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Emergency Medicine > Shock + Trauma > Flashcards

Shock + Trauma Flashcards

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1
Q

Levels of care on wards

A 
0 = normal ward 
1 = CCOT
2 = single organ failure 
3 = ventilation or >2 organ failure
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2
Q

ABG pros + cons

A

Pros - pO2

Cons - VBG + SpO2 usually adequate, painful

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3
Q

What are the life threatening thoracic injuries?

A 
ATOM FC 
Airway obstruction 
Tension pneumothorax
Open chest wound 
Massive haemothorax 
Flail chest 
Cardiac tamponade
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4
Q

What is HEPB?

A

To assess circulation

Hands
End organ perfusion - urine output
Pulse
BP

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5
Q

What are the causes of reflex syncope?

A

Vasovagal
Situational
Carotid sinus syncope

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6
Q

What are the causes of syncope due to hypotension?

A

Primary autonomic failure (Parkinsons)
Secondary autonomic failure (diabetes, spinal cord injuries)
Drug induced
Volume depletion

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7
Q

What are the causes of cardiac syncope?

A

Tachycardia
Bradycardia
Drug induced
Structural heart disease

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8
Q

What are the 4 main causes of collapse?

A

Head
Heart
Vessels
Drugs

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9
Q

What is the San Francisco syncope rule?

A 
CHESS
Congestive HF 
Haematocrit <30% 
ECG abnormal 
SOB 
Systolic <90
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10
Q

What is the OESIL risk score?

A

Age >65
History of CVD
Syncope w/o prodrome
Abnormal ECG

Score >2 = increased risk of cardiac death

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11
Q

What is the risk of shock + reperfusion?

A

Intracellular calcium overload = reduced myocardial contractility + ATP reduction
H+ excess causing reduced myocardial function
Increased lactic acid

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12
Q

What type of nerve damage can an anterior shoulder dislocation cause?

A

Axillary nerve damage - numbness in regimental badge area

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13
Q

What is ISS used for?

A

Scoring system as indicator of major trauma

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14
Q

Describe the pathology of neurogenic shock

A

Damage to T1-3
This is where autonomic sympathetic nervous system branches out
Causes bradycardia + hypotension

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15
Q

What are the Canadian C Spine rules?

A

Statifying pts with ?c spine injury - who needs radiography
Age >65 y/o
Dangerous mechanism of injury
If they’re able to be examined + actively rotate neck - don’t need radiography

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16
Q

What 4 areas to assess when faced with hypotension?

A

Heart rate
Volume status
Cardiac performance
SVR

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17
Q

What type of shoulder dislocation do epileptics typically get?

A

Posterior - light bulb sign

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18
Q

Causes of cardiogenic shock

A 
Cardiomyopathies
Cardiac valve problems 
Arrhythmias 
CHF
Most commonly MI
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19
Q

Management of cardiogenic shock

A

Fluids, blood transfusions, vasopressors, ionotropes

Management of MI

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20
Q

What are the types of shock?

A

Hypovolemic, cardiogenic, obstructive, distributive

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21
Q

S+S of shock

A

Low BP, decreased urine output, confusion, high HR

Dry membranes, reduced skin turgor + reduced CRT

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22
Q

S+S hypovolemic shock

A 
Rapid, weak, thready pulse 
Cool, clammy skin 
Rapid + shallow breathing 
Thirsty 
Cold + mottled skin
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23
Q

How is hemorrhagic shock classified?

A

Class 1-4
1 = <15% blood loss (<750ml), normal BP
2 = 15-30% blood loss (750-1500), fast HR, low BP
3 = 30-40% blood loss (1500-2000), fast HR, low BP, confusion
4 = >40% blood loss (>2000), critical HR + BP

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24
Q

S+S of cardiogenic shock

A 
Distended jugular veins 
Weak or absent pulse 
Abnormal heart rhythms, tachycardia 
Pulsus paradoxus (in tamponade)
Low BP
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25
S+S of distributive shock
High or low temp Tachycardia High RR
26
What are the types of distributive shock?
Sepsis, anaphylaxis + neurogenic
27
What are the general causes of each type of shock?
``` Hypovolemic = fluid loss Cardiogenic = ineffective pumping due to heart damage Obstructive = blood flow to/ from heart is blocked Distributive = abnormal flow in small vessels ```
28
Causes of obstructive shock
``` Cardiac tamponade Tension pneumothorax PE Aortic stenosis Constrictive pericarditis ```
29
Management of shock
Fluids Vasopressors Mechanical support
30
Pathology of compartment syndrome
Increased pressure in compartment bounded by unyielding fascial membranes compromises circulation + function of tissues within that space
31
Common causes of compartment syndrome
Trauma to limb eg long bone fracture, penetrating trauma, ischemic-reperfusion injury, coagulopathy, extravasation of IV fluids, limb compression
32
S+S of compartment syndrome
Progressive pain out of proportion to injury Tense swollen compartments Pain with passive stretching of muscles Motor deficits = late
33
Assessment of compartment syndrome
Surgeon review - measure compartment pressures | Use difference between diastolic BP + compartment pressure - <30 = elevated compartment pressure
34
What is a normal pressure of a tissue compartment?
0-8 mmHg
35
Management of compartment syndrome
``` Remove pressure Keep limb level with torso O2 + analgesics Manage BP Fasciotomy to fully decompress compartment ```
36
Complications of long bone fracture
Hemorrhage, DVT, compartment syndrome | Osteomyelitis, nonunion + osteoarthritis
37
What is a mangled extremity?
``` Injury to 3 of the 4: Bones Soft tissue Nerves Vessels ```
38
What are hard signs of vascular injury?
Pulsatile bleeding, expanding hematoma, distal ischemia
39
What signs in a facial injury indicate airway compromise?
Dysphonia Oedema of oropharynx Stridor
40
Mechanism of shoulder fracture
Falling from standing height
41
What classification is used for proximal humerus fractures?
Neer system
42
Management of proximal humerus fractures
Complex = refer to ortho Immobilisation using sling Closed management for impacted or non-displaced fractures (Neer one-part) Early mobilisation with pendulum exercises
43
Management of open fractures
Dose of broad spectrum abx | Referral to surgeons
44
Management of hand fractures
Splinting | Referral to hand surgeons - within 2-3 days for closed unstable fractures, 7-10 days for closed stable fractures
45
3 main categories of knee injuries
Acute knee pain Chronic knee pain associated with overuse Knee pain without trauma or overuse, associated with systemic symptoms
46
Conditions causing anterior or medial knee pain
``` Patllar fracture Patellar or quadriceps tendinopathy Patellofemoral pain Patellar subluxation Pes anserinus (medial hamstring) tendon + bursa Osteoarthritis Tibial tuberosity - Osgood Schlatter Medial plica syndrome ```
47
Conditions causing lateral + posterior knee pain
``` Iliotibial band Popliteus tendinopathy Biceps femoris tendinopathy Semimembranous-gastrocnemius bursitis Degenerative meniscal tear Baker's cyst ```
48
Describe patellofemoral pain
Peri-patellar knee pain that increases with squatting, prolonged sitting, climbing or descending stairs, running downhill
49
How to elicit pain in patellofemoral pain
Retropatellar tenderness Patellar compression test Patellar inhibition test (Clarkes)
50
What muscles are weak in patellofemoral pain?
Vastus medialis oblique + gluteus medius
51
What is patellar subluxation?
Pts with hx of patella dislocation can develop subluxation, Ehlers Danlos §or if vastus medialis is weak Knee 'gives way' Patellar apprehension test = positive
52
What is medial plica syndrome?
Trauma to peripatellar area or dislocations/ subluxation of patella, may develop thickening of medial patella plica Causes impingement of medial edge of patella, causing pain worse with movement Can cause audible pop
53
Features of iliotibial band syndrome
Insidious lateral knee pain that worsens with prolonged exercise Common in runners Assessed with Noble tests Associated with hip abduction weakness
54
What structures are important in forefoot pain?
``` First MTP joint 5th MTP joint Plantar surface of MTP joint Intermetatarsal spaces Plantar calluses Dorsal proximal interphalangeal calluses ```
55
What structures are important in midfoot pain?
``` Navicular Dorsal tarsometatarsal joints Cuboid Base of 5th metatarsal Plantar fibromas Ganglia ```
56
What structures are important in hindfoot pain?
``` Medial insertion of plantar fascia on calcaneuus Plantar os calcis Insertion of Achilles tendon Tarsal tunnel Peroneal tendons Anterior talotibial articulation Anterior talus - lateral corner Sinus tarsi ```
57
What are the common conditions seen at first MTP joint?
``` Bunions Hallux rigidus (arthritis) Turf toe (forced hyperextension of great toe) Gout ```
58
What is Ilizarov frame surgery?
Type of external fixation used in ortho surgery to lengthen or reshape limb bones
59
Causes of distributive shock
Sepsis Anaphylaxis Neurogenic
60
Causes of hypovolaemic shock
Hemorrhage Burns High output fistulas Dehydration
61
Common sites of bleeding
``` On the floor + 4 more: Floor (external) Chest Abdo Pelvis Long bones ```
62
Maintenance fluids canadian rule
``` 4:2:1 0-10kg = 4ml/kg/h 10-20 = 2ml/kg/h Remaining weight = 1ml/kg/hr Replace ongoing losses (estimated 10% of body weight) ```
63
When can you clear a C spine?
``` Orientated to time, person, place No evidence of intoxication No posterior midline cervical tenderness No focal neuro deficits No painful distracting injuries ```
64
When should you get a CT of a C spine?
If X ray is unclear or suspicious Any clinical indication of atlanto-axial subluxation High suspicion but normal X ray
65
What signs in Hx + O/E indicate a potential C spine injury?
Midline neck pain, numbness, distracting pain, head injury, intxication, LOC Posterior neck spasm, tenderness or crepitus, neuro deficit or autonomic dysfunction, altered mental state
66
What C spine x rays should be taken?
3 view: Lateral C1-T1 + swimmer's view Odontoid view (open mouth)
67
What is in a secondary survey?
``` SAMPLE S+S Allergies Meds Past medical hx Last ins + outs Events leading up to this ``` Physical exam Initial imaging
68
What views do you get on a FAST scan?
Subxiphoid pericardial window - shows heart chambers + pericardial effusion Perisplenic - shows spleen, L kidney + any free fluid Hepatorenal (Morrisons pouch) - shows liver, right kidney + any blood Pelvic/ retrovesical (Pouch of Douglas) - shows bladder + any free fluid
69
What is the best imaging for intracranial injury?
Non contrast CT
70
what is the emergency rule for consent to treatment?
Consent is not needed when pt is at imminent risk from serious injury AND obtaining consent is not possible or would increase risk to pt
71
What are the associated injuries with MVC?
Head on = head, thoracic, lower extremity T bone = head, C spine, thoracic, abdo, pelvic, lower extremity \ Rear end = hyper-extension of C spine
72
What is the cardiac box?
From sternal notch, nipples + xiphoid process | Any injury in this = be suspicious of cardiac injury
73
What are high risk mechanisms of injury?
MVC at high speed causing ejection from vehicle Motorcycle collisions Vehicle vs pedestrian Fall from height >12ft
74
What is Waddle's triad?
Vehicle vs pedestrian injuries Tibia-fibula or femur fractures Truncal injuries Craniofacial injuries
75
What injuries are caused by seatbelts?
Retroperitoneal duodenal trauma Intraperitoneal bowel transection Mesenteric injury L spine injury
76
When is an NG tube vs Foley used in abdo trauma?
Foley = unconscious pt who cannot void sponteneously | NG tube = used to decompress stomach. CI in basal skull fractures
77
What is the rule of thirds for stab wounds?
1/3 do not penetrate peritoneal cavity 1/3 penetrate but are harmless 1/3 cause injury requiring surgery
78
Management of open fractures
``` STAND Splint Tetanus prophylaxis Abx Neurovascular status Dressings ```

Emergency Medicine (24 decks)

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