The hypotensive trauma patient
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A look at the hypotensive trauma patient.
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The hypotensive trauma patient
- 1. The Hypotensive Trauma Patient By Kane Guthrie
- 2. Trauma in WA
- 3. But what about SCGH?
- 4. The Guide
- 6. The Hypotensive Trauma Patient
- 7. Causes?
- 8. Case Study
- 9. The Approach C :Catastrophic haemorrhage A: Airway > C-spine B: Breathing C: Circulation D: Disability E: Exposure
- 10. The Lethal Triad
- 12. ED Trauma CallPrimary Survey Secondary Survey
- 13. Physical Exam Focus on: ID all sites of external bleeding ID external markers of torso injury ID all penetrating wounds Pearls Roll the patient early Don’t underestimate scalp bleeding
- 14. Diagnostic Testing Bedside Testing: AP CXR AP Pelvis x-ray FAST, EFAST DPL is out. Definitive Testing CT scan (Donut of death) Surgical Exploration (Laparotomy, Angio)
- 15. Ultrasound FAST &EFAST Extension of physical exam Patient doesn’t have to move to it Looks for free fluid Can also Dx PTX Helpful for vascular access
- 16. Pathology Base deficit (VBG,ABG) Haemoglobin Lactate Haematocrit All must be in a series.
- 17. Airway Maintaining airway can be difficult R/T: Maxillofacial trauma Neck trauma Laryngeal trauma C-spine precautions Secure airway early
- 18. C-Spine Maintain precautions until Nexus Vs Canadian Imaging Clinically
- 19. Breathing Give O2 NRBM 15L RSI with in-line stabilization Prepare for difficult airway Beware of pre-existing co-morbidities Avoid hypotension, lower doses, ? use Ketamine
- 20. Circulation Don’t rely on HR & BP Place x 2 18g IVC Consider IO early if difficult access U/O and serial lactate guide Mx: Ketamine ?better for intubation/analgesia Fluid resuscitation blood is better Crystalloid Vs Colloid Do Inotropes have a role???
- 22. SBP <90mmHg
- 23. HR >120bpm
- 24. Positive FAST abdominal views1:1:1 Ratios (PRBCS, FFP, Platlets)
- 26. Abdo organs into chest cavity decreasing venous return to heart
- 27. Risk of aspirating gastric contents?Leg elevation better than nothing
- 28. Disability TBI ETOH, illicit, Metabolic (BSL), GCS < 8 Intubate??? Prefer GCS <12 Maintain adequate perfusion
- 29. Exposure Get complete exposure during assess Then: Keep patient warm Give warm fluids Monitor core temp = avoids hypothermia/ lethal triad.
- 30. Special Considerations Elderly Athletes Pregnancy Medication Hypothermia Pacemaker