED, NON REACTIVE PUPILS, UNRESPONSIVE TO VERBAL OR PAINFUL, ABNORMAL MOTOR
POSTURING,
CUSHING RESPONSE- WIDENING PULSE PRESSURE, REFLEX BRADYCARDIA, DEC RESP EFFORT.

PUPILS
1. UNILATERALLY FIXED AND DILATED PUPILS--- MAY INDICATED OCULOMOTOR NERVE
COMPRESSION FROM INC ICP AND HERNIATION SYNDROME
2. BILATERALLY FIXED AND PINPOINT PUPILS ---- MAY INDICATE AND INJURY AT THE PONS OR THE
EFFECTS OF OPIOIDS.
3. MODERATELY DILATED PUPILS SLUGGISH- MAY BE AN EARLY SX OF HERNIATION SYNDROME.

CSF TEST FOR GLUCOSE

BETA 2- TRANSFERRIN

COUP/COUNTRECOUP
HEAD STRIKES A SOLID OBJECT, A SUDDEN DECELERATION FORCE MAY RESULT IN BONY DEFORMITY
AND INJURY TO CRANIAL CONTENTS.
ASSESSMENT ALTERED LOC, BEHAVIOR, MOTOR OR SPEECH DEFICITS, SIGNS IF INC ICP

FOCAL BRAIN INJURY

CEREBRAL CONTUSION, INTRACEREBRAL HEMATOMA, EPIDURAL HEMATOMA, SDH, HERNIATION

CEREBRAL CONTUSION
DAMAGED BRAIN TISSUE USUALLY FROM BLUNT TRAUMA. USUALLY IN FRONTAL/TEMPORAL LOBES
.SIGN CONTUSION W SWELLING MAY CAUSE MIDLINE SHIFT WITHIN THE CRANIAL VAULT. MAX
EFFECT OF CONTUSION/EDEMA FORMATION USUALLY PEAK 18-36 HRS POST INJURY. DELAY
HEMORRHAGE OR FORMATION OF INTRACRANIAL HEMATOMA MAY OCCUR.

INTRA CEREBRAL HEMATOMA

OCCURS DEEP WITHIN BRAIN. FRONTAL/TEMPORAL LOBES. MAY CREATE MASS EFFECT, INC ICP NEUR
DETERIORATION. PROGRESSIVE AND OFTEN RAPID DECLINE IN LOC, HA, SX OF INC ICP, PUPIL ABN,
CONTRALATERAL HEMIPARESIS, HEMIPLAGIA, ABN POSTURING.

EPIDURAL HEMATOMA
90% ASSOC IWTH FX OF TEMPORAL OR PARIETAL SKULL THAT LACERATE THE MIDDLE MENINGEAL
ARTERY. INC BLEEDING COMPRESSES BRAIN TISSUE, INC ICP, DEC CBF, = 2 BRAIN INJURY. REQUIRE
SURGURY.
CAUSES FROM MVC AND FALL. CAN BE SPORTS RELATED
SSX- TRANSIENT LOC LASTING MIN TO HRS.
HA DIZZINESS, NV, CONTRALATERAL HEMI PARESIS, HEMIPLEGIA OR ABN POSTURING (FLEXION OR
EXTENSION) EXTENSION ASSOC WITH HERINATION AND POOR OUTCOMES
IPSILATERAL UNILATERAL FIXED AND DILATED PUPILS, RAPID DEC NEURO STATUS

SDH
COLLECTION OF BLOOD FORMED BENEATH THE DURA MATER USUALLY FOLLOWING ACCERLERATION,
DECELERATION OR COMB FORCES.
TEARING OF THE BRIDGING VEINS AND ASSOC WITH DIRECT INJYRY TO THE BRAIN TISS. CAN BE
ACUTE OR CHRONIC

ACUTE SDH
SSX WITHIN 72 HRS- HEMATOMA CAUSES A REDUCTION IN CBF, ATHLETES EX, SSX SEVERE HA, CHG
LOC, IPSILATERAL DILATED OR NON REACTIVE PUPIL CONTRALATERAL HEMIPARESIS

CHRONIC SDH
USUALLY IN OLDER PPL ON ANTICOAG OR ETOH, DUE TO BRAIN ATROPHY, FRAGILITY OF THE
BRIDGING VEINS AND COAG ALTERATION. SSX DEVELOP OVER TIME. ALTERED OR STEADY DEC OF
LOC, HA, LOSS OF MEMEORY, MOTOR DEFICIT, APHASIA, IPSILATER UNILATERAL FIX N DILATED
PUPIL, INCONT, SEIZURES
HERINATION
-SHIFTING OF BRAIN TISS WITH DISPLACEMENT INTO ANOTHER COMPARTMENT AS THE RESULT OF
BLEEDING OR EDEMA.
THE SHIFT COMPRESSES, TEARS OR SHEARS THE VASCULATURE, DEC PERFUSION. SUPRATENTORIAL
MOST COMMON IN TRUAMA

SSX
- ASYMMETIC PUPILLARY REACTION, UNILATERAL OR BILATERAL PUPILLARY DILATION, ABNORMAL
MOTOR POSTURING, NEURO DETERIORATION (LOSS OF NORM REFLEX, PARALYSIS OR CHANGE IN
LOC

DIFFUSE INJURIES
- OVER WIDESPREAD AREA. NOT ALWAYS ID ON XR OR CT BC DAMAGE INVOLVES CONTUSIONS OR
SHEARING AND STRETCHING OF THE MICROVASCULATURE NOT A LOCALIZED HEMATOMA
CAUSES- BLOW TO HEAD (SPORTS)
SX TRANSIENT LOC, HA DIZZINESS, NA, CONFUSION AND DISORIENTATION, MEMORY LOSS
CONCENTRATION DIFFICULTY, IRRITABILITY AND FATIQUE.

MILD TBI
CONCUSSION - GCS 13-15, BRIEF LOC
POST TRAUMATIC AMNESIA OF LESS THAN 24 HR
NO CHANGE SEEN ON NEURO STUDIES

MODERATE TBI
GCS- 9-12 SSX ALTER LOC, CONFUSED, AMNESIA AND FOCAL NEURO DEFICITS, MAY DETERIORATE TO
SEVERE HEAD INJURY OVER TIME

SEVERE TBI
GCS 8 OR LESS, SIGN LOC, ABN PUPILS, ABN POSTURING

DIFFUSE AXONAL INJURY

- FROM DIFFUSE SHEARING, TEARING OR COMPRESSIVE STESSES FROM ROTATIONAL OR
ACCELERATION/DECELERATION MOI, RESULTS FROM HYPOXIA OR ISCHEMIC INSULTS FROM INITAL
TRAUMA.
GRADED AS MILD, MOD, SEVERE. SEVERE DAI SIGN MORBIDITY OR MORTALITY. SSX UNCONC- MILD
LAST 6-24 HR, SEVERE- UNCONC MAY PERSIST FOR WEEKS/MONTHS OR PERSISTS IN VEGATATIVE
STATE
ICP, ABN POSTURING, HTN SBP 140-160, HYPERTHERMIA WITH TEMP 104-105, EXCESSIVE SWEATING,
MILD TO SEVER MEMORY LOSS.

SKULL FX
LINEAR, DEPRESS, BASILAR

SKULL FX SSX
LINEAR- NON DISPLACED FX SSX- HA, SURROUNDING SOFT TISS INJURY, POSS DEC LOC,
DEPRESSED- SAME AS ABOVE + PALPABLE DEPRESSION OF SKULL OVER FX SITE, POSSIBLE OPEN FX

BASILAR SKULL FX
FX OF ANY OF THE 5 BONES OF SKULL
RESULTS IN PUNTURES OR LAC TO BRAIN TISS OR CRANIAL NERVES AND CSF LEAKAGE,
OPEN PASSAGE FOR CSF, OCCURS CONCURRENTLY WITH FACIAL FX, CT USED TO ID AND MANAGE
SSX- HA, AMS, CSF EAR/NOSE, PERIORBITAL ECCHYMOSES, MASTOID ECCHYMOSES, BLEEDING
BEHIND THE TYMPANIC MEMEBRANE
FACIAL NERVE PALSY CN7

MAXILLA FX USING LAFORT SYSTEM

1 LEVEL OF TEETH
2-MID FACE
3COMPLETE CRANIOFACIAL SEPARATION INV MAXILLA, ZYGOMA, ORBITS AND BONES OF THE
CRANIAL BASE
SSX MASSIVE FACIAL EDEMA, MOBILITY AND DREPRESSION OF ZYGOMATIC BONES, ECCYMOSES
DIPLOPIA, OPEN BITE OR MALOCCLUSION.

INTERVENTIONS OF PT WITH BRAIN, CRAINAL OR MAXILLOFACIAL TRAUMA

1.ELEVATED HOB 30- DEC ICP
2.ICP DRAIN INDICATION- SEVERE TBI WITH ABN CT, OR NORM CT WITH 2 OR MORE OF THE
FOLLOWING: 40YR R OLDER, UNILATERAL OR BIL POSTURING, SBP <90
3. ADM MANNITOL- INDICATION INC DILATED PUPILS, LOSS OF CONSC, HEMIPARESIS. NOT FOR
HYPOTENSIVE SINCE IT WON'T LOWER ICP IN HYPOTENSIVE PT, POTENT OSMOTIC DIURETIC.
4. ADM ANTICONVULSAN MEDS- SEIZURE PROPHYLAXIS- DEPRESSED SKULL FX, SEIZURE AT THE TIME
OF INJURY, OR ON ARRIVAL TO ED, HX OF SEIZURES, PENETRATING BRAIN INJURY, SEVERE HEAD
INJURY ACUTE SDH, ACUTE EPIDURAL HEMOTAMA
5FEVER IS CHG IN SET POINT. COOLING BLANKET OR ICE PACKS FEVER INC ICP AND CEREBRAL
METABOLIC RATE AVOID SHIVERING ALSO INC ICP

test for fx
ct, mri , ANGOIGRAPHY, SKULL SERIES, LAB, COAG BLD ALCOHOL OR URINE TOX

AIRWAY ADJUNCTS
1. NASOPHARYNGEAL AIRWAY- CAN B USED IN RESPONSIVE AND UNRESPONSIVE PT.
CONTRAINDICATED INPT WITH FACIAL TRUAMA OR SUSPECTED BASILAR SK FX. ** REASSESS NEED
FOR PATENCY AND DETERMINE THE NEED FOR DEFINITIVE AIRWAY.
2. OROPHARYNGEAL AIRWAY-- USED IN UNRESPONSIVE TEMP MEASURE TO FACILITATE VENT WITH
BAG MASK DEVICE OR SPONTANEOUS VENT. UNTIL THEY CAN BE INTUBATED.

DEFINITIVE AIRWAYS
1. FAILURE TO MAINTAIN OR PROTECT THE AIRWAY
2. FAILURE TO MAINTAIN OXYGENATION OR VENT
3. A SPECIFIC ANTICIPATED CLINICAL COURSE
EX= APNEA, GCS <8, SEVERE MAXILLOFACIAL FX, FACIAL BURNS, LARYNGEAL OR TRACHAL INJURY OR
NECK HEMATOMA, HI RISK FOR ASPIRATION AND INABILITY TO PROTECT AIRWAY, COMPROMISE OR
INEFFECTIVE VENT,
ANTICIPATE DETERIORATIO OF NEURO STATUS

TYPES OF DEFINITIVE AIRWAY

1. ETT- ORAL OR NASAL.
NASAL CONTRAINDICATION- APNEIC, MID FACE FX LAFORT 2 AND 3, OR BASILAR SKULL FX,
FX OF FRONTAL SINUS CRIBRIFORM PLATE
NOT RECOMMENDED FOR PREGNANT WOMEN BLEEDING INC
2. SURGICAL AIRWAY PLACED WHEN ETT CANT B. EX LARYNX FX, OROPHARYNGEAL EDEMA OR
HEMORRHAGE.

DIFFICULTY AIRWAYS TO INTUBATE

C SPIN INJURY OR SEVER ARTHRITIS,
MANDIBULAR TRAUMA, OBESITY, SX SWELLIN INFLAMMATION (STRIDOR), SX OF INHALATION
INJURY, ANATOMIC VARIATION (SHORT NECK)