Flashcards in Pestana Trauma Deck (68):
Four signs of Basilar Fracture
Raccoon eyes, rhinorrhea, otorrhea, ecchymoses behind the ear.
Six steps of Epidural Hematoma? What will be seen on CT scan? Treatment?
1. Whacked on the side of the head
3. Lucid State
5. Fixed dilated pupil (ipsilateral)
6. Contralateral hemiparalysis (decerebrate)
CT scan (biconvex hematoma) and craniomoty.
Medical management of Increased ICP (5)
1. Elevate head
2. Hyperventilate (Get PCO2 to 35)
3. Fluid restriction
4. Mannitol or Furosemide
Hemisection from knife wound
Name and Deficits?
Brown-Sequard - Assess by MRI
Ipsilateral: Paralysis and no Proprioception
Contralateral: No pain
Burst fracture of vertebral bodies from car accident.
Name and Deficits?
Anterior Cord Syndrome - Assess by MRI
Loss of motor function, pain, and temperature on both sides. Preservation of proprioception.
Elderly rear ended, neck hyperextends
Name and Deficits?
Central cord Syndrome - Assess by MRI
Upper extremities: paralysis and pain
Lower extremities: mostly fine
What must be done if a traumatic event necessitates splenectomy?
PO Immunization against H. Flu B, Pneumococcus (Pneumovax 23, then 17), Meningococcus (Conjugate if 15-65, Polysaccharide if >65). Encapsulated Bacteria!
In a pelvic fracture, how do you rule out associated injuries?
Rectal exam, proctoscopy, pelvic exam (F), retrograde cystourethrogram (M)
How to treat pelvic fracture with ongoing significant bleeding?
Pelvic fixators and angiographic embolization of both internal iliacs.
A patient experiences a pelvic fracture. Tests? How are intraperitoneal bladder leaks treated vs. extraperitoneal?
Retrograde cystogram with postvoid films.
Intra: surgical repair + suprapubic cystostomy
After tetanus prophylaxis and cleaning of the burn, what agents are used for topical burns? Deep burns? Burns near the eyes?
Silver sulfadiazine. Mafenide acetate. Triple antibiotic ointment (silver burns the eyes).
If the patient has very limited 3rd degree burns, you should consider...
Early excision and grafting
Spider bite induces nausea, vomiting, muscle cramps.
Type and treatment?
Black Widow - IV Calcium Gluconate
Spider bite with skin ulcer (necrotic center and erythematous ring). Type and treatment?
Brown recluse - Surgical excision
Patient with multiple penetrating injuries that require surgery - he looks SHOCKY? Treatment? End goal?
Hemorrhagic shock. Stop the bleeding first. Replace fluids with Ringers/NS (no sugar) followed by packed RBC until urine output 0.5-2mL/kg/hr while not exceeding CVP of 15.
Describe a patient that looks SHOCKY (9)
Hypotensive, tachycardic, feeble pulses, urine output <0.5 ml/kg/h, pale, cold, apprehensive, shaking, sweating.
Patient presents with severe chest trauma, distended JVP, but in no respiratory distress looks SHOCKY? Tests and treatment?
Pericardial Tamponade. No CXR needed, maybe you can use sonogram. Pericardiocentesis.
Patient presents with chest trauma, distended JVP, in respiratory distress looks SHOCKY? Tests and treatment?
Tension pneumothorax. No CXR or ABG needed. Needle decompression in 2nd intercostal space (midclavicular), chest tube connected to underwater seal.
Cause of hypovolemic, cardiogenic, and vasomotor shock? CVP status? Treatments?
Hypo: Low SV from massive fluid loss, low CVP --> Stop any blood loss and fluids.
Cardio: Low CO from cardiac damage, high CBP --> Circulatory support DON'T give fluids.
Vasomotor: Bee sting or spinal injury, low CVP --> Vasopressors and fluids.
Patient whacked really bad in the head and is never fully awake afterwards? Treatment?
Acute subdural hematoma.CT scan, decrease ICP medically.
Severe brain trauma displays blurred grey-white interface and minute punctate hemorrhages on CT scan? Treatment?
Diffuse axonal injury. CT scan, decrease ICP medically.
Old patient exhibits progressive mental decline after minor head trauma a few days-weeks ago? Treatment?
Chronic subdural hematoma. CT Scan, surgically evacuate blood.
What is the best test to assess the status of the cervical spine?
Elderly patient presents with chest pain that (if not stopped) progresses to pneumonia? Treatment?
Rib Fracture. Local nerve block and epidural catheter.
Clinical presentation and treatment of (Tension) pneumothrorax? Treatment?
One side of the thorax has no breath sounds and is hyperresonant to percussion. Needle decompression in 2nd intercostal space (midclavicular), place chest tube in upper chest anteriorly, and connect to underwater seal.
Clinical presentation and treatment of hemothorax? When is surgery required?
One side of the thorax has no breath sounds and is dull to percussion. CXR, place chest tube in lower chest and draw out blood.
If intercostal artery is cut, serious blood loss can occur.
If >1500ml blood recovered initially, or >200ml/hr for more than 2 hours drains - operate.
What tests (and why)should initially be used on a non-SHOCKY patient after severe blunt trauma to the chest (5)?
CXR (lung contusion), ABG (respiratory dysfunction), EKG (myocardial contusion inducing arrhythmia), Troponins (cardiac ischemia), and Spiral CT angio (aortic transection).
Patient with severe blunt chest trauma presents with paradoxic breathing? Tests and treatment?
Flail chest. CXR (white out), ABG, Spiral CT angio. Use diuretics and fluid restriction to prevent fluid overload of contused lung. Place on bilateral chest tube respirator if needed.
Tell tale sign of transected AAA (2)?
Widened mediastinum on CT or left sided hemothorax. Otherwise asymptomatic.
Subcutaneous emphysema DDx (3)? Tests and treatment?
RUPTURE OF TRACHEA or BRONCHUS, esophogeal rupture (after endoscopy), tension pneumothorax. CXR and fiberoptic bronchoscopy. Surgically repaired.
A patient on a respirator after chest trauma develops sudden cardiac arrest? Treatment?
Air embolism. Cardiac massage with patient's left side down.
A patient with multiple lines after chest trauma develops sudden cardiac arrest? Treatment? How to prevent inappropriate placement?
Air embolism (air exposed to subclavian vein). Cardiac massage with patient's left side down. CXR.
A patient who suffered a great fall/car crash develops petechial rashes in the axillae and neck, fever, tachycardia, and thrombocytopenia. Respiratory distress follows? Treatment?
Fat embolism (fat will be seen in the urine). CXR and Ventilate.
Test for gun and knife wounds?
Blunt trauma of the abdomen that develops peritoneal irritation necessitates?
How to diagnose intra-abdominal bleeding in a hemodynamically stable patient? In a hemodynamically unstable patient?
FAST or DPL.
Perioperative complications from prolonged abdominal surgery (4)? Treatment of pre/post op complications?
Coagulopathy, hypothermia, acidosis (Terrible Triad) --> stop operation, warm patient, pack bleeding surfaces.
Abdominal compartment syndrome (distension, hypoxia, poor renal perfusion). --> Laparotomy and place mesh.
Symptoms of urethral injury (3)? Tests? Contraindications?
Blood at the meatus, inability to void, high riding prostate on DRE. Retrograde urethrogram. DO NOT PUT IN A FOLEY.
A patient reports lower rib pain? Tests? Complications?
CT scan to identify rib fractures that might have penetrated the kidney. AV fistula leading to CHF after damage to renal pedicle.
Man presents with a bullshit story about why his penis has a large hematoma on the shaft? Treatment?
Fracture of the penis after some freaky sex. Retrograde urethrogram followed by emergency surgery.
Crushing injury complications (5)? Treatments (4)?
Hyperkalemia, myoglobinemia, myoglobinuria, renal failure, compartment syndrome.
Fluids, mannitol, alkanize urine, fasciotomy.
Patient presents with chemical burn. Which is worse, acid or base? Treatment?
Base. Rapid irrigation with water.
What test diagnoses respiratory burns? What should be used to determine if they need a respirator?
Fiberoptic bronchoscopy. ABG.
Circumferential burns of the extremities can be fixed by?
Fluid needs after burns? What about for babies?
1 liter/hr of Ringers/NS (no sugar) and adjust to desired urinary output. Start with 20/mL/kg/hr before adjusting.
All bites require?
Tetanus prophylaxis and wound care.
What are the immediate, acute, and late developments of an electrical burn? Treatments?
Renal failure from myglobinemia/uria - Fluids, mannitol, alkalinize urine.
Dislocations or vertebral compressions (muscle contraction - Xray and resetting
Cataracts and demyelinizations - NA
How to estimate extent of burns in Adults? Infants?
Rule of 9's
A: head (1), arms (2), torso (4), legs (4)
C: head (2), arms (2), torso (4), legs (3)
After massive RBC transfusion you note hypocalcemia. Why?
RBC are stored in citrate (sequesters Ca). Dilution by excess fluid.
A patient presents with a stab wound to the upper thigh. You notice absent dorsal pedalis pulses and an expanding hematoma. How should you manage this patient?
Surgical exploration and repair.
A patient presents after suffering severe blunt trauma from a motor vehicle accident. On x-ray, you notice that the NG tube that you placed has curled back up into the left chest?
An 70 year old woman presents with a fractured humerus that she broke while lifting her groceries?
Metastatic bone cancer.
A patient suffers a motorcycle accident with pelvic fracture, work up suggests no urethral injuries. Before discharge you note microscopic hematuria. Tests?
No further tests are needed.
Patient who suffered spinal cord injury. What can improve neuromuscular function if injected within 8 hours?
High dose steroids (methylprednisolone).
How many regions are looked at for FAST. How many potential spaces?
4 - RUG, Subxiphoid, LUQ, Suprapubic
RUQ/LUQ: Pleural, Subphrenic, Hepato/spleno renal, infrarenal.
Suprapubic - Rectovesical (M)/uterine space (Pouch of Douglas in F)
Zone 1 of Retroperitoneal Hematoma?
Centrally located, associated with pancreaticoduodenal injuries or major abdominal vascular injury.
Zone 2 of Retroperitoneal Hematoma?
Flank or perinephric regions, associated with injuries to the genitourinary system or colon.
Zone 3 of Retroperitoneal Hematoma?
Pelvic location, frequently associated with pelvic fractures or ileal-femoral vascular injury.
How to tell if you are below the peritoneal reflection on FAST in M and F?
M: Prostate and Seminal Vesicles below peritoneal reflection
F: Cervix at the level of the peritoneal reflection.
Pathologic free fluid on FAST looks? Physiologic fluid looks?
Dark shadows on FAST?
Light shadows on FAST?
Air (gas in bowel).
What shiny sign might you see on FAST in RUQ or LUQ view?
The primary beam reflects from such a surface (e.g. diaphragm) but instead of directly being received by the transducer, it encounters another structure (e.g. a nodular lesion) in its path and is reflected back to the highly reflective surface (e.g. diaphragm). It then again reflects back towards the transducer.
How much fluid volume is required before FAST becomes sensitive?
650cc for lying flat. 500cc if Trendelenberg
Clotted blood can look like what on FAST
Difference between Blood and Ascites on FAST.
Ascites more sonolucent (black), homogeneous, and extensive.
Most common source of False Negative on FAST?
Hollow viscus injury.
If FAST is negative, but patient is unstable?
Repeat FAST or preform DPL.