ED/Trauma Flashcards
(29 cards)
GCS
E 4
V 5
M 6
4 - Eye-opening spontaneously
3 - Eye-opening to sound
2 - Eye-opening to pain
1 - No response
5 - Orientated
4 - Confused conversation
3 - Inappropriate words
2 - Incomprehensible sounds
6 - Obeys command 5 - Localises to pain 4 - Withdraws to pain 3 - Flexion decorticate posture 2 - Abnormal extension decerebrate posture 1 - No response
Preferred method of haemorrhage control in external haemorrhage
Packing
Haemothorax caused by laceration to which vessel commonly?
intercostal vessel/internal mammary artery
When is surgical exploration/thoracotomy warranted in haemothorax?
> 1500mL blood drained immediately on chest drain
ongoing losses of >200mL/hour for >2 hours
Mediastinal traversing wounds Ix
CT angiogram
oesophageal contrast swallow
Diaphragmatic injury is normally on which side?
Left side
Scoring system used for ACS + purpose
GRACE
calculates predicted 6 month mortality
Aortic dissection pathology
tear in intimal layer
formation and propagation of subintimal haematoma
Most common site of aortic dissection
90% occurs within 10cm of aortic valve
Stanford A dissection location
ascending aorta/aortic root
Stanford B dissection location
descending aorta
DeBakey I dissection location
ascending aorta/aortic arch/descending aorta
DeBakey II dissection location
ascending aorta only
DeBakey III dissection location
descending aorta distal to left subclavian artery
Hyponatraemia after head injury most likely to be due to
SIADH
NEXUS criteria
Full spine immobilisation if: GCS <15 neck pain/tenderness paraesthesia in extremities focal neurological deficit suspected C spine injury
Immediate CT head within 1 hour if (7):
GCS <13 GCS <15 2h after admission suspected open/depressed skull fracture suspected skull base fracture focal neurology vomiting >1 episode post traumatic seizure coagulopathy
Indications for hemicraniotomy (4):
age <60
clinical deficit in MCA territory
decreased GCS
>50% territory infarct
ECG changes for thrombolysis or percutaneous intervention
ST elevation of > 2mm (2 small squares) in 2 or more consecutive anterior leads (V1-V6) OR
ST elevation of greater than 1mm (1 small square) in greater than 2 consecutive inferior leads (II, III, avF, avL) OR
New Left bundle branch block
Criteria for immediate request for CT scan of the head (children) (12)
Loss of consciousness lasting more than 5 minutes (witnessed)
Amnesia (antegrade or retrograde) lasting more than 5 minutes
Abnormal drowsiness
Three or more discrete episodes of vomiting
Clinical suspicion of non-accidental injury
Post-traumatic seizure but no history of epilepsy
GCS less than 14, or for a baby under 1 year GCS (paediatric) less than 15, on assessment in the emergency department
Suspicion of open or depressed skull injury or tense fontanelle
Any sign of basal skull fracture (haemotympanum, panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign)
Focal neurological deficit
If under 1 year, presence of bruise, swelling or laceration of more than 5 cm on the head
Dangerous mechanism of injury (high-speed road traffic accident either as pedestrian, cyclist or vehicle occupant, fall from a height of greater than 3 m, high-speed injury from a projectile or an object)
Pregnant patient with trauma - which position should they be placed in?
Left lateral decubitus
Displaced uterus from vena cava to reduce compression and increase venous return
ATLS formula for burns resuscitation
2ml x wt x TBSA
half in first 8h
half in next 16h
Wallace’s rule of nines
front + back of the head and neck = 9% front + back of each arm and hand = 9% chest = 9% abdomen = 9% upper back = 9% lower back = 9% front + back of each leg and foot = 18% genital area = 1%
Which hormones are elevated following trauma?
ADH, catecholamines and corticosteroids
