Trauma

Question 1

A blunt cerebrovascular injury to the neck often occurs with deceleration. What vessels are often affected?

Answer 1

Internal Carotid arteries
Vertebral arteries

Question 2

How will injury to the Internal Carotid/Vertebral arteries present?

Answer 2

Focal neurological deficit – like a stroke

Question 3

What is Flail Chest?

Answer 3

> 3 consecutive rib levels with > 2 breaks in each

Question 4

> 3 consecutive rib levels with > 2 breaks in each is called?

Answer 4

Flail chest

Question 5

How will Flail Chest present?

Answer 5

Paradoxical motion
= As chest expands with inspiration, the portion of ribs affected will compress and vice versa with expiration they will expand

Question 6

If Flail chest is present, what diagnostic studies should be obtained?

Answer 6

X-ray/CT and possibly CTA

Question 7

What is the treatment for Flail Chest?

Answer 7

ORIF with pain management

Question 8

What pain medication should be given for Flail Chest or severe rib fractures?

Answer 8

Anesthetics – opioids will decrease respiratory rate and do not want that

Question 9

Hemothorax is blood in the pleural space often due to?

Answer 9

Rib fracture that lacerates intercostal arteries

Question 10

How will a Hemothorax present?

Answer 10

Decreased lung sounds and DULLNESS to percussion

Question 11

What will be seen on X-ray with Hemothorax?

Answer 11

Horizontal Meniscus

Question 12

What are 2 treatment options for a Hemothorax?

Answer 12

Thoracostomy (chest tube)
Thoracotomy to stop bleed if severe

Question 13

Pneumothorax is air in the pleural space. How will it present?

Answer 13

Decreased lung sounds and HYPERRESONANCE to percussion

Question 14

What is the treatment for a Pneumothorax? Tension Pneumothorax?

Answer 14

Thoracostomy (chest tube)
– Needle thoracostomy for Tension Pneumothorax

Question 15

What extra sign can be present with a Tension Pneumothorax that will not be present with a regular Pneumothorax?

Answer 15

Distended jugular veins due to compression of venous structures

Question 16

A Pulmonary Contusion often occurs following chest trauma. How will it present?

Answer 16

Worsening hypoxia/dyspnea and tachypnea following the trauma

Question 17

What lung sound may be heard with a Pulmonary Contusion?

Answer 17

Rales

Question 18

What will be seen on X-ray with a Pulmonary Contusion? CT?

Answer 18

X-ray = Patchy infiltrates
CT = Ground glass opacities

Question 19

Treatment for a Pulmonary Contusion?

Answer 19

Oxygen and maintain PEEP

Question 20

Blunt Cardiac Injury may present in what 2 ways?

Answer 20

• Arrhythmias
• Shock with low EF

Question 21

What workup should be done for a Blunt Cardiac Injury?

Answer 21

ECG
Troponins
Echo

Question 22

Treatment for Blunt Cardiac Injury?

Answer 22

Watch for arrhythmias and limit IVF

Question 23

Injury to the aorta often follows a deceleration injury. What will be seen on X-ray?

Answer 23

Widened Mediastinum

Question 24

What is the treatment for an aortic injury/dissection?

Answer 24

Lower BP with IV beta blocker
+/- stent/surgery

Question 25

Cardiac Tamponade is blood in the pericardial space. What are the main 3 signs?

Answer 25

Hypotension Muffled/distant heart sounds Distended jugular veins

Question 26

Cardiac Tamponade is blood in the pericardial space. What are the main 3 signs?

Answer 26

Hypotension Muffled/distant heart sounds Distended jugular veins

Question 27

What can be seen with the BP with Cardiac Tamponade?

Answer 27

Pulsus Paradoxus = With inspiration, the SBP drops by more than 10

Question 28

What may be seen on EKG with Cardiac Tamponade?

Answer 28

Low voltage QRS complexes

Question 29

What may be seen on CXR with Cardiac Tamponade?

Answer 29

Enlarged cardiac silhouette

Question 30

What may be see on Echo with Cardiac Tamponade?

Answer 30

Right atrial/ventricular collapse

Question 31

Treatment for Cardiac Tamponade?

Answer 31

- Pericardiocentesis - Pericardial Window

Question 32

If Cardiac Tamponade is suspected based on the symptoms, do you need to get a CXR?

Answer 32

NO -- will not offer much help... just treat

Question 33

With burns, what 3 things is the patient at risk for?

Answer 33

Infection Hypothermia Hypovolemia

Question 34

With burns, what 3 things is the patient at risk for?

Answer 34

Infection Hypothermia Hypovolemia

Question 35

With burns, the capillaries will leak and will often result in?

Answer 35

EDEMA

Question 36

What 2 complications are common with burn patients?

Answer 36

ARDS Compartment syndrome

Question 37

What fluids should be given to burn patients?

Answer 37

Lactated Ringers

Question 38

What must be placed to assess volume status in a burn patient?

Answer 38

Transurethral catheter

Question 39

List signs of an Inhalation injury?

Answer 39

- Soot in nares/singed nose hairs - Carbonaceous sputum = grey/black - Erythema of oropharynx

Question 40

If a patient has signs of an Inhalation injury, what should be done? What are those signs?

Answer 40

Prophylactic INTUBATION - soot in nares/singed nose hairs - Carbonaceous sputum = grey/black - Erythema of oropharynx