Ross Trauma 2 (up to slide 62) Flashcards
(46 cards)
What artery are you concerned about in hyperextension of the neck with compression against transverse process?
Vertebral artery
What artery are you concerned about with hyperflexion of the neck with compression between the mandible and spine?
Carotid artery
In what circumstances of blunt and vascular injury to the neck would you consider imaging?
- Hyperextension w/ compression of art. against transverse process
- Hyperflexion w/ compression btw mandible and spine
- direct blows with mid face fx
- intra-oral trauma
- basilar skull fx
A pt presents with dizziness, vertigo, ataxia, nystagmus, dysarthria, and diplopia. What blood vessel is injured?
Vertebral a
A pt presents with bruits, TIA’s, and Horner Syndrome. What blood vessel is injured?
Carotids
What is Horner syndrome?
Disruption of sympathetic flow to eye
- Constricted pupil
- Droopy eyelid
- Eye does not sweat
*miosis, ptosis, anhidrosis
If a pt presents with a blunt injury to the neck, are asympto with no signs (hard or soft) do they need imaging?
No, imaging is low yield - can d/c home
Any penetration into the platysma needs what type of consult?
Trauma Surgeon consult
What are the 3 zones of injury for the neck?
- Clavicles to cricoid
- Cricoid to mandible
- Mandible to base of skull
Work up for penetrating neck trauma
- If platysma is not penetrated - clean and close. If yes, need consult
- Consider zone of injury - if zone 2 may go to OR (moving more toward using Hard and Soft signs)
- If can’t tell how deep - look for Hard and Soft signs
What are vascular Hard Signs in a neck injury?
- hematomas
- bleeding
- pulse deficit
- shock and neuro deficit 2/2 to art. interruption
What are l_aryngeal and tracheal_ Hard Signs in a neck injury?
- voice alteration
- airway compromise
- subQ emphysema
- crepitus
- hemoptysis
What are esophageal Hard Signs in a neck injury?
- pain
- neck tenderness
- subQ emphysema
- dysphagia
- bleeding from NGT or mouth
*MOST common missed injury
What are Soft Signs in neck injury?
- small hematoma
- mild dysphagia
- mild dysphonia
- mild subQ emphysema
- mild tenderness in neck
What are indications for a pt with penetrating neck trauma to go to surgery?
- Unstable
- Hard Signs
- Arterial bleeding
What are indications for a pt with a penetrating neck trauma to get a CT?
- Soft Signs
- Zone 1 and 3 need CT angiography
- Zone 2 Sx vs CT
*Glory CT
In a clothesline or strangulation injury what are PE findings that require further inquiry?
- hoarseness
- dysphagia
- pain below hyoid
What are the 3 Le Fort maxillofacial trauma factures?
- maxillary teeth from face: malocclusion
- become pyramid shaped, involve nose: malocclusion (infraorbital V2, CN5)
- craniofacial dysfunction: airway compromise due to edema
A pt presents with a flattened cheekbone, diplopia, and an upward gaze. What fractures are you concerned about?
- Zygomatic fx
- Orbital floor (maxillary bone) fx
In maxilofacial lacerations what potential injuries should you be aware of?
- Nerve injury: CN 5, 7
- Parotid gland esp Stenson’s duct
What signs would a pt with an orbital blow out fx possibly present with?
- enophthalmos
- diplopia w/ upward gaze
- dec eye mvmt
- MCC bone = maxillary (entrapment of inf. rectus m)
- infraorbital n entrapment (V2, CN 5)
Orbital blow out fracture management
Generally no need for emergent SX but may need repair in 7-10 days, consult maxillofacial services
What are you looking for on PE in chest trauma?
- Bruising (patterns), open wounds, subQ air, JVD, breathing patterns
- Listen to lungs, heart
- Palpate for fx or areas of tenderness
- Get CXR (don’t wait for this to tx unstable pt)
What are the “Lethal Six” of the Deadly Dozen in chest trauma?
- Airway obstruction
- Tension pneumothorax
- Cardiac tamponade
- Open pneumothorax
- Hemothorax
- Flail chest
