0071643192.pdf

■ Following trauma, patients can elicit any of the five types of shock:

■ Hypovolemic (hemorrhage)

■ Distributive (brain/spinal cord injury)

■ Cardiogenic (direct myocardial injury)

■ Obstructive (tension pneumothorax or cardiac tamponade)

■ Dissociative (inhalation of carbon monoxide or cyanide)

■ Treat hypotension with an initial challenge of 1–2 L of isotonic fluid.

DISABILITY

■ Perform a rapid neurologic evaluation to assess patient’s level of consciousness.

■ The Glasgow Coma Scale (GCS) is a 3–15 score of mental status that mea-

sures three attributes: Eye opening, verbal response, and best motor response

(see Table 3.2).

■ AVPU (Alert; responds to Vocal stimuli; responds to Painful stimuli; Unre-

sponsive) is a simpler method of describing level of consciousness.

■ Assessment of extremity motor and sensation is part of the secondary survey.

EXPOSURE/ENVIRONMENT
■ Undress the patient to look for additional injuries to torso and extremities.
■ Cover the patient in a warm blanket or external warming device to prevent
hypothermia. Check a core temperature in patients who may be cold or hot.
TRAUMA

TABLE 3.1. Classes of Hemorrhage

CLASSICLASSII CLASSIII CLASSIV

BP Normal Normal Decreased Decreased

HR <100 100 – 120 120–140 >140

Volume blood loss <750 mL 750–1500 mL 1500–2000 mL >2000 mL

Percent blood loss < 15% 15–30% 30–40% >40%

Class II hemorrhage:

Tachycardia

Class III hemorrhage:

Tachycardia and hypotension

An easy way to remember the

maximum GCS score is to

remember 4, 5, 6 moving

down from the eyes (max. 4)

to the mouth (max. 5) to the

arms (max. 6).

GCS was designed for use

specifically in the setting of

trauma.

TABLE 3.2. The Glasgow Coma Scale

EYEOPENING SCORE VERBALRESPONSE SCORE MOTORRESPONSE SCORE

Spontaneous 4 Oriented 5 Follows commands 6

To voice 3 Confused 4 Localizes pain 5

To painful stimuli 2 Inappropriate words 3 Withdraws from pain 4

Never 1 Unintelligible sounds 2 Flexor response 3

None 1 Extensor response 2

None 1