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Trauma > Trauma > Flashcards

Trauma Flashcards

0
Q

What is the #1 cause of traumatic death in the US?

How many deaths?

A

MVC’s (2011)
5.5 million accidents
2.2 million injuries
33 thousand deaths

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1
Q

What is the formula for Kinetic Energy (KE)?

A

KE = 1/2 Mass x velocity squared

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2
Q

Frontal Impact:

How much intrusion on a 30mph accident?

A

About 2ft.

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3
Q

List 4 differential dx based on a frontal impact (deceleration injury)?

A

TBI
Facial/scalp lacs
C-spine
Tracheal injury

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4
Q

Ddx for lateral impact “b” pillar intrusion

A

Brain injury

C-spine

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5
Q

Which type of impact has the most survivors?

A

Rear-end

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6
Q

How much more likely is a pt. To die if ejected from the vehicle?

A

25x

1 in 3 have c-spine injury

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7
Q

What differentiates a level 1 hospital?

A

Provides total care: prevention to rehab

Specialty care all areas

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8
Q

What differentiates a level II hospital?

A

Able to initiate “definitive” care for all patients

All specialty care except internal medicine

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9
Q

What differentiates a level IV hospital?

A

24hr lab
Limited surgical capabilities
ATLS coverage

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10
Q

What are the criteria for utilizing air transport?

A

Distance greater than 25 miles
Remote environment
Difficult extrication

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11
Q

What are the 3 categories of mandatory trauma system entry?

A
  1. Physiological
  2. Anatomical
  3. MOI
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12
Q

What are 2 categories of discretionary trauma entry?

A
  1. High energy transfer situation

2. Comorbid factors

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13
Q

Name the 3 mandatory physiological criteria for trauma system entry?

A

Systolic BP 29 or airway management required

GCS < or = 12

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14
Q

Name the 5 mandatory anatomical criteria for trauma system entry?

A

Flail chest
2 or more obvious femur or humerus fractures
Penetrating injury to head, neck, torso, or groin
Amputation above wrist or ankle
Spinal injury with limb paralysis

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15
Q

Name the 3 mandatory MOI criteria for trauma system entry?

A

Heavy extraction > 20 min
Death of same car occupant
Ejection

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16
Q

List the different kinds of shock

A

Hypovolemic

Distributive: sepsis, anaphylaxis

Cardiogenic

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17
Q

What is the calculation for cardiac output?

A

CO = SV x HR

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18
Q

What is the calculation for BP?

A

BP = CO x SVR

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19
Q

What is the approximate possible blood loss for:
Humerus break?
Radius or Ulna?

A

Humerus: 750mL

Radius/Ulna: 250-500mL

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20
Q

What is the approximate possible blood loss from the following fractures:
Tib/fib:
Femur:
Pelvis:

A

Tib/fib: 500-1000mL
Femur: 1-2L
Pelvis: Massive

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21
Q

How much blood can accumulate in the chest cavity from trauma?

A

2L per side

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22
Q

How much blood loss is associated with class 1-4 hemmorhage

A

Class 1: less than 15% (up to 750mL)
Class 2: 15-30% (750-1500mL)
Class 3: 30-40% (1500-2000mL)
Class 4: over 40% (over 2000mL)

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23
Q

What does DIC stand for?

A

Disseminated intravascular coagulation

24
Q

What is DIC?

A

Disseminated Intravascular coagulation.
A condition in which excessive clotting occurs in the smaller vessels of the body which results in low platelet levels leading to possible serious external or internal bleeds.

25
Q

What is DICC?

A

Disoriented
Irritable
Combative
Comatose

26
Q

What makes up plasma?

A

Proteins: albumin, globulin, fibrinogen
Water: 98%
Other: electrolytes, nutrients, waste

27
Q

What are the 2 fluids that are compatible for blood transfusions?

A

Normal saline

ABO compatible plasma

28
Q

List the signs of a blood transfusion reaction

A 
Fever/chills
Pain
Sense of impending doom
Hypotension
Oliguria, anuria
DIC
Hemoglobinemia
Hemoglobinuria
29
Q

What are some of the treatment aspects of a transfusion reaction?

A 
Stop the transfusion
Maintain airway and IV access
Support blood pressure
Oxygen
Antihistamines
Adrenaline/corticosteroids
30
Q

What are the 3 meningal layers of the brain (outer to inner)

A

Dura, arachnoid, pia

31
Q

What is normal ICP?

A

10-15 mm/hg

32
Q

What is MAP and how do you calculate it?

A

Mean Arterial Pressure

Diastolic + 1/3 pulse pressure

33
Q

What is CPP?

How is it calculated?

A

Cerebral perfusion pressure.

CPP = MAP-ICP

34
Q

What is CBF and how is it calculated?

A

Cerebral blood flow.

CBF = CPP/CVR

35
Q

Starting with a rise in ICP, explain Cushing’s syndrome.

A

Increased ICP leads to decreased CPP. The body raises BP (MAP) to compensate for the decrease in CPP. The rise in MAP triggers baroreceptors in the aortic arch to trigger a reduction in heart rate (bradycardia). CPP= MAP-ICP.

36
Q

What causes Cheyne Stokes breathing in a TBI patient?

A

The body is trying to balance cerebral vascular resistance through the acid/base balance in order to maintain adequate CBF.
Hypercapnea causes cerebral vasodilation which helps CBF but increases ICP.
Hypocapnia causes cerebral vasoconstriction which decreases ICP but reduces CBF.

37
Q

How is TBI managed?

A

Controlled hyperventilation (30-35 etc02 goal)
Sp02 > 90%
Elevate head
Less than 8, intubate……if symptomatic
Maintain SBP >90

38
Q

What effect does Hypercapnia have on cerebral vessels?

A

Dilation

39
Q

What is Brown-Sequard syndrome?

A

Brown-Sequard syndrome (BSS) is a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side. BSS may be caused by a spinal cord tumor or trauma

40
Q

What are the 5 criteria listed in the NEXUS study?

A
  1. No midline cervical tenderness
  2. No focal neurological defects
  3. Normal alertness
  4. No intoxication
  5. No painful, distracting injury
41
Q

What are the 4 classifications of burns?

A

Thermal
Chemical
Electrical
Inhalation

42
Q

Name 3 non-medical events that could lead to hyperkalemia.

A

Trauma: compartment syndrome
Burns causing tissue death
Kidney trauma

43
Q

What are the most commonly fractured ribs?

A

4-9

44
Q

Define “flail chest”

A

More than one rib broken in more than one location

45
Q

How large of a chest wall hole is required to overcome tracheal air preference?

A

> 2/3”

46
Q

Define “in extremis”

A

At risk of death

47
Q

What is “pulsus paradoxis” and what can it be a symptom of?

A

A decrease of 10mm/hg or greater in systolic BP during inspiration.
Cardiac Tamponade

48
Q

What is the set of symptoms often seen with cardiac tamponade?
Name the symptoms.

A

Beck’s Triad

  1. Narrowing Pulse Pressure
  2. JVD
  3. Muffled heart sounds
49
Q

What is “comotio cordis”?

A

Sudden cardiac arrest from being struck in precordium by a hard object

50
Q

What are the most common abdominal organs to be injured in blunt trauma?

A

Spleen & Liver

51
Q

What is “Cullen’s sign”?

A

Ecchymosis around umbilicus

52
Q

What is Grey’s-Turner sign?

A

Ecchymosis on flanks

53
Q

What is Kehr’s sign?

A

Acute pain in the tip of the shoulder (when pt. Is supine with legs elevated) due to blood or irritants in the peritoneal cavity. Classic symptom for ruptured spleen.

54
Q

Regarding ballistics, what is hydrostatic shock?

A

Remote wounding effects due to the pressure wave in body tissues, can lead to neural tissue damage, organ shutdown, bone and spine fractures, etc.

55
Q

What did the “knockdown” study about buffalo imply?

A

The buffalo that died instantaneously was a result of ruptured vessels in the brain due to hydrostatic shock (hydraulic shock)

56
Q

What is the difference between high order and low order explosives?

A

Speed of the shock wave.

HE explosives emit a supersonic shockwave.

57
Q

Name and describe the 4 types of blast pathophysiology.

A

Spalling: caused by shockwave moving through tissue
Implosion: gas trapped in hollow organs compressing then expanding.
Shearing: tissues moving at different speeds
Irreversible work: force exceeding the strength of the tissue.

Trauma (1 decks)

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