Trauma
Considerations
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Emergency/full stomach
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Difficult airway due to C-spine injury/immobility
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ATLS approach to resuscitation
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Multiple obvious & occult injuries
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Need for ongoing assessment & resuscitation
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Hypovolemia, hypothermia, coagulopathy, acidosis
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Potential toxic ingestions, uncooperative patient
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Immediately life-threatening injuries:
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Airway obstruction
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Tension pneumothorax
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Open pneumothorax
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Cardiac tamponade
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Massive hemothorax
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Flail chest
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Delayed/hidden injuries:
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Thoracic aortic disruption
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Tracheobronchial disruption
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Myocardial contusion
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Traumatic diaphragmatic tear
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Esophageal disruption
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Pulmonary contusion
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Pregnancy Considerations
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↑ risk of aspiration, difficult airway
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Altered pattern of injury: preterm labour, abruption, uterine rupture, amniotic fluid embolism, alloimunization
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Delayed decompensated shock secondary to physiologic changes: hypervolemic hemodilution
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Altered ACLS:
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IV above diaphragm
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Chest compressions higher
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Left uterine displacement
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Stat cesarean section at 4 minutes post cardiac arrest
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2 patients requiring:
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Fetal monitoring
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Obstetrics/pediatrics consults
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Steroids for fetal lung maturity if <34 weeks GA
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MgSO4 for fetal brain protection
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Considerations RE: imaging (CT, X-ray)