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ACC > Trauma > Flashcards

Trauma Flashcards

1
Q

What are the signs a patient with a spinal injury may have?

A 
Diaphragmatic breathing
Evidence of neurogenic shock
Priapism
Responds to pain only above clavicle
Flexed posture of upper limbs/flaccid areflexia
Complains of loss of sensation/function
Spinal tenderness/bruising
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2
Q

How is a spinal injury managed immediately?

A 
Optimise O2 & adequate ventilation
Maintain spinal cord perfusion
Immobilise
Spinal examination
Urinary catheter & NG tube
Definite imaging
Early specialist advice
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3
Q

What are the signs of MSK trauma?

A 
Limb deformity/amputation
Localised pain
Soft tissue wound
Splinting applied pre-hospital
Pelvic instability
neurovascular compromise
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4
Q

What are complications of MSK trauma?

A

Nerve compression
Skin necrosis
Compartment syndrome

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5
Q

What makes up the trauma triad of death?

A

Coagulopathy
Metabolic acidosis
Hypothermia

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6
Q

When is the canadian C-Spine rule applied?

A

Alert, stable (GCS 15) trauma patients with suspected cervical spine injury

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7
Q

According to the Canadian C-Spine rule what mandates radiography input?

A
  • > 65
  • Dangerous mechanism
  • Paraesthesias in extremities
  • Unable to actively rotate neck 45 degrees L or R
  • No low RFs allowing safe assessment of RoM

If low risk rules met no need to scan

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8
Q

What type of injuries are triaged to a MTC?

A

-Chest injuries
-Traumatic amputation
-Penetrating trauma
-Open/closed head injury
-Time critical burns
-Fall from height >3feet
-Axial lead to head
MVC high speed/ejection
-Bicycle collision/bullseye

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9
Q

What does eFAST look for?

A

Pneumothorax
Haemothorax
Pericardial effusion
Intraperitoneal haemorrhage

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10
Q

Define shock

A

Circulatory failure leading to inadequate organ perfusion & tissue oxygenation leading to abnormal metabolic function

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11
Q

What are the types of shock?

A

Cardiogenic
Hypovolaemic
Obstructive
Distributive: Anaphylactic, Septic, Neurogenic

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12
Q

What are the causes of the different types of shock?

A

-HypoV: Haemorrhage, dehydration, intravascular
-Obstructive: PE, tension PT
-Cardio: MI, arrhythmia, valvular, obstruction to flow
COOL & PALE
-Distributive: Sepsis, epidural, adrenal insufficiency, drugs & toxins, anaphylaxis, lack of vasomotor tone, neurogenic, liver failure
WARM W/VASOD

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13
Q

What are the consequences of shock & repercussion?

A
  1. Intracellular Ca overload leading to dec myocardial contractility, dec ATP & degradation of ion pumps via free radicals
  2. H+ excess causes dec catecholamine effect & dec myocardial function
  3. Metabolism becomes glycolysis dependent so inc FFA & lactic acid
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14
Q

Why may a central venous catheter be inserted in a critically ill patient?

A
  • Measure central venous pressure- indicator of fluid status

- Permit the use of drugs that can only be given into a central vein (NorA)

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15
Q

Why may an arterial line be inserted in a critically ill patient?

A
  • Beat-beat measurement of blood pressure
  • Regular & repeated arterial blood sample
  • Analysis of waveform can indicate adequacy of filling
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16
Q

What equipment is available in a resus kit?

A 
Portable suction
All airway devices
Stethoscope
Bag & mask ventilation
laryngoscope
syringes
Drugs bag
oxygen cylinder
17
Q

What are the initial investigations for an unconscious patient brought into A&E?

A 
CT/MRI head
ECG
Glucose
Bloods & Tox screen
ABG
Sepsis screen
18
Q

What is classed as a dangerous mechanism of injury?

A 
Fall from >1m
Axial load to head (diving)
MVC at high speed, rollover, ejection
Bicycle collision
Motorized recreational vehicles
19
Q

If C-Spine rules apply, what type of scanning should be done?

A

CT

If euro abnormality post-CT: MRI

20
Q

What factors mean a head CT should be done within 1hour?

A 
GCS <13
GCS <15 at 2hours after the injury
Suspected open/depressed skull #
Sign of basal skull # (panda eyes, cerebrospinal fluid leakage, Battle's sign)
Post-traumatic seizure
Focal neuro deficit
>1 episode of vomiting
Warfarin: ALL get a CT
21
Q

What factors mean a head CT should be done within 8hours?

A

> 65years
Hx of bleeding/clotting
Dangerous mechanism
30mins retrograde amnesia

22
Q

In a head injury, when should a neurosurgeon be involved?

A 
Persisting coma after initial resus
Unexplained confusion >4hours
Deteriorating GCS after admission
Progressive focal neuro signs
CSF leak
Definite/suspected penetrating injury
Seizure without full recovery
23
Q

What operations require a group and save?

A 
Hysterectomy (simple)
Appendicectomy
Thyroidectomy
Elective LSCS
Laparoscopic cholecystectomy
24
Q

What operations require Cross-match of 2u?

A

Salpingectomy for ruptured ectopic pregnancy

Total hip replacement

25
Q

What operations require Cross-match of 4-6u?

A 
Total gastrectomy
Oophorectomy
Oesophagectomy
Elective AAA repair
Cystectomy
Hepatectomy
26
Q

What makes up the Primary Survey?

A

Airway maintenance w/C-Spine protection
Breathing & ventilation w/high flow O2
Circulation w/haemorrhage control
Disability & neurologic status w/prevention of secondary injury
Exposure & environmental control (temp)

27
Q

What are the potential sites of bleeding?

A 
On the floor &amp; four more:
External wounds
Chest cavity
Abdominal cavity
Pelvic cavity
Long bone fractures
28
Q

What is a GCS Score made up of?

A
  • Best eye response: 4) Spontaneous 3) Verbal 2) Pain 1) No eye opening
  • Best verbal response: 5) Oriented 4) Confused 3) Inappropriate words 2) Incomprehensible sounds 1) No verbal response
  • Best motor response: 6) Obeys command 5) Localizes pain 4) Withdrawal from pain 3) Flexion to pain 2) Extension to pain 1) No motor response
29
Q

What can cause organ failure?

A

Consequence of direct injury (toxin, MI, pneumonia)

As a consequence of shock w/tissue ischaemia & dysfunction occurring as a consequence of hypoxia

30
Q

What are the indicators of specific organ failure?

A

Resp: Requires O2 +/- ventilation
CV: Low BP, vasopressors/inotropes
Renal: Reduced/no urine output, raised creatinine
NS: Reduced conscious level
Liver: Low sugars, high lactate, encephalopathy, coagulopathy, raised bili
Haem: Low platelets, deranged coag (PTT)

31
Q

What are the clinical signs of shock?

A 
Inadequate perfusion: 
-General: BP <90s, lactate >3, BE < -4, reduced CRT
-Brain: Lethargy, somnolence
-Kidneys: Oliguria/anuria
Attempted compensation:
-Tachycardia
-Tachypnoea
32
Q

What is a central venous catheter used for?

A

Similar to assessing JVP clinically:
Indicator of fluid status
Permit the use of drugs that can only be given in a central vein (NorA)

33
Q

Which vasoactive drugs should be given in:
HypoV
Cardiogenic
Distributive shock

A

HypoV: Fluids
Cardio: Inotrope (Dobutamine)
Dist: Vasopressor (NorA)

ACC (21 decks)

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