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Senior - Emed 4 > Review Deck > Flashcards

Review Deck Flashcards

(56 cards)

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1
Q

GCS categories

A

Mild 14-15
Moderate 9-13
Severe 3-8

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2
Q

What is the lower limit of autoregulation for CCP?

A

CCP <60

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3
Q

If you dont have a ICP monitor you must?

A

Keep MAP >80

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4
Q

MC type of brain herniation?

A

UNCAL herniation

  • temporal lobe damage
  • causes ipsilateral fixed dilated pupil
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5
Q

What is cerebellotonsillar herniation?

A

Cerebellum starts to herniate through foramen magnum

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6
Q

S/s of cerobellotonsillar herniation?

A

Pinpoint pupils
Flaccid paralysis
Sudden death

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7
Q

What is upper transtentorial herniation?

A

Caused by a lesion on the posterior fossa

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8
Q

S/s of upper transtentorial herniation?

A

Conjugate downward gaze
Absence of vertical eye movements
Pinpoint pupils

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9
Q

What are the intubation agents for brain injury?

A

Induction agent

  • Etomidate .3mg/kg IV
  • Propofol 1-3 mg/kg IV

Paralytics

  • succinylcholine 1-1.5 mg/kg IV
  • rocuronium .6-1 mg/kg IV
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10
Q

Etomidate factoids?

A

Induction agent

  • .3 mg/kg IV
  • Neuroprotective
  • May lower ICP
  • Adrenal suppression unlikely in 1 dose
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11
Q

Propofol factoids

A

Induction agent

  • 1-3mg/kg
  • anti-seizure properties
  • HOTN (if inadequate fluids)
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12
Q

Succinylcholine factoids

A

Paralytics

  • 1-1.5mg/kg
  • short acting

Avoid in

  • burns
  • excessive muscle trauma
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13
Q

Rocuronium factoids?

A

Paralytics

  • 0.6-1.0 mg/kg IV
  • short active
  • safe in hyperkalemia
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14
Q

A linear skull fracture with overlying laceration is?

A

An open fracture

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15
Q

Test for CSF?

A

Beta 2 transferring

- not found in mucous or tears, only CSF

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16
Q

Comparrison of head injurires

A

Lesson 2
Slide 66

“He said its a great chart”

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17
Q

Most frequently injured abdominal organ(s)?

A

Overall: liver
Sports: spleen

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18
Q

What is the greatest benefit of the FAST exam?

A

Rapid ID of free intraperitoneal fluid in the HYPOtensive pt in blunt abdominal trauma

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19
Q

Blunt trauma unstable + FAST:

Blunt trauma unstable - FAST:

Blnt trauma stable:

A

Blunt trauma unstable + FAST: OR

Blunt trauma unstable - FAST: repeat FAST/resuscitate

Blnt trauma stable: CT

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20
Q

Indications for laparotomy in blunt trauma pt?

A

Absolute

  • anterior abd inj w HOTN
  • abd wall disruption
  • peritonitis
  • free air under diaphragm
    • FAST/DPL in hemodynamically unstable pt
  • CT says you need it

Relative

    • FAST/DPL in stable pt
  • Solid visceral inj in stable pt
  • hemoperitoneum on CT w/o clear source
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21
Q

Indications for laparotomy in penetrating trauma?

A

Absolute

  • inj to abd, back, flank w HOTN
  • abd tenderness
  • GI evisceration
  • High suspicion for transabdominally trajectory after GSW
  • CT diagnosed inj req surgery

Relative
- + local wound exploration after stab wound

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22
Q

Spinal injury is most often?

A

Cervical spine is MC

  • C2 MC of cervical
  • C5-C7 2nd MC
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23
Q

Spinal nerve anatomy?

Study These Flashcards
A

31 pairs of spinal nerves

  • 8 cervical
  • 12 thoracic
  • 5 lumbar
  • 5 sacral
  • 1 coccygeal
24
Q

Corticospinal tract

Study These Flashcards
A

DO NOT cross so ipsilateral clinical findings

Controls motor

  • muscle weakness
  • spasticity
  • increased DTR
  • babinski’s sign (toes flare, extend)
25
Spinothalamic tract?
Crosses in spinal cord - contralateral findings Pain and temp - loss of pain ant temp (contralateral)
26
Dorsal columns?
Vibration and proprioception Ipsilateral
27
What is required to see light touch sensation completely lost?
Damage to Both: - spinothalamic tract - dorsal columns It says COMPLETE loss
28
Incomplete cord syndromes?
Anterior cord syndrome Central cord syndrome Brown sequard syndrome
29
Anterior cord syndrome?
Anterior cord compression caused by - flexion of c spine - thrombosis of anterior spinal artery Leads to - complete paralysis below lesion - loss of pain and temp - preservation of vibratory function
30
Central cord syndrome?
Caused by - hyperextension injuries - disruption of blood flow to spinal cord - c spine stenosis Leads to quardraparesis - greater in upper than lower extremities Loss of pain and temp - greater in upper than lower extremities
31
Brown sequard syndrome?
Transverse hemisection of spinal cord or unilateral cord compression IPSILATERAL - spastic paresis - loss of proprioception and vibration CONTRALATERAL - loss of pain and temp Only one with both ipsilateral and contralateral
32
Your amazing radiology trained eyes spot a throacolumbar spine fx, now what?
Get a CT | - you cant ignore that shit
33
Rule of 10s?
Burn treatment Acute fluid resuscitiaon Adults: = 80kg: 10ml/hr x %TBSA >/= 80kg add 100 ml/hr q 10 kg over 80 Kids: 3x TBSA x kg - amount of fluid to give in 1st 24 hrs - 1/2 of total amount in first 8 hrs
34
Preferred fluids for burns?
Lactated ringer PlasmaLyte Dont use NS
35
When treating burns how can you track fluid status?
Monitor urine output Titrate to: - adults: 30-50ml/hr - kids: 0.5 - 1ml/kg/hr
36
level 1 trauma center characteristics?
24 hr availability of: - surgeon: every type - neuroradiology - hemodialysis Program that establishes and monitors effect of injury prevention and education efforts Organized trauma research program
37
Blunt abdominal trauma unstable pts need?
FAST exam + : OR - : stabilizer
38
Blunt abdominal trauma stable pts need?
Fast exam + : OR - : CT
39
Penetrating trauma pts need?
Unstable : or
40
Any unstable pt needs?
OR or US
41
Any Stable trauma pt needs?
CT
42
What does FAST look for? (Limitations)
Fluid - doesn’t ID blood or not - doesn’t tell you what is bleeding
43
There will be a scenario
It will ask you if you should intervene on this pt if HR is 100 in trauma: - we expect that, dont make a big deal of it
44
Nexus criteria
Criteria for omitting c spine imaging ``` No posterior midline C spine tenderness No evidence of intoxication Altered mental status No focal neuro deficits No painful distracting injuries ``` Or ``` NEXUS N: neuro E: ETOH X: distracting inj U: unstable (alterd LOC) S: spine (midline tenderness) ```
45
Blood loss class I?
``` Blood loss: 750ml Blood loss %: 15% Pulse: <100 Blood pressure: normal Pulse pressure: normal/increased ```
46
Blood loss class II
``` Blood loss: 750-1500 Blood loss %: 15-30% Pulse: 100-120 Blood pressure: normal Pulse pressure: decreased ```
47
Blood loss Class III
``` Blood loss: 1500-2000 Blood loss %: 30-40% Pulse: 120-140 Blood pressure: decreased Pulse pressure: decreased ```
48
Blood loss Class IV
``` Blood loss: >2000 Blood loss %: 40% Pulse: >140 Blood pressure: decreased Pulse pressure: decreased ```
49
ED thoracotomy
Pts w: - penetrating chest trauma - witnessed signs of life during transport - at least come cardiac electrical activity upon arrival
50
Pts who dont qualify for thorocotomy?
Penetrating trauma: - CPR (pulseless) - with out signs of life Blunt trauma - CPR (pulseless) - myocardial electrical activity
51
Things that happen before transfer
The only thing I found was that they should be Hemodynamic stability But then one of the slides says they can be transferred IOT get stabilized So IDK, if you have any ideas please change this card
52
Difference between laparoscopy and laparotomy?
Laparoscopy: scope Laparotomy: big cut
53
What kind of pt needs laparotomy?
All patients w - persistent hypotension - abdominal wall disruption - peritonitis Need surgical exploration
54
In penetrating and blunt trauma with concern for broken vessels you should get?
CT angiography
55
Gold standard test for abdominal injury?
CT w IV contrast
56
Definitive treatment?
Surgeons definitively treat ED does not definitively treat - only stabilize

Senior - Emed 4 (6 decks)

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