Flashcards in ER, TRAUMA, ICU, SURGERY Deck (77)
2 components of disability portion of trauma assessment
Glasgow coma scale and finger-stick blood glucose.
4 classic findings in a basilar skull fracture
Battle sign (bruises on mastoid process)
CSF coming out of nose or ears
HTN + bradycardia + bradypnea
Rx involved in treatment of anterior spinal cord syndrome following a traumatic injury
Immediate high-dose IV steroids, ideally within 8 hours of methylprenisolone
Zone 1 of the neck
Clavicle -- > cricoid cartilage. Includes great vessels, aortic arch, trachea, esophagus, lung apices, cervical spine, spinal cord, and cervical nerve roots.
Zone II of the neck
Cricoid cartilage -->angle of the mandible. Carotid and vertebral arteries, jugular veins, pharynx, larynx, trachea*, esophagus*, cervical spine*, and spinal cord*
Zone III of the neck
Angle of the mandible -->base of the skull. Salivary and parotid glands, esophagus*, trachea*, cervical spine*, carotid arteries*, jugular veinS*, major cranial nerves.
Penetrating injury to zone I: initial assessment
4 vessel CTA
Penetrating injury to zone II: initial assessment
surgical exploration or doppler US + selective exploration
Penetrating injury to zone III: initial assessment
4 vessel CTA + triple endoscopy
If chest tube placement is delayed in tension ptx, what should be done in the meantime?
Needle decompression on the affected side at the 2nd or 3rd IC space at midclavicular line or 5th IC space at midaxillary line
Important part of treatment in flail chest
ANALGESIA! otherwise, patient may become hypoxic from limiting breathing due to pain.
What are the next steps in mgmt of blunt abdominal trauma in a patient with STABLE vital sings?
ABC, establish IV access at 2 sites with large bore IV, NG tube and Foley, CT And/Pelvis, Stat H&H +/- blood type and cross.
What are the next steps in mgmt of patient with blunt abdominal trauma and UNSTABLE vitals?
Primary and secondary survey, asses for and manage pelvic fx, FAST, if no blood in pelvis and angio is normal, CT Abd/pelvis + observation +/- admission
If blunt trauma without blood in abdomen, next steps?
Follow H+H. If hemodynamically unstable or falling H+H, angio with possible embolization.
What are the classic signs for a urethral injury?
Look for blood at urethral meatus, high riding "blamable" prostate, or absence of palpable prostate. If signs of injury, perform retrograde urethrogram to rule out injury prior to Foley cather placement.
Criteria that must be met prior to discharge of pregnant woman after traumatic event?
Contractions occurring no more often than >1 q 10 min.
Normal fetal heart tracing
No vaginal bleeding
No abdominal pain
Chest trauma + hypotension + JVD + distant heart sounds -->next step?
Pelvic fracture + DPL shows blood in pelvis
Pelvic fracture + DPL shows urine in the pelvis
Pelvic fx + DPL shows nothing + hemodynamic instability
Angio with poss embolization
Blunt abdom trauma + unstable vital signs + FAST shows fluid in pelvis
Blunt abdom trauma + unstable vital signs + FAST shows NO fluid in pelvis
Angio with possible embolization
Blunt abdominal trauma + unstable vital signs + FAST inconclusive
1-4 points in Eye Opening category of GCS
Spontaneous = 4
To voice = 3
To pain = 2
None = 1
1-5 points in Verbal Response category of GCS
Oriented = 5
Confused = 4
Inappropriate words = 3
Incomprehensible = 2
None = 1
1-6 points in Motor response category of GCS
Obeys commands = 6
Localizes pain = 5
Withdraws from pain = 4
Flexion with pain = 3
Extension with pain = 2
None = 1
While the head of an unconscious patient is turned, a patient's eyes follow the movement, rather than being fixed at a point in space. This is suggestive of which injuries?
Vestibular, cranial nerve, pontine, or medullary.
Important part of treatment in neck trauma (penetrating injury)
Prophylactic abx due to increased risk of contamination by oropharyngeal flora.