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Year 3 Surgery > Major Trauma > Flashcards

Major Trauma Flashcards

1
Q

What is ROCSM?

A

Restriction of Cervical Spine Motion

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2
Q

At what GCS score are patients unable to maintain their airway?

A

8 or below

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3
Q

What is important about a fracture to the first rib?

A

Requires such significant energy that it is v likely there are other injuries

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4
Q

What is shock?

A

Failure of the circulation to provide adequate perfusion to the tissues

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5
Q

What are the classes of shock?

A

Class I - <15% blood loss - normal vitals
Class II - 15-30% blood loss - tachycardia + narrowing of pulse pressure
Class III - 30-40% blood loss - low BP, reduced urine output, anxiety/mild confusion, tachypnoea
Class IV - >40% blood loss - reduced consciousness

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6
Q

What are the 5 places that blood can be sequestered in the body during major trauma? (On the floor and four more…)

A

External bleeding
Abdominal bleeding
Chest bleeding
Long bone bleeding (especially femoral)
Retroperitoneal bleeding

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7
Q

What is Poiseuille’s law

A

That flow through a tube is proportional to the radius to the power 4 and inversely proportional to the length (i.e. short and fat tubes better than long thin ones for resus)

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8
Q

What is the definition of a major transfusion?

A

Replacement of total blood volume in 24 hours (i.e. > 10 units of blood)

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9
Q

What are the common complications of major transfusion?

A

Metabolic alkalosis
Hypocalcaemia
Hypothermia
Hyperkalaemia

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10
Q

Why does major transfusion cause hypocalcemia?

A

There is addition of sodium citrate to blood products - the citrate binds to calcium in the patient and inactivates it.

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11
Q

Why does major transfusion cause metabolic alkalosis?

A

Citric acid and lactate from the stored blood are converted to bicarbonate in the liver.

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12
Q

Why does major transfusion cause hyperkalaemia?

A

Cell lysis in the stored blood = release of K+
Also K+ / H+ pump stops working as well - allows K+ to leak out of the cells.

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13
Q

What is the function of tranexamic acid? How does it do this?

A

It stops clots breaking down
It binds (reversibly) to plasminogen - reduces the conversion of plasminogen to plasmin (plasmin is used to break down fibrin in clots)

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14
Q

What is the window for tranexamic acid to be given as treatment?

A

Within 3 hours

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15
Q

Deceleration injuries can do what to the aorta?

A

Cause a tear at the ligamentum arteriosum - is unsurvivable.

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16
Q

In deceleration injuries - at which point does the aorta tear?

A

At the ligamentum arteriosum (between aortic arch and pulmonary trunk).

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17
Q

What is Beck’s triad

A

Signs of cardiac tamponade
- Muffled heart sounds
- Low BP
- Distended neck veins

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18
Q

What is the most common cause of cardiac tamponade?

A

Blunt chest injury from hitting a steering wheel

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19
Q

What is the immediate management of a long bone fracture?

A

Splinting - can tamponade bleeding and reduce pressure on nerves or TVs

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20
Q

Which three things are scored for GCS?

A

Eye Response
Speech Response
Motor Response

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21
Q

How is the eye scored on GCS?

A

4 - Spontaneous movement
3 - To Speech
2 - To Pain
1 - No response

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22
Q

How is speech scored on GCS?

A

5 - Orientated to time and place
4 - Confused
3 - Inappropriate words
2 - Incomprehensible sounds
1 - No response

(Orientated, confused, words, sounds, unresponsive)

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23
Q

How is motor control scored on GCS?

A

6 - Obeys command
5 - Moves to localised pain
4 - Flex to withdraw from pain
3 - Abnormal flexion
2 - Abnormal extension
1 - No response

24
Q

What are the GCS thresholds for brain injury?

A

13-14 = mild brain injury
9-12 = moderate brain injury
8 or below = severe brain injury

25
Q

Why is the airway at risk with a GCS less than 8

A

Risk of occlusion of the airway from the tongue

26
Q

What is the difference between primary and secondary brain injury?

A

Primary = result of direct injury to the brain tissue
Secondary = failure to maintain adequate oxygenation and perfusion the brain tissue during assessment

27
Q

What is the Monro-Kellie doctrine?

A

It says that the brain is in a fixed chamber - and that venous volume and CSF will be moved out first in the case of raised ICP (75ml of each)

28
Q

What is the point of decompensation with raised ICP?

A

Is the point where the brain starts to herniate out of the foramen magnum.

29
Q

What clinical sign can indicate the point of decompensation? What CN is effected to result in this?

A

Blown / dilated pupil
CN III which travels around the border of the foramen magnum

30
Q

What do you need to worry about if a patient has been lying on a hard board for > 2 hours?

A

Pressure ulcers

31
Q

Why can trauma patients be at risk of hypothermia?

A

Pre-hospital exposure
Iatrogenic - removal of clothing, rapid infusion of cool fluids

32
Q

How high does the diaphragm go in expiration?

A

5th intercostal space

33
Q

Which is the most commonly injured abdominal organ?

A

The liver

34
Q

How is liver injury managed?

A

Often conservatively
If severe - may need surgery for packing or resection (v rare).
Can do endovascular tx if available.

35
Q

How is the spleen most commonly injured?

A

Blunt trauma

36
Q

How is splenic injury treated?

A

If unstable with significant injury = splenectomy
Lesser injury & stable = splenic artery embolisation
Minor injury = conservative manage & close monitoring

37
Q

How is the kidney most commonly injured?

A

Blunt trauma

38
Q

What is the most common clinical sign that the kidney is injured?

A

Haematuria (visible or microscopic)

39
Q

How are renal injuries often managed?

A

95% can be managed conservatively
Surgery or endovascular intervention if unstable

40
Q

How does the pelvis commonly break?

A

In more than one place - like a polo mint

41
Q

What is the commonest cause of pelvic injury?

A

High energy blunt injury

42
Q

What is important to consider when dealing with a pelvic injury?

A

That blood loss can be significant in this area - the pelvis can hold the entire blood volume.

Is lots of pelvic vasculature that can bleed.

Damage can occur to abdomen or pelvic viscera

43
Q

What is the cause of an unstable “open book” pelvic fracture?

A

Anterior-posterior compression

44
Q

What are the signs of an unstable pelvic fracture?

A

Externally rotated legs
Bleeding / bruising (perineum, PR, PV)

45
Q

How do we initially treat an unstable pelvic fracture? Why?

A

Pelvic binder - reduces the volume and therefore the potential blood loss.

46
Q

What is the management of a pelvic fracture?

A

Diagnosis - CT, MRI, Retrograde urethrogram, angiography (+/- embolisation)

Control bleeding - pelvic binder (temporary), surgery (less common), radiological intervention (v common)

Fix bones - externally or internally

47
Q

What are the following all warning signs of? What should you do?

Soot in mouth/nose
Facial burns
Singed facial hair
Stridor / noisy breathing
Swelling of lips or tongue

A

Signs of possible impending airway obstruction

Secure an early definitive airway

48
Q

If chest burns are substantial, what intervention can help with the patient’s breathing?

A

Escharotomy

49
Q

Why do burns patients needs fluids?

A

To replace losses from capillary leaks due to inflammation (not bleeding)

50
Q

What do we do for chemical burns?

A

Flush with large amounts of warm water for 20-30 minutes

51
Q

Which chemical burn is worse - acid or alkali?

A

Alkali - penetrates more deeply and causes widespread tissue necrosis

52
Q

What is the consequence of electrical burns that we need to be worried about?

A

Muscle breakdown –> rhabdomyolysis –> renal failure

53
Q

Why can muscle breakdown cause kidney failure?

A

Breakdown release creatine kinase, lactic acid, myoglobin and potassium - some of these block the renal tubules –> tubular necrosis –> renal failure

54
Q

What is a secondary survey of a patient in the trauma setting?

A

Top to toe exam of the P after completion of immediate treatment to ensure that nothing has been missed.

55
Q
A

Year 3 Surgery (11 decks)

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