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Clinical Decision Making Exam 1 > Ross Trauma > Flashcards

Ross Trauma Flashcards

1
Q

first consideration in trauma management

A

well being of you and your staff → scene safety

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2
Q

protective gear includes (4)

A

gown

gloves

goggles

hair bonnet

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3
Q

3 types of parameters that help identify a trauma pt

A

mechanistic

anatomic

physiologic

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4
Q

fall indications for major trauma in peds pt

A

fall is:

2-3 times the height of the child

>10 ft

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5
Q

fall indications for major trauma for adult pt

A

>20 ft

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6
Q

how many feet in 1 story

A

10

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7
Q

mechanism criteria for major MVA trauma (6)

A

death in same vehicle

pt ejection

vehicle rollover

intrusion

auto-pedestrian/bicycle > 20 mph

MVA > 20 mph

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8
Q

intrusion guidelines for major MVA trauma (2)

A

>12 in in occupant

>18 in anywhere

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9
Q

anatomic criteria for major MVA trauma (8)

A

penetrating injury to head, neck, torso

2 or more proximal long bone fx

amputation proximal to wrist or ankle

open or depressed skull fx

crushed or mangled extremity

neuro deficits

pelvic fx

flail chest

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10
Q

physiologic criteria for major MVA trauma (3)

A

vitals:

conscious state GCS < 13

hypotn sys <90

rr <9 OR > 30

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11
Q

primary survey consists of (5)

A

airway

breathing

circulation

disability

environment/expose pt

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12
Q

disability in primary survey represents

A

neuro

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13
Q

how should provider proceed with primary survey

A

one step at a time

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14
Q

when can primary survey be completed simultaneously

A

if more than one provider can perform ABC

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15
Q

airway management includes

A

c spine precaution

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16
Q

circulation management includes

A

stop bleeding

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17
Q

2 methods of airway management

A

oral airway

intubate

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18
Q

indications for intubation (4)

A

massive facial injury

GCS 8 or less

significant neck trauma

penetrating head injury

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19
Q

do not miss in breathing management

A

PTX/tension PTX

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20
Q

management of sucking chest wound

A

cover on 3 sides

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21
Q

3 indications for tension PTX

A

distended neck veins

absent breath sounds unilaterally

deviated trachea

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22
Q

management of tension PTX

A

immediately decompress

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23
Q

2 methods of bleeding management

A

pressure

tourniquet

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24
Q

first steps in advanced trauma life support

A

activate trauma team

designate captain

AMPLE hx

ABC

vitals/monitor

undress

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25
Q

what does AMPLE stand for

A

allergies

medications

PMH

last meal (what time)

events surrounding time of injury

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26
Q

what is this showing

A

tension PTX

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27
Q

signs and symptoms of hemorrhage by class

A
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28
Q

what hemorrhage class does HR begin to rise

A

class II (mild) → 15-30% blood loss

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29
Q

what hemorrhage class does bp begin to go down

A

class III (moderate) → 31-40% blood loss

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30
Q

what hemorrhage class indicates need for blood products

A

class II (mild ) = possible

class III (moderate) = definitely

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31
Q

do not forget exam on everyone (even unconscious)

A

neuro

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32
Q

triangle of death

A

bleeding

hypothermic

coagulopathy

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33
Q

GCS eye scale

A

1-4

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34
Q

GCS verbal scale

A

1-5

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35
Q

GCS motor scale

A

1-6

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36
Q

GCS severe coma indications

A

3-8

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37
Q

GCS moderate coma indications

A

9-12

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38
Q

GCS mild coma indications

A

13-15

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39
Q

pt undressed

full head to toe exam is done

better history obtained

A

secondary survey

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40
Q

pt undressed

full head to toe exam is done

better history obtained

A

secondary survey

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41
Q

t/f: FAST exam can be done before OR after the secondary survey

A

T

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42
Q

IVs to obtain

A

2 large bore

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43
Q

t/f: IV’s can be obtained before or after secondary survey

A

T

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44
Q

all trauma pt’s who are women of child bearing age need

A

tetanus booster

pregnancy test

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45
Q

clinical clearance protocol used to exclude c-spine injury

A

nexus criteria

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46
Q

5 nexus criteria

A

awake and alert

no e.o intoxication

no midline cervical tenderness

no focal neuro deficits

no painful distracting injury

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47
Q

if pt meets nexus criteria you can

A

take off backboard and remove c-collar clinically

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48
Q

nexus criteria is meant to identify

A

low risk neck pain that does NOT need xray

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49
Q

4 stages of hypovolemic shock

A

initial

compensatory

progressive

refractory

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50
Q

where is tourniquet placed

A

as proximal as possible

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51
Q

structures mc injured in blunt neck trauma

A

hard structures:

larynx

trachea

c spine

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52
Q

structures less commonly injured in blunt neck injury

A

soft structures (vascular):

carotid a

vertebral a

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53
Q

horner’s syndrome in trauma pt might indicate

A

carotid dissection

miosis, ptosis, anhidrosis

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54
Q

vertigo in trauma pt might indicate

A

vertebral dissection

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55
Q

c-spine injury has high association w. __ trauma

A

blunt

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56
Q

med that prevents cleavage of plasmin and degradation of fibrin → decreases bleeding w.o significant adverse s.e

A

TXA (tranexamic acid)

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57
Q

when must TXA be given

A

early in bleeding process

after 3 hours can be harmful

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58
Q

dosing for TXA

A

adults: 1 gm
kids: 0.5 gm

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59
Q

imaging for blunt neck trauma

A

neck CT w. and w.o contrast

will cover c-spine as well

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60
Q

drops of __ are concerning in GCS monitoring

drops of __ are very bad in GCS monitoring

A

2

3

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61
Q

strangulation injury is concerning for damage to __ structures (2)

A

hard and soft

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62
Q

imaging for strangulation injury

A

CT w. and w.o contrast

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63
Q

indication for surgery consult in strangulation injury

A

LOC

hard signs

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64
Q

3 indications for d.c for strangulation injury

A

asymptomatic

no soft signs

imaging of low yield

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65
Q

if the __ is penetrated, pt. will need trauma or surgical consult regardless of zone

A

platysma

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66
Q

what does FGH stand for

A

fetus → pregnant?

glucose

hypertet → tetanus

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67
Q

what does FAST exam stand for

A

focused

assessment

(with)

sonography

(for)

trauma

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68
Q

zone 1 of the neck

A

clavicle/sternum to cricoid cartilage

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69
Q

zone 2 of the neck

A

cricoid cartilage to angle of the mandible

70
Q

zone 3 of the neck

A

superior mandible to skull

71
Q

landmarks for zones of neck:

1:

2:

3:

A

1: sternal notch
2: cricoid cartilage
3: angle of mandible

72
Q

penetrating injuries to which neck zones do not immediately go to OR

A

1 and 3

73
Q

penetrating injuries to zone __ need surgical consult in OR

A

2

74
Q

neck hard signs

A

ha2spnmc

hematoma

hemoptysis

active bleeding

subq emphysema

pulse deficit

neuro deficit

mouth/NGT bleed

crepitus

75
Q

neck soft signs

A

hsv + mild tenderness

hematoma, small

sub q emphysema

voice changes

mild neck tenderness

76
Q

GI/airway hard signs

A

hcpts3d2

hemoptysis

cyanosis

ptx

tracheal deviation

stridor

sucking wound

subq emphysema

distress, respiratory

dysphagia/phonia

77
Q

management of foreign body in neck

A

do not remove

may be auto tamponade

78
Q

what should be avoided in maxillofacial injury

A

NGT

79
Q

maxillary bone fx w. sx of malocclusion

A

le fort fx 1

80
Q

fx w. involvement of nasal bone, malocclusion, +/- V2 involvement (anesthesia of skin of face/teeth)

A

le fort 2 fx

81
Q

how would you classify this injury

A

penetrating neck injury

82
Q

neck trauma is classified into

A

blunt

penetrating

83
Q

fx thru zygomatic arches and orbits

A

le fort 3

84
Q

management of le fort 3 fx

A

prophylactic intubation or transfer

85
Q

major concern in le fort 3 fx

A

edema → airway compromise

86
Q

management of nasal bone fx

A

no x-ray

look for intranasal hematoma → drain

ENT if reduction needed

87
Q

what is this showing

A

carotid artery dissection

88
Q

carotid a dissection typically occurs w. __ injury

A

hyperflexion

89
Q

nasal lacerations are concerning for damage to which CN

A

V

VII

90
Q

structures of concern in nasal laceration

A

parotid gland

stenson’s duct

91
Q

structures of concern in nasal laceration

A

parotid gland

stenson’s duct

92
Q

lethal 6 to look for in primary survey

A

oh fact

airway obstruction

tension ptx

cardiac tamponade

open PNX

HTX

flail chest

93
Q

management of airway obstruction

A

manage airway

intubate

94
Q

management of tension PTX

A

needle decompression

chest tube

95
Q

management of cardiac tamponade

A

needle drainage

xiphoid window

96
Q

beck’s triad

A

JVD

hypotn

muffled heart sounds

97
Q

management of HTX

A

CT

+/- OR based on CT output

98
Q

paradoxical movement of chest wall dt 2-3 fx in consecutive ribs → prevents oxygenation and increases WOB

A

flail chest

99
Q

management of flail chest

A

intubation if severe

OR for fixation

100
Q

indication of significant thoracic aorta injury w. blunt chest trauma

A

hypotn

101
Q

imaging for significant thoracic aorta injury w. blunt chest trauma

A

CXR if unstable

CT w. contrast if stable

102
Q

5 cxr findings of thoracic aorta injury

A

widened mediastinum

loss of aortic knob

left mainstem bronchus depression

apical capping

obliteration of distance btw pulm art and aorta

103
Q

parameter for widened mediastinum

A

8 cm

104
Q

mc moi for thoracic aorta injury

A

large velocity changes:

high speed MVA from 75 mph to 0 in short distance

105
Q

what is this showing

A

tension PTX

106
Q

3 indications of tension PTX on CXR

A

mediastinal shift

collapsed lung

depressed hemidiaphragm

107
Q

problem w. xray in rib fx

A

only seen 50% of the time

108
Q

concern w. rib fx in elderly

A

atelectasis

PNA

109
Q

indication for admit for rib fx in elderly

A

more than 2 or 3 fx

110
Q

indication for emergent care in rib fx

A

flail chest → 2-3 fx in consecutive ribs → increases wob

111
Q

what is this showing

A

massive tension PTX

112
Q

consider abdominal trauma if injury is below the __

down to the __

A

nipple line

pubis

113
Q

4 indications for emergent laparotomy

A

diffuse peritonitis

penetrating GSW w. peritoneal violation

evisceration

abd tenderness w. hypotn

114
Q

what is this showing

A

cardiac tamponade

enlarged bottle shaped heart

115
Q

2 PE findings that require work up of abd CT scan dt high likelihood of injury

A

chance fx

handlebar or seatbelt sign

116
Q

what is this showing

A

HTX

damage to great vessels of lung

117
Q

what is a chance fx

A

lumbar fx

118
Q

what is this showing

A

handlebar sign

119
Q

what is this showing

A

seatbelt sign

120
Q

imaging that is done as part of PE

A

FAST US →

quick method to find blood

121
Q

abd tenderness in light of blunt trauma indicates __

A

ruptured hollow viscus

easily missed

122
Q

significant blood loss in abd cavity w.o drastic change in external appearance of abd

A

ruptured hollow viscus

easily missed even w. CT

123
Q

what is this showing

A

pulmonary contusion

124
Q

28 yo s/p fall off bike

what do you think?

A

PTX w. rib fx

125
Q

fx of __ ribs indicates high force fx w. likely occult injury

A

ribs 1-2

126
Q

do not d.c pt if they have fx to which ribs

A

1-2

127
Q

t/f: flail chest can occur w. 1 rib fx

A

f! must be multiple rib fx

128
Q

complication of rib belts

A

atelectasis → PNA

129
Q

indication for thoracotomy

A

loss of vitals w.in 2-3 min of arrival

130
Q

pelvic fx classifications (3)

A

lateral compression

vertical shear

AP compression

131
Q

indication for high mortality with pelvic fx

A

hypotn

dt bleeding into the pelvis

132
Q

type of pelvic fx esp high risk for hypotn → mortality

A

open book

133
Q

what classification is an open book pelvic fx

A

AP compression

134
Q

immediate tx for pelvic fx (2)

A

pelvic binders

0 neg blood

135
Q

pelvic binders are a part of the __ survey

A

primary

136
Q

indication for OR in extremity trauma

A

hard signs

137
Q

extremity trauma hard signs (5)

A

5p hot

pain

paralysis

paresthesia

pulselessness

palor

hematoma, large

obvious arterial bleeding

thrill/bruit

138
Q

what are the 5 p’s

A

pain

pallor

pulse

paresthesia

paralysis

139
Q

mc injured organ in abd trauma

A

liver

140
Q

indications for CT scan for extremity trauma

A

soft signs

141
Q

extremity trauma soft signs that indicate CTA (6)

A

h3pcn

hematoma, small

hemorrhage hx

hypotn, unexplained

proximal to major vessel

complex fx

nerve damage

142
Q

resuscitation fluid/blood protocol

A

1 L crystalloid solution

3 L blood products

+/- tranexamic acid

143
Q

test to perform in extremity trauma if no hard/soft signs

A

ABI

144
Q

parameter for abnormal ABI

A

< 0.9

145
Q

what do you order in extremity trauma, if ABI is < 0.9 (2)

A

CT angiogram

+/- ortho consult

146
Q

3 special populations in trauma care

A

peds

geriatrics

pregnant

147
Q

4 complicating factors in peds trauma pt’s

A

big heads/thinner skull bones

less calcified skeletal system

different vitals

tachycardic first → bp drop later

148
Q

__ may be the only keys to early recognition of hypovolemia in peds trauma pt’s (2)

A

tachycardia

narrowed pulse pressure → poor skin perfusion

pulse pressure over systolic pressure

149
Q

3 complicating factors for geriatric trauma pt’s

A

sicker for any given pathology

meds can blunt responses

pre-existing conditions → 2x higher mortality

150
Q

4 pre existing conditions of concern in geriatric trauma pt’s (the ones listed on study guide)

A

cirrhosis

coagulopathy

COPD

ischemia

151
Q

management of pregnant trauma pt (2)

A

take care of MOC first

perform radiological studies to determine injury

152
Q

if pt has calcaneus fx, also look for __ fx

A

lumbar

153
Q

indications for admit in pregnant trauma pt (3)

A

vaginal bleeding

abd tenderness

changes in fetal heart tones

154
Q

when should the lethal 6 be identified

A

primary survey

155
Q

t/f: the lethal 6 all have immediate remedies

A

t!

156
Q

soft signs in extremity trauma are an indication for

A

CTA

157
Q

hard signs in extremity trauma are an indication for

A

ortho consult/OR

158
Q

steps in evaluation of extremity trauma (5)

A
  1. evaluate for hard/soft signs in primary survey
  2. soft signs → CTA
  3. hard signs → ortho consult
  4. if no hard or soft signs → ABI
  5. if ABI < 0.9 → CTA
159
Q

do not delay ortho consult for abdominal injury if pt has (2)

A

red flags

abnormal vitals

160
Q

t/f: rib fractures in young pt’s are generally benign

A

T!

painful, but benign

161
Q

HTX is often due to

A

vessel injury

162
Q

what does widened mediastinum make you think of

A

thoracic aorta injury

163
Q

fxn of V1

A

sensation to forehead

corneal reflex

164
Q

fxn of V2

A

sensation to cheek

165
Q

fxn of V3

A

sensation to jaw/chin

jaw opening

bite strength

166
Q

PE findings of V1 injury

A

loss of sensation to forehead

loss of corneal reflex

167
Q

PE findings of V2 damage

A

loss of sensation mid face

168
Q

PE findings of V3 damage

A

weakness/paralysis of muscles of mastication

deviation of mandible toward side of lesion

169
Q

basic fxn of CN VII

A

facial expressions

taste anterior ⅔ of tongue

corneal reflex

170
Q

PE findings of CN VII damage

A

loss of corneal reflex

oss of facial muscle expresion

mouth droop

loss of nasolabial fold

loss of taste anterior ⅔ of tongue

171
Q

must to exam for nasal lacerations

A

PE exams for CNV and CNVII

172
Q

where is exam of zone 2 penetrating neck trauma done

A

OR

Clinical Decision Making Exam 1 (22 decks)

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