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CCFP(EM) Omar > Trauma > Flashcards

Trauma Flashcards

1
Q

Indications for laparotomy in stab wound

A

Evisceration<div>Peritonitis</div><div>Hemodynamic instability</div><div>Impalement</div><div>Frank blood on NG/rectal</div>

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2
Q

<p>Name 3 patient or wound characteristics that would decrease the reliability of Local wound exploration (LWE) for anterior stabs.</p>

A

<ul> <li>Small puncture wounds (eg - ice pick)</li> <li>Significant obesity</li> <li>Multiple stab wounds</li> <li>Lack of patient co-operation</li> <li>Long tangential stab wounds</li> </ul>

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3
Q

<p>There is no commercial binder available. What else can you do? Describe.</p>

<p>What is a common pitfall to avoid?</p>

A

<p>‣Use a folded bedsheet centered over the <em>trochanters </em>secure with towel clips.</p>

<p>‣Internal rotation of legs and taping the ankles.</p>

<p>‣Avoid placing over the iliac crests.</p>

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4
Q

What non-abdominal injuries are associated with seat belt inj

A

L-Spine Chance #

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5
Q

“<img></img><div>What is this #</div><div>Stable vs unstable?</div><div>Why?</div>”

A

<p>Chanse # (Transverse # through vertebral body with posterior element involvement/splaying - involves PLL. Misdiagnosed as compression # )</p>

<div>Unstable</div>

<div>3 column involvement</div>

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6
Q

<p><strong>Hard and Soft Signs of Major Aerodigestive or Neurovascular Injury </strong></p>

A

“<p><img></img></p> <strong>Anatomical</strong> <strong>Hard Sign</strong> <strong>Soft Sign</strong> <span><strong>Airways</strong></span> <span>Airways compromise</span> <span>Hemoptysis</span> <span>Air bubbling through the wound</span> <span>Dyspnea, Dysphonia</span> <span>Massive SC emphysema</span> <span>Chest tube air leak</span> <span><strong>Vascular</strong></span> <span>Expanding/pulsating hematoma</span> <span>Non expanding hematoma</span> <span>Active/brisk bleeding</span> <span>Oroparyngeal blood</span> <span>Hemorrhagic shock</span> <span><strong>GIT</strong></span> <span>Hematemesis</span> <span>Dysphagia</span> <span><strong>Neuro</strong></span> <span>Neuro deficit</span> <span><strong>Others</strong></span> <span>Subcut or mediastinal air</span> <span>Crepitus</span> “

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7
Q

Brown-Sequard syndrome

A

Hemisection of SC<div>Ipsilateral loss of vibration/properioception</div><div>Ipsilateral motor loss (lat corticospinal tr)</div><div>Contralateral loss of pain/temp</div>

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8
Q

Can you remove C-collar after nefgative CT in blunt trauma in obtunded patient?

A

Yes if the patient can grossly move all 4 limbs (normal motor exam)

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9
Q

Name potential 4 harms of C-Spine immoblization

A

Increased ICP due to decrease venous return<div>Pressure ulcers</div><div>Increased aspiration risk</div><div>Impaired airway access</div><div>Pain</div><div>Potential for missed injuries</div>

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10
Q

<p>Explain the anatomic reason for the clinical findings of UE weakness in central cord syndrome</p>

A

<p>Fibers controlling UE are central</p>

<p></p>

<p>Tight spinal canal + hyperextension injury results in bleeding/edema into central part of cord - not always any acute bony abnormality</p>

<p><b>What should your next management steps be?</b></p>

<p>Switch to an Aspen collar, consult neurosurgery, MRI</p>

<div></div>

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11
Q

DOPE

A

Dislodgement of EET<div>Obstruction of ETT</div><div>PTX</div><div>Equipment failure</div><div><br></br></div><div>Others:</div><div>Temponade</div><div>air embolism</div><div>air trapping</div>

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12
Q

2018 ATLS updates

A

“<img></img><div><img></img><br></br></div><div><img></img><br></br></div>”

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13
Q

Anticoagulation reversal guidleines

A

“<img></img>”

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14
Q

PECARN

A

“<img></img>”

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15
Q

Canadian C-Spine rule in trauma

A

“<img></img>”

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16
Q

What is meant by (Dangerous Mechanisms) in trauma?

A

• Fall from > 1 meter/5 stairs<br></br>• Axial load of head<br></br>• MVC with ejection, rollover, > 60 mph<br></br>• Motorized recreational vehicle collision<br></br>• Bicycle collision

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17
Q

Low risk factors (prior to assessing ROM)

A

Simple rear-end MVC<br></br>Sitting position in ED<br></br>Ambulatory at any time<br></br>Delayed onset of neck pain<br></br>No midline cervical tenderness

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18
Q

CERVICAL SPINE TRAUMA<br></br>NEXUS Criteria

A

N - Neuro deficit<br></br>E - EtOH (alcohol)/intoxication<br></br>X - eXtreme distracting injury<br></br>U - Unable to provide history (altered LOC)<br></br>S - Spinal tenderness (midline)<br></br>Imaging indicated if any present

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19
Q

“<img></img><div>Name 3 potential vision threatening Dx ass with this trauma</div>”

A

Orbital floor / blowout #<div>Globe rupture</div><div>Retrobulbar hematoma</div><div>Hyphema</div><div><br></br></div><div>NB: No points for orbital rim # as it is not vision-threatening</div>

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20
Q

<p>What are some physical findings of an orbital blow-out fracture?</p>

A

<ul> <li>Enopthalmos</li> <li>Infraorbital paresthesia</li> <li>Impaired upward gaze</li> </ul>

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21
Q

“<img></img><div>Which eye is affected? Why?</div>”

A

Left eye<div>Inf rectus entrapment</div>

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22
Q

<p>Name 2 physical findings of a retrobulbar hematoma.</p>

A

“Exophthalmos<div>Decreased VA</div><div>Increased IOP</div><div><span>Relative Afferent Pupillary Defect (</span><b>RAPD</b><span>)</span><br></br></div><div>Subconjuctival hge</div>”

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23
Q

<p>What ultrasound finding rules-in a pneumothorax? Describe</p>

A

<p>Lung point - when you have lung slide and lack of lung slide in the same rib space.</p>

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24
Q

<p><strong>Name 3 limitations of FAST exam in blunt abdominal trauma</strong></p>

A

<ol> <li>Does not detect retroperitoneal injury</li> <li>Operator dependent (250-750cc)</li> <li>Can be negative early in trauma</li> <li>Does not detect perforated viscus (unless FF)</li> <li>False negatives - clotted blood, adhesions</li> <li>False positives - ascites, physiological FF</li> <li>Indeterminate scans (rib shadow etc)</li> </ol>

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25
Q

What is permissive hypotension

A

<p>Restriction of volume replacement to:</p>

<ul> <li>Avoid clot dislodgement</li> <li>Avoid dilution of clotting factors</li> <li>Avoid the triad of death (hypothermia, acidosis and coagulopathy)</li> </ul>

<div></div>

<div>Tolerated SBP of 70 (mPB 50-60)</div>

<div></div>

<div><strong>CI in:</strong></div>

<div></div>

<ul> <li>TBI with GCS < 8</li> <li>SCI</li> <li>No direct access to OR</li> </ul>

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26
Q

Indications for MTP

A

<div>ABC score</div>

> 2 of:<div>Penetrating Torso inj</div><div>+FAST</div><div>SBP<90</div><div>HR>120</div><div><br></br></div><div>Others:</div><div>2 units in 4 hrs or >150 ml/hr</div>

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27
Q

Complications of MTP

A

Hypothermia<div>HyperK</div><div>HypoCa</div><div>Transfusion reaction</div><div>Abdominal Compartment synd</div><div>TRALI</div><div>TACO</div>

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28
Q

<p>What are the indications for imaging of blunt renal trauma in adults?</p>

A

<ul> <li>Adults - imaging if gross hematuria <strong>or</strong> SBP <90 + any hematuria</li> <li>(Vs kids - anything >50 RBC/hpf requires imaging)</li> </ul>

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29
Q

Indications for CT in blunt abd trauma in children

A

Abd tenderness<div>Unreliable exam</div><div>AST/ALT>100</div><div>Gross hematuria</div>

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30
Q

Indications of chest tube in occult PTX

A

Mech vent<div>Air transfer</div><div>Ground transfer with personell inexperienced of putting chest tubes</div><div>Clinical situation</div>

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31
Q

C-Spine rules

A

“<img></img>”

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32
Q

Exclusion criteria for Canadian C-spine rule

A

Non-traumatic cases<div>GCS <15</div><div>Unstable VS</div><div>Age <16</div><div>Acute paralysis</div><div>Known vert dis</div><div>Previous c-spine surgery</div>

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33
Q

Simple rear end MVA EXCLUSIONS:

A

<div>pushed into oncoming traffic</div>

<div>hit by a bus/large truck</div>

<div>rollover</div>

<div>hit by high speed wehicle</div>

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34
Q

<p>Name 3 risk factors that should prompt further screening for Blunt CerebroVascular Injury in asymptomatic patients?</p>

A

<ul> <li>Severe facial trauma - especially Lefort II or III</li> <li>Basilar skull # with carotid canal involvement</li> <li>Any C1-C3 #</li> <li>Other C-spine #’s involving transverse foramen, subluxation or ligamentous injury</li> <li>Near-hanging with anoxic brain injury</li> <li>Severe TBI with GCS <6</li> <li>Clothesline-type injuries</li> </ul>

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35
Q

Indications for prophylactic AB in lacerations

A

Imm compromized/chemo<div>Animal/human bites</div><div>Complex inj (crush mech, extensive contamination, puncture)</div>

36
Q

Pt had quadriplasia post fall, what physical exam finding will aid in determining if she has any chance or recovery?

A

Presence or absence of voluntary anal contraction and sacral (S4/5) sensation<div>Sacral sparing-Key prognostic indicator suggestive of incomplete injury and potential for some motoe recovery</div>

37
Q

Common features of neurogenic shock

A

Bypotension<div>Bradycardia</div><div>Peripheral vasodilation (flushed skin)==> hypothermia</div><div><br></br></div><div><br></br></div>

38
Q

Level of inj in neurogenic shock

A

T6 and higher

39
Q

Mx of neurogenic shock

A

Fluid bolus<div>Pressors</div><div>PRN atropine</div><div>Trendlenburg</div><div>Keep warm</div>

40
Q

Neurogenic vs spinal shocks

A

“<img></img>”

41
Q

<p>In the ED setting, what vital sign parameters are <u>most</u> important in preventing secondary injury(2)?</p>

A

<ul> <li>O2 >92%</li> <li>SBP >100-110 (>100 for 50-69 yo, >110 for 15-49/>70)</li> <li>EtCO2 - aim for eucapnia</li> <li>Normothermia</li> </ul>

42
Q

<p>What are the indications for osmotic therapy (mannitol or HS) in the setting of severe TBI (in the ED)?</p>

A

<p>Clinical signs of impending herniation from ICP</p>

<p> Posturing, Cushing’s, fixed/dilated pupils</p>

<p>On advice from neurosurgery</p>

43
Q

<p>Name 3 other things you can do in the ED to help prevent secondary brain</p>

A

<ul> <li>Normothermia,</li> <li>elevate HOB,</li> <li>sedation, analgesia,</li> <li>loosen collar,</li> <li>glucose management</li> </ul>

44
Q

Eligibility for Head CT in head injury

A

<ul> <li>Blunt trauma to head with</li> <li>LOC/amnesia/disorientation,</li> <li>initial GCS >13,</li> <li><24 hours</li> </ul>

45
Q

<p>What features increase the risk of ciTBI in kids <2 years with a scalp hematoma?</p>

A

<ul> <li>Age <3 months</li> <li>Non-frontal (ie - parietal or temporal)</li> <li>>3cm</li> <li>Associated symptoms</li> </ul>

46
Q

<p>What subgroup of <2 year olds with isolated hematoma have the highest risk of TBI?</p>

A

<p>< 3 months - highest risk of TBI on CT (but low risk of needing surgery)</p>

<ul> <li>PECARN - of 111 patients with isolated hematoma <3 most - 21% had TBI on CT, but only 2% required surgery</li> </ul>

47
Q

PECARN head CT rules

A

“<img></img><img></img>”

48
Q

Tetanus prophylaxis

A

“<img></img>”

49
Q

What sre the indications of escharotomy?

A

Loss of distal pulses ass with circum burn<div>Torso-restriction of ventilation</div><div>Prophylactically-circum burn if long transport time is expected</div><div><br></br></div>

50
Q

Indications of referral to a tertiary burn centre?

A

<ul> <li>Full thickness >10%</li> <li>Partial thickness >25% if between 10-50 yo, otherwise >20%</li> <li>Inhalational, chemical or high-voltage electrical burns</li> <li>Major trauma</li> <li>Patients with underlying co-morbidites</li> <li>Involvement of face, ears, hand, feet or perineum.</li> </ul>

51
Q

Features of NAI/burns

A

Pattern of injury-scald/immersion burns<div>Age-is the child mobilizing?</div><div>Parental supervision</div><div><br></br></div><div><i><u>What else:</u></i></div><div><b>Hx</b>: the mech of injury is inconsistent with the pattern.</div><div> The hx of parents is inconsistent</div><div> Any other children at home?</div><div><b>P/E</b>: clear-cut edge, gloves and stocking pattern, specific shapes (cigarrettes) are NAI</div><div><br></br></div><div><b>Action</b>: Must report the child</div><div>No obligation to report the mother unless you are very suspicious of life threatening condition.</div>

52
Q

Le Fort #

A

I: Malocclusion, maxilla mobile<div>II: Facial lengthening, infraorbital paresthesia</div><div>III: Caved in, flattened face, CSF rhinorrhea</div>

53
Q

Blunt chest trauma/DDX:

A

Think about chest wall and structures<div>Ribs #, flial chest</div><div>Lungs: contusion, laceration</div><div>Tracheoesophageal rupture</div><div>Aortic rupture</div><div>Pneumo/hemo thorax</div><div>Cardiac contusion, laceration of aortic root</div>

54
Q

What are the features of aortic rupture on X-ray:

A

<p>šWide mediastinum (>6cm on PA, >8cm on AP)</p>

<p>šObscured aortic knob</p>

<p>šDisplaced NG tube</p>

<p>šWidened paratracheal stripe</p>

<p>šDepression of right mainstem bronchus</p>

<p>šApical cap</p>

<p>šHemothorax (esp. left side)</p>

<p>šLateral displacement of trachea</p>

<p>š1st/2nd rib #</p>

55
Q

<p><strong>Name 5 history or physical exam findings that would increase your suspicion of an aortic injury.</strong></p>

A

<ul> <li>Major chest trauma – on exam or history</li> <li>Ex – high speed MVC, seat belt sign, contusions</li> <li>Unequal BP’s in UE’s</li> <li>Hypertension in UE, hypotension in LE</li> <li>Hypotension/tachycardia</li> <li>Rib/sternal #’s – especially 1st/2nd rib</li> <li>Flail chest</li> <li>Intrascapular murmur/bruits</li> <li>Hemothorax</li> </ul>

56
Q

Target BP and HR in aortic rupture

A

BP==>100<div>HR==>60</div>

57
Q

What meds will you use in Rx of aortic rupture?

A

BB then vasodilators (to prevent reflex tachycardia which increases the shearing force on intima)<div>Eg:</div><div>Labetalol/Esmolol then nitroprusside or nicardipine</div>

58
Q

<p>What clinical exam findings will support your diagnosis of a globe rupture? Name 5</p>

A

<ul> <li>Pupil – irregular shape, non-reactive, RAPD</li> <li>Decreased vision</li> <li>Bloody chemosis or severe subconj hemorrhage*</li> <li>Hyphema</li> <li>Lens injury</li> <li>Flat/shallow anterior chamber</li> <li>Extrusion of contents</li> <li>FB</li> <li>Lens dislocation</li> </ul>

59
Q

<p>If you were uncertain of the diagnosis of globe rupture, what <em>bedside </em>test could you do? Describe.</p>

A

<ul> <li>Seidel test – fluorescein washed away by leaking aqueous</li> </ul>

60
Q

<p>Globe rupture,What is your work-up (1) and management plan for this patient (5)?</p>

A

<ul> <li>CT</li> <li>Protect eye</li> <li>Antibiotics</li> <li>Tetanus</li> <li>Ophthalmology</li> <li>Elevate HOB</li> <li>Antiemetics/analgesia</li> <li>NPO</li> </ul>

<p>šWhat bedside test is CI in this patient?</p>

<ul> <li>IOP measurement</li> </ul>

61
Q

Unstable spine fractures

A

“Jefferson Bit Off A Hangman’s Thumb<br></br>Jefferson<br></br>Bilateral facet dislocation<br></br>Odontoid<br></br>Atlanto-occipital dissociation<br></br>Hangmans<br></br>Teardrop”

62
Q

Cord syndromes

A

<br></br>Anterior :<br></br>Flexion injury 🔜direct ink to ant cord ➡️ complete paralysis and sensory loss below level of injury<br></br><br></br>Central:<br></br>Hyperextension 🔜mostly motor function in UE more LE<br></br><br></br>Brown - Sequard<br></br>Hemisection or unilateral SC compression 🔜 ipsilateral loss of motor, properioception and vibration and contralateral loss of pain and temp

63
Q

Most common complications of trauma in pregnant

A

Placential abruption<div>Uterine rupture</div><div>Fetal-maternal hge</div><div>Preterm labour</div>

64
Q

What is the first window of FAST exam?

A

“Blunt trauma ==> Morrison’s pouch<div>Stab wound ==> pericardial window</div>”

65
Q

Cervical fractures

A

” <strong>Fracture</strong> <strong>Vert involved</strong> <strong>X-Ray</strong> Jefferson C1 burst # the lateral masses of C1 shoulder align with the lateral parts of the C2 vertebral body Hangman bilateral C2 pedicle fracture C2 displaced anteriorly on C3 Odontoid fractures C2 <p>3 Types</p> <p>Types 2&3 are unstable</p> Bilateral facet dislocation anterior displacement greater than 50% diameter of vertebral body. “

66
Q

C-Spine #

A

“<img></img>”

67
Q

Unstable Cervical Fractures

A

“<img></img>”

68
Q

Formulas for Peds

A

“<img></img>”

69
Q

Fluid Rx for hemorrhagic shock in peds

A

10-20 ml/kg of crystalloid boluses x 3 max then:<div>pRBC 10 ml/kg</div><div>FFP 25 ml/kg</div><div>PLT 10 ml/kg</div>

70
Q

Hard signs for neck trauma

A

<b>Airways</b>:<div> Stridor</div><div> Air bubbling wound</div><div><b>Vascular</b>:</div><div> Shock</div><div> Active bleeding</div><div> Expanding hematoma</div><div><b>GIT</b>:</div><div> Hematemsis</div>

71
Q

NEXUS rule

A

Clear if NO any of the following is present:<div>1. Focal deficit</div><div>2. Midline spine tenderness</div><div>3. ALOC</div><div>4. Intoxication</div><div>5. Distracting injury</div>

72
Q

Canadian C-spine rule clearing criteria

A
  1. No high risk factors:<div> age <65</div><div> no dangerous mechanism</div><div> no paresthesia</div><div><br></br></div><div>2. Low risk factors are present to allow safe assessment of motion</div><div><br></br></div><div>3. The pt can actively rotate the neck to 45 degrees</div>
73
Q

Trauma blood work drawn

A

CBC,<div>lactate,</div><div>VBG,</div><div>fibrinogen,</div><div>liver enzymes,</div><div>BhCG,</div><div>INR/PTT</div><div>Bl type and screen</div>

74
Q

<h3>Transport checklist</h3>

A

“<h3><span><strong>ABCDEFGHIJKLMN</strong></span></h3> <div> <p><strong>Airway:</strong>Secured endotracheal tube verified on CXR</p> <p><strong>Breathing:</strong>Oxygen saturation +/- ETCO2, chest tube(s) functioning and secured</p> <p><strong>Circulation:</strong>Documentation of serial BP and HR, timing of tourniquets, volume/type blood products given, pelvic binder for suspected or confirmed pelvic injury</p> <p><strong>Disability:</strong>Documentation of serial GCS or AVPU, neurologic exam prior to paralysis, timing of paralytic</p> <p><strong>Exposure:</strong>Splint fractures, dress wounds, then cover patient and keep them dry</p> <p><strong>Fluids:</strong>Measure urine output, chest tube output, IV fluids given</p> <p><strong>Gut:</strong>NG tube placed and confirmed</p> <p><strong>Heme:</strong>Tranexamic acid or prothrombin complex concentrates given, INR drawn</p> <p><strong>Infusions:</strong>Sedation and analgesia</p> <p><strong>JVP:</strong>Signs of tension pneumothorax/tamponade</p> <p><strong>Kelvin:</strong>Initial and current temperature. Keep patient warm.</p> <p><strong>Lines:</strong>Two lines minimum, check all lines (IV, IO, foley, chest tubes)</p> <p><strong>Micro:</strong>antibiotics and tetanus as needed</p> <p><strong>Next of Kin:</strong>Family made aware of plan, contact information documented</p> <span><strong><br></br></strong></span></div>”

75
Q

Vision threatenening occular trauma

A

<ol><li>Retrobulbar hematoma with orbital compartment syndrome</li><li>Hyphema</li><li>Retinal detachment and</li><li>Globe rupture</li></ol>

76
Q

Ottawa ankle rules

A

“<img></img>”

77
Q

What are the indications for performing a peri-mortem cesarean section?

A

witnessed arrest,<div>the fetus is viable >24wk (gravid uterus >4 finger breadths above umbilicus), and</div><div>can be performed within 4-5min.</div>

78
Q

You are expecting a trauma pt 10 min away, what are your Mx priorities?

A

Trauma team activation<br></br>Gown in appropriate PPE<br></br>Prepare necessary equipment including airway equipment/chest tube tray/rapid transfuser<br></br>Prepare warmed fluids<br></br>Draw up medications for pain, TXA, intubation, etc.<br></br>Alert transfusion medicine for potential need for blood products<br></br>Alert surgical team that potential surgical patient<br></br><br></br>Note: This question asks how to prepare before a trauma patient arrives. No marks are given for any interventions done to the patient (who is 10 mins away)

79
Q

<p>List the indications for an ED (Trauma Room) Thoracotomy</p>

A

<p><strong>Penetrating Trauma</strong></p>

<ul> <li>Cardiac Arrest with signs of life in the field</li> <li>SBP <50 mmHg after fluid resuscitation</li> <li>Severe Shock with clinical signs of tamponade</li> </ul>

<p><strong>Blunt Trauma</strong></p>

<ul> <li>Arrest in ED</li> </ul>

<p><strong>Theoretic</strong></p>

<ul> <li>Suspected Air Embolus (post-instrumentation)</li> </ul>

80
Q

<p>List the indications for an urgent <u>OR </u>Thoracotomy</p>

A

<p>Initial Chest tube drainage > 20cc/kg</p>

<p>Ongoing chest tube drainage > 7cc/kg/hr</p>

<p>Increasing hemothorax on CXR</p>

<p>Pt remains hypotensive despite adequate blood replacement and other sources of blood loss have been ruled out</p>

<p>Pt decompensates after initial response to resuscitation</p>

81
Q

Canadian C-Spine rule

A

” <p>1.Is there a HIGH Risk factor that mandates an X-RAY? (No -> go to step 2)</p> <p>2.Is there a LOW Risk factor present that allows a safe assessment of ROM? (Yes -> go to step 3)</p> <p>3.Can the patient rotate 45° left & right?</p> <p><strong>HIGH RISK Factors</strong></p> <p>• > 65 years</p> <p>•Parasthesias</p> <p>•Dangerous mechanisms</p> <p>•Fall > 5 stairs (or 3 ft)</p> <p>•Axial load to head</p> <p>•High speed (>100kph)</p> <p>•Ejection</p> <p>•Rollover</p> <p>•ATV, Bike collision</p> <p>•</p> <p><strong>LOW RISK Factors</strong></p> <p>•Simple rear end MVC (except bus, truck, highspeed, pushed into traffic, rollover)</p> <p>•Ambulatory, sitting in ED</p> <p>•Delayed onset of neck pain</p> <p>•Absence of midline c-spine tenderness</p> <p><strong><em>100%</em></strong><strong><em> </em></strong><strong><em>sensitivity and 42.5%</em></strong><strong><em> </em></strong><strong><em>specificity for clinically important c-spine injury</em></strong></p> “

82
Q

Canadian CT Head Rules

A

<p><strong>Prospective Cohort</strong></p>

<p><strong>Inclusion:</strong></p>

<ul> <li>Minor CHI</li> <li>Blunt Head trauma within 24 hours</li> <li>Witnessed LOC</li> <li>Amnesia or witnessed disorientation</li> <li>GCS 13 – 15</li> </ul>

<p><strong>Exclusion:</strong></p>

<ul> <li>Pregnant</li> <li>On anti-coagulant</li> <li>Age , 16</li> <li>> 24 hours</li> <li>No history of trauma</li> <li>Obvious penetrating skull injury or depressed #</li> <li>Acute focal neuro definict</li> <li>Major trauma with unstable VS</li> <li>Seizure prior to ED visit</li> <li>A return visit to the ED for reassessment of the same injury</li> </ul>

<p><strong>HIGH Risk for Neurosurgical intervention</strong></p>

<p>1.<strong>Failure to reach GCS 15 within 2 hours</strong></p>

<p>2.<strong>Suspected open skull#</strong></p>

<p>3.<strong>Suspected basal skull#</strong></p>

<p>4.<strong>Vomiting ≥2 </strong></p>

<p>5.<strong>Age ≥65</strong></p>

<ul> <li></li> </ul>

<p><strong>MEDIUM Risk for Clinically Important Head Injury</strong></p>

<p>1.<strong>Amnesia before impact > 30 minutes</strong></p>

<p>2.<strong>Dangerous mechanism</strong></p>

<p>–<strong>Pedestrian struck</strong></p>

<p>–<strong>Ejection from vehicle</strong></p>

<p>–<strong>Fall from height (>3ft or 5 steps)</strong></p>

<p>–</p>

<ul> <li><strong>100% sensitive for HIGH risk</strong></li> </ul>

<p><strong>98.4% sensitive for MEDIUM risk</strong></p>

83
Q

<p>Definition of Massive Transfusion, complications, which are immune-mediated?</p>

A

“<ul> <li>Massive Transfusion > 10 U pRBC in a 24 hr period</li> <li><strong>Acute complications:</strong></li> </ul> <p style=""><em>Consumptive coagulopathy</em></p> <p style=""><em>Excessive fibrinolysis</em></p> <p style=""><em>Dilutional coagulopathy</em></p> <p style=""><em>Hypothermia</em></p> <p style=""><em>Acidosis, citrate, hypo Ca/Mg</em></p> <p style=""><em>Hyper K+ (on last week’s ER)</em></p> <p style=""><em>TRALI</em></p> <p><strong>Immune-mediated</strong></p> <p style=""><em>Haemolytic transfusion reactions (e.g. ABO or Rh)</em></p> <p style=""><em>Non-haemolytic febrile reaction</em></p> <p style=""><em>Allergic Reaction (simple or severe/anaphylaxis)</em></p>”

84
Q

<p>Indications for acute seizure prophylaxis in head injuries. What is the goal?</p>

A

<ul> <li>Depressed Skull #</li> <li>Paralyzed & intubated pt</li> <li>Seizure at the time of injury</li> <li>Seizure in ED</li> <li>Penetrating Brain Injury</li> <li>Severe HI (GCS<8)</li> <li>Acute Subdural hematoma</li> <li>Acute Epidural hematoma</li> <li>Acute ICH</li> <li>Prior history of seizures</li> </ul>

<p>GOAL:</p>

<ul> <li>To reduce the risk of early seizures (early prophylaxis) (decrease 66%) \prevents additional insult (increase ICP) to the brain -> does not prevent late post-traumatic seizures</li> </ul>

85
Q

PECARN 2

A

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CCFP(EM) Omar (27 decks)

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