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Hypotension indicates that death is imminent. Causes of circulatory compromise
Effects of circulatory compromise
In all aspects of trauma management, the primary survey is the first priority Primary surveyAirway with c-spine stabilisation (see airway management section) Breathing
(see breathing management section) Circulation assessmentExamine Pulse
Capillary Refill
Skin colour/temperature
Blood Pressure
Look for other signs of circulatory inadequacy
Management of circulation
Ensure adequate monitoring of saturations: cardiac monitor, finger on femoral pulse for pulse check. If the pulse is abscent or less than 60 and there are no other signs of life: commence immediate chest compressions and full cardiopulmonary resuscitation. 1. Chest compressions Infant <1 year
Ratio of compressions to breaths: 5:1 landmark infant Small Child <8 years
Ratio of compressions to breaths 5:1 Larger child Landmark Two fingers above the xiphisterum Technique Two hands overlaid (as in adults) Rate 100 per minute Ratio of compressions to breaths 15:2 2. Ensure adequate vascular access
Sites of venous access
3. Obtain blood specimens for:
4. Assess and manage haemorrhage Control haemorrhage:
Splint and stabilise fractures.
5. Fluid Resuscitation Look for any signs of circulatory compromise, as above. If present consider fluid resuscitation with blood as per your own institution protocol, or as per the APLS algorithm below:
Obtain an URGENT SURGICAL REVIEW if there has been inadequate response to the first two fluid boluses. Reassess: HR, capillary refill, and other signs of circulatory adequacy. If the circulatory signs are deteriorating and not responding to fluid bolus, consider whether there is:
In hypovolaemia, fluids will need to be infused rapidly. This requires:
6. Inotropic support Injured patients usually require replacement of volume rather than use of inotropes. Consider discussion with a paediatric intensive care physician if you consider your patient requires inotropic support. 7. After assessment: re-assessment Repeat Primary Survey and continue monitoring vital signs, saturation, conscious state and urine out-put. Specific management issues of circulation
Suggesting reading list
How do you check for distal circulation?The five main assessments that must be completed when assessing distal circulation are capillary refill, color, temperature, pulses and swelling.
What is the appropriate site to check the pulse on a newborn quizlet?The brachial or apical pulse is the best site for assessing an infant's or a young child's pulse because other peripheral pulses are deep and difficult to palpate accurately.
When examining a conscious patient's chest What should you do?When examining a conscious patient's chest, it is important to: assess for unequal motion of one side or section of the chest. Scene hazards that are NOT visible to emergency responders include: poisonous fumes.
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