Trauma Flashcards

Question

Where are the majority of your glycogen stores?

Answer 1

In the muscles

Answer 2

The bones, specifically red bone marrow in the trabecular bone. Fractures can lead to catastrophic haemorrhage even without vascular damage

Answer 3

Internal bleeding (+compartment syndrome) External bleeding Infection (e.g. osteomyelitis) Nerve damage (+/- loss of function) Tissue damage Thrombo emboli

Answer 4

Control blood loss Expose (Clothing, jewellery etc.) Access neurovascular system Splintage/immobilisation Analgesia Open fractures - rinse with water or saline and cover (photo first) Retraction of bone under skin (with documentation)

Answer 5

The shattering effect or explosive blasts

Answer 6

Increased pressure within a closed osteofascial compartment leading to impaired circulation. It is a surgical emergency

Answer 7

Lower leg in adults, humerus and forearm in paeds - but it can occur in any muscle

Answer 8

Fractures Burns Crush injuries Thrombosis Infections Tight casts Splints

Answer 9

Presence of fat particles in the micro-circulation, causing tissue damage & systemic inflammatory response causing pulmonary, neurological and renal systems

Answer 10

Most commonly orthopaedic trauma - can present up to 10 days after

Answer 11

Primary: Scalp lacerations Skull fractures Cerebral contusions Cerebral lacerations Intracranial haemorrhage Diffuse axonial injuries Secondary: Ischaemia Hypoxia Cerebral swelling Infection

Answer 12

Early signs - Headache - Vomiting - Deterioration in GCS, Pupil changes Late signs - Continued deterioration in conscious level - Abnormal flexion or extension to pain/spontaneously - Impaired brainstem reflexes - Increase in systolic BP and widening pulse pressure - Bradycardia - Slowing of respiration

Answer 13

Bleeding between the skull and the dura mater Arterial bleed – high pressure, rapid expansion 85% associated with skull fracture Requires rapid decompression Good prognosis if evacuated as an emergency Blood trapped between the skull and dura, showing the classic biconvex (bow-shape) outline on the right of the brain (left as viewed). Some mid-line shift.

Answer 14

Bleeding between the dura mater and the arachnoid mater Associated with high energy impact Venous blood – slow, insidious expansion Found in 30% of severe TBI Requires surgical decompression Outcome variable

Answer 15

Bleeding occurs within the subarachnoid space between the arachnoid membrane and pia mater Traumatic different from spontaneous or aneurysmal SAH Most likely causes (73%) are high speed injuries such as motor vehicle collision.

Answer 16

Treat and prevent: Hypoxia Hypotension Hyperventilation

Answer 17

Patients aged 18 or over who have a known or suspected head injury where GCS is 12 or less and the injury has occured within the last 3 hours

Answer 18

Secondary injury with a progression level of up to 4 segments may occur in a few days and may continue for a few weeks Spinal swelling and secondary ischaemia Loss of spinal autoregulation Hypotension and hypoxia are very significant Release of excitatory amino acids (Glutamate), activation of NMDA receptors, and other cytotoxic substances resulting in cellular hypoxia and apoptosis

Answer 19

Drugs/alcohol intoxication Distraction injuries

Answer 20

Usually eventually bradycardia A spinal injury disrupts the descending spinal pathway This results in an underactive sympathetic nervous system, which in turn means the parasympathetic system is unopposed.

Answer 21

The bulbocavernosus reflex (BCR) is a well-known somatic reflex that is useful for gaining information about the state of the sacral spinal cord segments. The BCR traditionally involves contraction of the bulbo- and ischiocavernosus pelvic floor muscles, often referred to as the ‘bulbocavernosus muscle’, in response to stimulation of the glans penis or clitoris.

Answer 22

Central cord syndrome (also known as central cervical cord syndrome) is the most common form of an “incomplete spinal cord injury”—one in which the spinal cord's ability to transmit some messages to or from the brain is damaged or reduced below the site of injury to the spinal cord. Presents with: Sensory loss - Cape like distribution (upper extremities and thorax with sacrum spared) Motor loss - Weakness that is more prominent in the upper extremities than lower extremities) Autonomic regulation - Loss of bowel and bladder. Orthostatic hypotension may also be seen

Answer 23

Patients over 50 years of age: Hyperextension with a previous history of degenerative changes in the spinal canal Patients under 40 years of age: High-velocity trauma (RTC, skiing, etc.)

Answer 24

A rare type of incomplete SCI usually seen in penetrating trauma, including knife and gunshot wounds. It can also occur with the loss of vascular supply due to a herniation or oedema to a hemisection. Presents with: Ipsilateral loss of motor function, ipsilateral loss of sensation, and proprioception and contralateral loss of pain and temperature Symptoms are due to a lesion involving the corticospinal, dorsal column, and spinothalamic tracts, respectively

Answer 25

A rare incomplete SCI that accounts for approximately 1–3% of spinal injuries, it is caused by decreased vascular perfusion to the anterior spinal artery, which supplies the anterior 2/3 of the spinal cord or increased direct pressure on the spinal cord caused by compression trauma or “over-flexion.” First signs are bilateral loss of motor function, pain, and temperature sensation, which is dominant to lower extremities Also acute severe back pain, loss of neurologic function (bladder and bowel)

Answer 26

An incomplete spinal injury that affects the posterior aspect of the spinal cord containing dorsal column fibers. Typically involves loss of proprioception and vibratory sensation with preserved motor function Presents with: Sensation of “electric shocks” running down their spine (Lhermitte’s sign) Causes include vascular compromise to the posterior spinal artery, trauma, multiple sclerosis (MS), vitamin B12 deficiency, and syphilis

Answer 27

Anterior and posterior

Answer 28

Neurogenic shock means the entire nervous system is in shock Spinal shock – just the spinal system is affected

Answer 29

Defined as a sudden uncontrolled rise in BP(SBP can reach 250-300mmhg) with a pathological response to sympathetic stimuli (stimuli triggers a sympathetic response below level of lesion. Vasoconstriction below level of lesion causes hypertension and triggers baroreceptor mediated bradycardia). **This occurs suddenly and it’s a medical emergency** Causes include constipation and urine retention. Symptoms includes headache, sweating/shivering, chest tightness

Answer 30

It can appear during the first year of injury but it is unusual during the first month.

Answer 31

Bladder Bowel Back passage issues ( haemoorhoids ) Boils Bones Baby (breastfeeding , pregnancy , sexual intercourse)

Answer 32

Occurs usually in Lesions above T6 but can occur with lesions above T10

Answer 33

Faecal impaction, bladder distension, bladder infection, cold or draught on skin, pressure sores, sharp objects pressing on skin

Answer 34

Do not carry out or maintain full-inline spinal immobilisation if they are at low risk for a cervical spine injury: i.e. **pain-free, and able to rotate their neck 45 degrees to left and right**

Answer 35

Airway compromise or known spinal deformities

Answer 36

Plus NT (not testable due to immobilisation/pain/refusal)

Answer 37

Alert GCS 15/15 No sedation, drink or drugs on board No pain No neurological deficit Only by qualified specialist - usually neurosurgeon.

Answer 38

Circulation Or as part of full secondary survey

Answer 39

**Listen** for patency: Speaking/shouting Noisy airflow (stridor, wheeze, snoring, gurgling) No airflow **Look** for obvious obstructions: Facial injuries Obvious foreign bodies Vomit Blood Burns/oedema **Feel** for air movement

Answer 40

Assess rate (approx if time critical), depth and quality of respirations (ideally on approach) Assess saturations Expose if necessary and look (TWELVE) -**T**rachael deviation -**W**ounds, bruising, swelling, obvious flail segments/fracture -**E**mphysema -**L**aryngeal crepitus (should be present) -**V**eins distended -**E**verything else - Tensions, pneomos/haemos **FEEL** Hands on chest -Equal and bilateral chest rise -Flail segments -Pain **AUSCULTATE**

Answer 41

Reassess any previously controlled catastrophic haemorrhages Assess patient colour - central and peripheral Assess radial and peripheral pulses with heart rate and capillary refill Assess patient's temperature and texture to touch Blood pressure, ECG can be done here or in secondary survey Assess for internal bleeds, treat with: -Splinting -Fluids -TXA

Answer 42

Life threatening **external** haemorrhage

Answer 43

Full GCS Pupils Blood glucose would most likely be assessed during secondary survey

Answer 44

Assess temperature Expose patient preserving dignity

Answer 45

Open book/sprung pelvis - Broken symphysis

Answer 46

Windswept pelvis -internal rotation of one or both of the hemi-pelvises

Answer 47

Malgaigne fracture/bucket handle fracture -disruption of bony ring and vertical displacement of a hemi-pelvis

Answer 48

ALPHA PVC A-Air hunger L-Low/falling CO2 P-Pale H-Hypotension A-Abnormal sensorium P-Pulse fast or slow V-Venous collapse C-Clammy