EM and Trauma Flashcards
(37 cards)
when ischaemia is present how long do you have to repair the vascular trauma to prevent irreversible muscle ischaemia and loss of function
6-8h
isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia -
which arteries and Dx infarct
Perforating arteries around internal capsule, thalamus and basal ganglia
Lacunar infarct
safest option to control bleeding from the liver
Pack the liver and close abdomen with Bogota bag system
Resection/Repair can be consirdered later once physiology normalised, definitive attempts at suturing or resection at primary laparotomy are complicated by severe bleeding
most effective rewarming technique for hypothermia stage 2 moderate
Stage 2 28-32 degreees
Warmed intraperitoneal fluid
management of severe hypothermia
20-28 degrees
peritoneal lavage
haemodialysis
cardiac bypass
Mx of addison’s crisis
IV hydrocortisone 100mg 6hrly unitl stable
1L NaCl/30min-1h w dextrose if hypoglycaemic
Start PO after 24h and wean to nornmal dose over 3-4days
common findings of Le Fort 2 fractures
infraorbital parasthesia, palatal mobility, malocculsion
enopthalmos if severe
preferred Ca replacement
IV calcium gluconate 10ml of 10% over 10 mins
CXR findings in diaphragmatic rupture
Hemidiaphragm not visible
Bowel loops in lower half of thorax
Mediastinum displaced
restlessness, agitation + involuntary upward deviation of eyes - which crisis, causes and Mx
Oculogyric crisis
Phenothiazines
Haloperidol
Metoclopramide
Mx - Procyclidine
Flail chest w <90% sats - Mx
Intubation and Ventilation
indication for splenic resection
Hilar injury
Major haemorrhage
Cause of GI haemorrhage in 30% burns
Curling Ulcer - caused by reduced blood supply to stomach
how can flail chest cause T PTX
Can lacerate underlying lung and create flap valve
what causes renal failure following fasciotomy and how to treat
Myoglobinuria
Treat with aggressive IV fluids
signs of orbital apex syndrome
Complete opthalmoplegia
Ipsilateral visual loss and pupillary defect
Loss of corneal reflex
Ptosis
Altered cutaneous sensation from forehad to vertex
nerves affected in superior orbital fissure syndrome
Cranial nerve 3, 4, 6
Frontal branch of trigeminal nerve
Fluid resuscitation rate + urine output target in electrical injury
4ml hartmanns x kg x %TBSA
1-1.5ml/kg/hr until urine clears
Mx of toxicity due to prilocaine
Methylene blue
ipsilateral ataxia, nystagmus, dysphagia, facial numbess, cranial nerve palsy and contralateral hemisensory loss - Dx
Lateral medullary syndrome
max dose for lignocaine, bupivicaine and prilocaine
Lignocaine 3mg/kg 1% = 100mg/10ml
Bupivicaine 2mg/kg
Prilocaine 6mg/kg
gold standard investigation for placental abruption in pregnant trauma patients
CTAP
Indications for escharotomy
circumferential full thickness burns to torso or limbs
to relieve compartent syndrome or oedema (may present w parasethesia)
where do aortic transections typically occur
Distal to ligamentum arteriosum
