Lecture Notes: Trauma and Emergency Medical Procedures

Key Medical Procedures

• Needle Thoracentesis
  • Also known as pleural decompression or needle decompression.
  • Slang term: "darting the chest."
  • Indication: Development of JVD (Jugular Venous Distension) suggesting tension pneumothorax.

Tension Pneumothorax

• Signs:
  • Jugular Venous Distension (JVD)
  • Absent breath sounds
  • Tracheal deviation (opposite side of injury)
• Type of Shock: Obstructive
• Management: Immediate needle decompression.

Myocardial and Pulmonary Contusions

• Myocardial Contusion
  • Risk of V-fib if impact occurs between R and T wave (Comotio Cordis).
  • Treated with unsynchronized cardioversion.
  • Lidocaine for V-fib or V-tach without pulse due to trauma.
• Pulmonary Contusion
  • Bruised ribs and lungs worsen before healing.
  • No splinting possible, making recovery slow.

Traumatic Asphyxia

• Often results in bilateral tension pneumothorax and diaphragmatic ruptures.
• Indicators: Blue discoloration from the nipple line up due to torn superior vena cava or aorta.

Differentiating Ruptures

• Tension Pneumo vs. Diaphragmatic Rupture vs. Bronchial Rupture:
  • Diaphragmatic: Absence of breath sounds, no chest rise, belly inflates with ventilation.
  • Bronchial: Air sounds present but no inflation, swells above epigastric area.

Chest Injuries

• Sucking Chest Wound
  • Immediate treatment with a gloved hand.
  • Use three-sided occlusive dressing (flutter valve).

Pulmonary Embolism (PE)

• Risk Factors:
  • Female, smoker, on birth control, recent delivery, or bone fracture.
• Diagnosis: VQ scan
• Signs: Sudden chest pain, shortness of breath, possibly clear breath sounds.

Deep Vein Thrombosis (DVT)

• Causes: Prolonged sitting, varicose veins.
• Potential Outcome: More likely to cause a pulmonary embolism than arterial occlusion.

Head Injuries

• Symptoms and Management:
  • Projectile vomiting can lower heart rate and pressure, risking aspiration.
  • Maintain MAP at 90-110 to avoid hypotension.
  • Herniation signs: Pupil changes, Cushing's response, jaw clenching.
• Types of Bleeds:
  • Subarachnoid: Thunderclap headache.
  • Epidural: Immediate unconsciousness followed by lucidity and rapid decline.
  • Subdural: Slow development, symptoms worsen when lying flat.

Abdominal Injuries

• Solid Organs:
  • Somatic pain; liver, spleen concerns for hemorrhagic shock.
• Hollow Organs:
  • Visceral pain; risk of sepsis from contents leakage.

Neck Injuries

• Use gloved hand and occlusive dressing to prevent air entry.
• Direct pressure can be applied to one side.

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These notes cover the essential points from the lecture on trauma and emergency procedures. Be sure to review definitions, symptoms, and appropriate responses for the various conditions discussed.