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DipPEC 2025 > Trauma > Flashcards

Trauma Flashcards

(72 cards)

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1
Q

Airway assessment?
TWELVE C

A

Tracheal deviation
Wounds
Emphysema
Laryngeal tenderness
Venous distension
Oesophageal injury
Carotid - bruit/hematoma/ swelling

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2
Q

RSI Intubation preparation?
STOP IC BARS

A

Suction
Tube - size and one smaller
Oxygen
Pharmacology - induction/ paralysis/ sedation
IV access
Connect monitors and confirmatory devices
Blade/Bougie
Alternative airways
Rescue devices
Surgical

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3
Q

Difficult ventilation? LEMON 🍋

A

Look - distortion/dentition/disproportion/dysmotility
Evaluate 3-3-2
Mallampati
Obstruction/ obesity
Neck mobility

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4
Q

Difficult BVM? BONES🦴

A

Beard
Obese
No teeth
Elderly
Stiff lungs

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5
Q

Difficult LMA? RODS 🪠

A

Restricted mouth opening
Obstruction
Distorted airway
Stiff lungs

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6
Q

Classes of hemorrhagic shock ?

A

Class 1 <15% Increased HR
Class 2 15-30% Narrow pulse pressure
Class 3 30-40% Reduced BP / HR 120/ Fluids + blood TF
Class 4 >40% Lethargic/anuric/ HR 140

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7
Q

Shock index ?
- The formula
- What ratio is considered shocked

A

HR / SBP
0.5-0.7 is normal
Shocked >0.9

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8
Q

Track 3 Equipement?
- What is it used for

A

Isolated femur fractures only

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9
Q

Transexamic acid (Cyclokapron)
- Trial of evidence ?
- When indicated
- Dosage

A
  • Crash 2 trial
  • Within first 3 hours of trauma
  • Dosage: 1g IV stat Then next 1g over 8hours
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10
Q

Triad of death ?
Diamond of death?
Lethal Pentad?

A

Acidosis
Hypothermia
Hypercoagulopathy

Hypocalcemia has been added - diamond of death
Hypotension - lethal pentad

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11
Q

Permissive hypotension?
- When is it indicated ?
- Aim?

A
  • Penetrating trauma patients
  • Avoid exsanguination but high enough for perfusion / don’t pop the clot with over resuscitation
    Map of 65mmHg
    SBP 100mmHg
    if patient known hypertensive - higher values may be considered
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12
Q

Airway management algorithm?

A
  1. Oxygen
  2. Jawthrust
  3. Adjuncts
  4. Intubate
  5. Surgical
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13
Q

Assessment of breathing ?

A

External
Movement
Auscultation
Percussion
Saturation

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14
Q

Lethal breathing pathologies ?

A

Tension pneumothorax
Open pneumothorax
Flail chest

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15
Q

Needle decompression site?

A

5th ICS

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16
Q

ICD tube size

A

28-32 French

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17
Q

Causes of Shock ?

A

Hypovolaemia/Haemorrhagic

Cardiogenic

Obstructive:
- Tension pneumothorax
- Pericardial tamponade

Distributive
- Neurogenic shock
-Septic shock

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18
Q

Massive blood transfusion?

A

> 10units pRBC in 24hours
Or
4 units in 1 hour

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19
Q

Expected HB and Hct increase per unit ?

A
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20
Q

GCS

A

E4V5M6

Eyes
4 - spontaneously
3 - to voice
2- to pain
1- no response

Verbal
5 - orientated
4- confused
3 - words
2 - sounds
1 - no response

Motor
6 - obeys commands
5- localizes pain
4 - withdraw from pain
3 - decorticate flexion
2 - decerebrate extension
1 - no response

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21
Q

AVPU and GCS equivalent

A

A - 15
V - 13
P - 8
U - 3

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22
Q

Canadian Head CT Rules
- What is it used for?
- High risk criteria GSSAV
- Medium risk criteria AD
- Exclusion criteria

A
  1. Used to determine which patients with minor injuries require CTBs (GCS 15-13)

High risk criteria
- GCS< 15 for >2 hours post injury
- suspected skull # - depressed or open
- Base of skull # features - haemotympanum, raccoon eyes, battles sign, CSF nose or ear
- 2 or more episodes of vomiting
- > age 65

Medium risk
- amnesia >30 mins before impact
- dangerous mechanism ( PVA/ ejection/ fall > 1m or > 5 stairs)

Not applicable to:
- Nontrauma
- GCS<13
- Age <16
- Bleeding disorder/ anticoagulant
- Seizure after injury

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23
Q

Nexus CT Head Rule
- What is it used for?
- 8 Factors

A

If these 8 factors are absent there is a low risk of intracranial injury with blunt head trauma & therefore can be discharged

  1. Evidence of skull fracture
  2. Scalp hematoma (not face or neck)
  3. Any focal deficits
  4. GCS = or <14
  5. Abnormal behavior
  6. Persistent vomiting
  7. Coagulopathy - hemophilia, medications, hepatic insufficiency
  8. Age >65
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24
Q

Components of exposure?

A

Expose
Log roll
Spine
PR/DRE
Head to toe
Keep warm

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25
Indications for DRE?
Rectal haemorrhage or defects Spinal cord injury Pelvic fracture Blood at meatus or haematoma perineal Intraperitoneal hemorrhage
26
TEG Thromboelastogram ?
R time - coagulation factors => FFP k time - fibrinogen => cryoprecipitate Alpha - fibrinogen => cryoprecipitate MA - platelets => plts or DDAVP Lysis - cyclokapron
27
Head injury principles ? Neuroprotection
1. BP - no hypotension ! 2. Blunt intubation response 3. Prevent hypoxia/ hypercapnia/ hyperthermia and hypoglycemia Head up 30’ Sedation and analgesia Hyperventilation? Osmotherapy - hypertonic saline (3% 3ml/kg over 10mins) - mannitol Craniectomy Hypothermia Barbiturates / phenytoin LP
28
E-FAST quick review
1. Lung slide / m-mode 2. Cardiac pericardial fluid >1cm / serial scans 3. RUQ / morrisons pouch 4. LUQ / least likely to see fluid here 5. Suprapubic
29
E-FAST algorithm ?
30
HOTT protocol
Hypovolaemia Oxygenation Tension Tamponade
31
Indications for thoracotomy
CPR<10mins Witnessed sign of life within unit Penetrating trauma
32
Thoracotomy
1. Intubate - advance ETT into right bronchus (ventilate right lung) 2. ICD 3. Clamshell or rib spreader 4. Visualize heart and careful phrenic nerve 5. Find injury and occlude 6. Cardiac massage 7. Call surgeon
33
REBOA ?
Resuscitative endovascular balloon occlusion of the aorta (REBOA) involves the temporary occlusion of the aorta, using a percutaneously deployed intravascular balloon, usually inserted via the femoral artery.
34
TBI - severity?
Mild GCS 13-15 Moderate GCS 9-12 Severe GCS 3-8
35
Is it CSF?
Halo sign Beta 2 transferrin
36
Subdural vs epidural bleeds ?
Source Shape Crosses bridging lines Presentation
37
Monroe Kellie Doctrine
38
Uncal herniation
Occulomotor nerve
39
Cushings triad ?
Bradycardia Widened Pulse pressure Irregular respiration (Cheyne stokes)
40
Cerebral perfusion pressure ?
CPP= MAP- ICP Normal 60-70 Normal ICP 5-15mmHg
41
Concussion ? Mild TBI
42
Nasal bone fracture ? Septal hematoma ?
ENT referral
43
Facial fractures - Le fort
1 2 3
44
Maxilla fracture
45
Eye injuries
Globe rupture Hyphema Retrobulbar hematoma Retinal detachment Corneal abrasion
46
Globe rupture features ? Mx?
47
Hyphema severity ? Mx?
Micro hyphema - slit lamp “cell&flare” <33% 33-50% >50% 100% 30 degrees head up Opthalm referral
48
Retrobulbar hematoma features and Mx?
Lateral canthotomy
49
Canadian C spine Rule
1. High risk factors ? - >65yrs - dangerous mechanism - paresthesia in extremities 2. Low risk factors ? - ambulatory at scene - no neck pain at scene - simple rear-end MVA - no midline tenderness 3. AROM 45 degrees left and right ?
50
C spine series ?
1. Open mouth 2. Lateral 3. AP 4. Swimmers
51
Unstable C Spine fractures ? Jefferson Bit Off A Hangman’s Thumb
Three coloumn theory Jefferson Bilateral facet dislocation Odontoid type 2/3 Any fracture atlanto-axial or atlanto-occipital Hangman’s Teardrop
52
Jefferson #
C1 burst # High association of C2 fracture MOA: axial load like diving Open mouth view
53
Odontoid frcature
Type 1 Type 2 - unstable / 10% have transverse lig rupture ?=unstable Type 3 - unstable
54
Hangman Fracture
C2 Pars interarticularus # Falls and high velocity car accident Violent snapped back
55
Spinal shock vs neurogenic shock
Spinal shock - bulbocavernosus reflex first to return - Flaccidity and loss of reflexes Neurogenic shock - Dx of exclusion -loss of vasomotor tone - above T6 level - hypotension - bradycardia - warm peripheries Mx - fluids (often don’t respond) - Noradrenaline / adrenaline - atropine / pacing
56
Spinal cord lesions
Dorsal column Corticospinal Spinothalamic Anterior cord syndrome Central cord syndrome Brown sequard syndrome
57
Chance fracture
58
Zones of the neck
Angle of jaw to cricoid to suprasternal notch
59
Hard vs soft signs of penetrating neck trauma
Hard signs - airway obstruction - expanding haematoma - active bleeding -haemorrhagic shock -Vascular bruit or thrill - Cerebral ischaemia - Decreased or absent radial pulse Soft signs - haemoptysis/haematemesis - oropharyngeal blood - dyspnoea/ Dysphagia - subcutaneous or mediastinal air - chest tube air leak - nonexpanding haematoma - focal neurological deficit
60
Kendrick extraction device
61
Massive Haemothorax
>1.5l initial output >1/3 blood volume 200ml/hr for 2-4hrs
62
Blood volume %
Adult 7% of weight Child 8-9% of weight
63
Neuro Obs time frame ?
6hrs from injury
64
NEXUS c spine NSAID
Neuro deficits Spinal tenderness Altered LOC Intoxication Distracting injury
65
Life threatening chest trauma ATOM FC
Lethal Airway obstruction Tension pneumothorax Open pneumothorax Massive haemothorax Flail chest Cardiac Tamponade Potentially leathal Aortic injury Thorax injuries - simple pneumo/haemo Oesophageal injury Muscular diaphragm injury Fistula or tracheobronchial Contusions to heart or lung
66
Haematuria ?
Blunt trauma Now microscopic = ok Now macroscopic = not ok Penetrating injury - any haematuria not ok
67
Signs of urethral injury ? Imaging?
Blood at meatus Perineal or scrotum haematoma High riding prostate Straddle injury Retrograde cystogram
68
Peripheral vascular injury Hard vs soft signs
69
Pregnant trauma patient Normally alkalotic Aortocaval decompression Anti-D dose ? For abdominal trauma - <12wks 50mcg ->12wk 300mcg
70
Modified Brooke/Parkland Adult >20% Children >15%
mls x %BSA x wt First half in 8hrs Second half over 16hrs Adult 2ml Child 3mls Electrical 4mls
71
Referral to burns centre ?
Any Full thickness
72
Indications for DPL

DipPEC 2025 (21 decks)

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