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Crawford - Trauma Flashcards

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1
Q

Definition of trauma

A

Physical damage to living tissue caused by extrinsic forces, often violence, accident, etc.

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2
Q

Describe timing and causes of death in triphasic disease.

A

1st phase – Seconds to minutes; deaths due to major or severe injuries
2nd phase – Minutes to hours; deaths due to treatable but life-threatening injuries
3rd phase – Days to weeks; deaths due to multiple organ system failure or infection

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3
Q

80% of trauma deaths occur when?

A

first hour after injury

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4
Q

“Lethal triad” seen in ER

A

hypothermia -> coagulopathy -> acidosis -> hypothermia…

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5
Q

What is the primary survey?

A

ABCDE

Quickly assess vital functions and intervene

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6
Q

What is secondary survey?

A

“Head to toe, treat as you go”
H&P exam
Every square cen/meter
“A finger or tube in every orifice”

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7
Q

Initial XR in ER trauma

A

Cross table C-spine, pCXR, Pelvis

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8
Q

When is FAST (Focused Abd Sonogram for Trauma) used? What is specifically examined?

A

Unstable patient in ED
Rapid U/S looking for blood or fluids around heart or in abdomen
4 views: perihepatic space, perisplenic space, pericardium, bladder/pelvis

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9
Q

Downsides of FAST exam?

A

High false negative
Operator dependent
Only picks up fluid over 500mL
Poor for use in obese

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10
Q

When to intubate according to GCS?

A

“less than 8, intubate”

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11
Q

Signs of basilar skull fracture

A

Battle’s sign
Hemotympanum
Raccoon’s eyes

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12
Q

Cerebral perfusion pressure = _______ - ________

A

mean arterial pressure - ICP

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13
Q

In an epidural hematoma, keep cerebral perfusion pressure above _______. How?

A

65-70 mmHg

with pressors (vasopressin, norepi, epi, dopamine)

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14
Q

What is Cushing’s Reflex?

A

HTN and bradycardia = BAD!!!

may occur in response to epidural bleed and elevated ICP

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15
Q

How is elevated ICP treated?

A
  1. Seda/on and pain management
  2. Hypertonic saline 3% - limits 3OM spacing in brain
  3. Mannitol – diure/c to remove intracellular fluid (osmo/c) 4. Hyperven/la/on- very temporarily
  4. Chemical paralysis – reduces cerebral oxygen demand
  5. Surgical procedures – craniotomy vs craniectomy
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16
Q

How to r/o ruptured globe in eye trauma?

A

good EOM

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17
Q

EOM entrapment is _________ until proven otherwise.

A

orbital fracture

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18
Q

How to treat retrobulbar hematoma?

A

emergency lateral canthotomy

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19
Q

LeFort fractures

A

facial fractures involving the maxillary bone and surrounding structures

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20
Q

Nexus Rules for clearing C-spine precautions and getting XR

A

No midline tenderness No neurologic deficits
No intoxicants
No distracting injury Normal mental status

If none of the above criteria present, C-Spine cleared and imaging is not required.

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21
Q

Spinal fracture management

A

Immobilization - NOT traction

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22
Q

Chance fracture

A
  • Complete anterior-posterior spinal fracture
  • Unstable fracture
  • High association with mesenteric or bowel injury
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23
Q

What is SCIWORA?

A

Spinal cord injury without obvious radiographic abnormality

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24
Q

young adult with sudden CVA symptoms =

A

Carotid Artery Dissection

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25
Why give anticoagulation in carotid artery dissection?
prevent embolic stroke
26
Typical location of aortic disruption? Why?
ligamentum arteriosum due to rapid deceleration
27
Signs of aortic disruption on PE and XR
Difference of +10mmHg between R/L arms should raise suspicion CXR demonstrates widened mediastinum, apical capping, or tracheal displacement
28
Treatment of aortic disruption
Emergent aor/c repair (endovascular) or replacement
29
Treatment of open pneumothorax
cover hole on 3 sides
30
Treatment of tension pneumothorax
EMERGENCY needle decompression
31
Late signs of tension pneumothorax
JVD | Tracheal deviation
32
Location of needle decompression for tension pneumothorax
2nd intercostal space at midclavicular line; advance needle OVER rib
33
How to do tube thoracostomy?
36 Fr or bigger tube (bigger the better) Sentinel hole must be within pleural cavity Output from CT (>1500ml ini/ally, or >200ml/hr) requires surgical exploration
34
Iatrogenic cause of hemothorax
intercostal vessel injured during chest tube insertion
35
Sign of diaphragm injury on exam
bowel sounds in chest
36
Significance of any 1st rib or scapular fractures
require large energy to produce fracture must look for other injuries even if patient ok
37
What must be causing a continued large air leak with 2 well-placed chest tubes?
tracheal or bronchial tree injury
38
Hallmark sign of Pericardial Tamponade
Becks triad - hypotension, muffled heart tones, JVD
39
What must you think in association with PEA?
Pericardial tamponade
40
Prophylactic immunizations for splenectomy or higher than Grade III laceration
Izzies for encapsulated organisms: H. flu, Menigococus, Pneumococcus
41
Abdominal compartment syndrome exam findings
Exam reveals a hypotensive pa/ent, increasing ven/lator resistance, diminished urine output, with a firm abdomen, and significantly elevated bladder pressures >30mmHg
42
Treatment of abdominal compartment syndrome
laparotomy (open abd) even if in ED or ICU - can't wait!!!
43
All open fractures require what treatment?
antibiotics
44
What should always be eval'd on a fall from height injury?
entire spine and bilateral calcanei
45
Treatment of pelvic fractures
"close the book", Sam-Sling, sheet, external fixation, surgical repair
46
What urethral injuries require RUG before advancing a catheter?
Blood at the meatus, high-riding prostate, or perineal ecchymosis
47
Fat embolism syndrome characterized by what symptoms?
petechial rash, confusion, hypoxia, bilateral pulm infiltrates, microfat in urine
48
If vascular injury suspected, then what should be checked?
Ankle/Brachial index ABI less than 0.90 needs further eval
49
What is occluded in compartment syndrome?
arterial blood flow to contained space
50
Pain out of proportion to exam with absent pulse and pallor of extremity =
compartment syndrome
51
How is compartment syndrome treated?
Fasciotomy
52
Best method of hemorrhage control? other options?
Direct pressure and elevation others: Tourniquet, Cautery, Suture
53
Where can you lose enough blood to bleed to death?
"CARTS" = Chest, Abdomen, Retroperitoneum, Thigh, Street (at the scene)
54
Rule ratio for massive blood transfusion
1:1:1:1 Rule (try to make whole blood) - plasma, platelets, RBCs
55
______ is narrowest part of pediatric airway, whereas ______ is narrowest part in adults.
cricoid | vocal cords
56
Rule for trauma in a pregnant patient
Treat the mother = save the fetus
57
Important positioning of pregnant patient
prop on right side or roll backboard to keep uterus off the vena cava
58
First degree vs second vs third
1st: only epidermis affected 2nd: epidermis and dermis; BLISTERS 3rd: dermis destroyed including dermal appendages; no pain or blanching
59
Rule of 9's when estimating percentage of body burned
``` Head = 9 Each arm = 9 Front of each leg = 9 Front of torso = 18 Back of torso = 18 ```
60
Leading complication in burns, causing high morbidity
infection -> systemic sepsis
61
Fluid resuscitation treatment in burns
Parkland formula: % BA x kg x 4mL/hr = total fluid needed in next 24 hrs 1/2 in first 8 hrs and 1/2 in next 16 hrs NS or LR
62
How to measure adequate circulation and hemodynamic stability in burn patient? What is normal?
urine output with Foley catheter at least 0.5 mL/kg/hr in adult at least 1 mL/kg/hr in child
63
When is escharotomy indicated?
in circumferential burns of extremities or anterior trunk where there is risk for compartment syndrome
64
Most common topical burn ointment
Sulfadiazine (Silvadene)
65
How to treat minor burn?
Bacitracin and gauze

ED/Surgery (16 decks)

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