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1. Deceleration Not all organs decelerate at once
2. Will die from a 1. Descending thoracic aorta (ligamentum arteriosum)
tear in these 2 2. Duodenum (ligament of trites)
things
3. Difference be- Pellets expand on impact and cause multiple injuries to internal structures
tween pellets and Bullets damage whatever is in the direct path and can ricochet off bones
bullets
4. Trimodal distrib- 1. Minutes- at scene, "the golden hour"
ution of trauma 2. Minutes-hours: ER, OR
death 3. Days-weeks: ICU from complications
5. 6 phases of trau- 1. Prehospital resuscitation
ma care 2. Hospital resuscitation
3. Definitive care and operative phase
4. Critical care.
5. Intermediate care
6. Rehabilitation
6. 1. Prehospital Re- GOAL: immediate stabilization and transport
suscitation
7. 2. ER Resuscita- 1. Rapid primary survey
tion 2. Resuscitation of vital functions
3. Secondary survey
4. Initiation of definitive care 9home or admit)
8. a) Primary survey ABCDE
Airway
Breathing
Circulation
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, Trauma (ICU)
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Disability
Exposure/environmental control
9. Airway -Assess airway patency
-Position patient
-Open airway
-Stabilize c-spine
-Interventions
10. Breathing OPEN AIRWAY DOES NOT ASSURE ADEQUATE VENTILATION AND GAS EXCHANGE
-Supplemental O2 for ALL trauma pts
11. Circulation Look for hemorrhage
12. Disability -Rapid neuro assessment
AVPU
Alert
Responds to Verbal
Responds to Pain
Unresponsive
-Glasgow Coma scale
13. Exposure/envi- -Cut away clothing
ronmental -Prevent heat loss
control -Keep trauma patients WARM
14. b) Resuscitation -2 large bore IVs (18G or bigger)
phase -Blood samples drawn
-Warm LR/blood
-Urinary catheter
-NG tube (prevents aspiration, decompression, etc)
15.
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