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Trauma Flashcards

0
Q

What are the heavy organs commonly injured in acceleration-deceleration injuries

A

Fluid filled loops of bowel, thoracic aorta, liver, spleen, kidneys

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1
Q

What are the components of the primary survey

A 
Airway
Breathing
Circulation
Disability (neurological deficits)
Exposure/environment
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2
Q

Components of AMPLE history

A 
Allergies
Medications
Previous illnesses
Last meal
Events surrounding injury
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3
Q

Treatments for compromised airway

A

Oxygen, relieve obstructions, oral tracheal intubation, nasotracheal intubation, surgical airway (cricothyroidotomy, tracheostomy)

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4
Q

Tx for pneumothorax

A

Needle decompression in the 2nd intercostal space midclavicular
Chest tube

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5
Q

Tx for hemothorax

A

Volume replacement

Chest tube

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6
Q

Tx for open chest wound

A

Semiocclusive dressing

Chest tube

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7
Q

Rapid faint pulse suggests what

A

Profound hypovolemia

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8
Q

Slow, full pulse may indicate what

A

Neurologic injury with increasing ICP or hypercarbia

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9
Q

What are signs of peripheral perfusion

A

Level of consciousness, rate of capillary refill, urine output, body temperature

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10
Q

When would you fail to see tachycardia with hypovolemia

A

Pt on beta-blockers or pacemaker

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11
Q

Indication for ER thoracotomy and open cardiac massage

A

Hypovolemic cardiac arrest despite CPR and defibrillation

Arrest with penetrating chest injury

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12
Q

What are two signs of basilar skull fracture

A

Raccoon eyes and Battle’s sign

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13
Q

Surgical procedure for cardiac tamponade where pericardium is visualized from a subxyphoid approach

A

Pericardial window

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14
Q

Procedure to decompress pericardial tamponade awaiting surgery

A

Pericardial centesis

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15
Q

Gold standard for great vessel injury

A

Angiography

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16
Q

How to evaluate esophageal perforation

A

Esophagoscopy and contrast swallow

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17
Q

Tx for ongoing organ bleeding or perforation

A

Laparotomy

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18
Q

Which organ injuries can be managed nonoperatively in stable patients

A

Liver and spleen

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19
Q

What do you do if you see blood at the urethral meatus

A

Retrograde urethrography

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20
Q

Bladder injuries heal spontaneously except which kind

A

Intraperitoneal bladder rupture

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21
Q

Which renal injuries require surgery

A

Renal pedicle disruption

Major parenchymal damage with hemorrhage

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22
Q

Prolonged ischemia or venous injury requires vascular repair with what else

A

Fasciotomy

Anticipate swelling and tension in muscle compartments.

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23
Q

Which fractures are associated with hypovolemic shock

A

Bilateral femur fracture

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24
What decreases risk of fat embolism syndrome in open fractures
Adequate splinting and stabilization
25
Recommended IV access for peds
Intraosseous
26
What is the priority in burn injuries
Stop burning with neutral solutions
27
Burn that involves epidermis only
First degree burn
28
Signs of a first degree burn
Erythema
29
Burn that is partial thickness (part of the dermis)
Second degree burn
30
Signs of a second degree burn
Vesicles, swelling, moistness, pain
31
Burn that is full thickness, through dermis
Third degree burn
32
Signs of a third degree burn
Charred, waxen, leathery appearance, dryness, painless on burn surface
33
How do you determine extent of burns
Rule of 9's
34
When 2nd and 3rd degree burns cover >20%, what is required
IV fluid resuscitation
35
What should be included in ABG for burn patients
Carbon monoxide level CarboxyHb >10% is significant
36
What fluid should be used to resuscitate a burn patient
Lactated Ringers
37
When should cold compresses be used on a burn
If it covers <10% BSA
38
Tx of any burn includes
``` Shielding the burn Topical antimicrobial (silver nitrate) Debridement and escharectomy ```
39
Which organism can be prophylaxed against in 2nd degree burns
Beta hemolytic streptococci (S. pyogenes)
40
Where is muscle most damaged in electrical burns
Muscle closest to the bone Most resistance generates the most heat
41
Tx for muscle involvement of electrical burns
Early escharotomy, fasciotomy, debridement | Repeated explorations at 1-2 days possible
42
How do you treat oliguria and acidosis in electrical burns
Mannitol | Bicarbonate
43
Two long term sequelae of electrical burns
Transverse myelitis | Cataracts
44
Tx for flail chest
Fluid restriction, diuretics Bilateral chest tubes R/o transection of aorta
45
Petechial rashes in axilla and neck, fever, tachycardia, thrombocytopenia
Fat embolus
46
Buzzword for CT scan as an appropriate test
"Hemodynamically stable"
47
Which type of shock has elevated central venous pressure
Intrinsic cardiogenic shock
48
What should be withheld from patients in cardiogenic shock
Fluid and blood
49
Can hypovolemic shock occur secondary to intracranial bleeding
No
50
What is the approach for GSW to upper neck
Arteriogram
51
What is approach for GSW to lower neck
Arteriogram, esophagogram, esophagoscopy, bronchoscopy
52
Symptoms of Brown-Sequard syndrome
Ipsilateral: paralysis, loss of proprioception Contra: loss of pain and temp
53
Tx of rib fracture in elderly
Nerve block | Epidural catheter
54
What must be done after splenectomy
Vaccination against encapsulated organisms
55
Tx of pelvic fractures with ongoing bleeding
Pelvic fixators followed by angiographic embolization of both internal iliac arteries
56
Tx for urethra injury starts with what
Retrograde urethrogram Dont insert Foley until its done!
57
Diagnosis of bladder injury requires what
Retrograde cystogram and postvoid films
58
Tx for extraperitoneal and intraperitoneal bladder leaks
Extra: foley catheter Intra: surgical repair, suprapubic cystostomy
59
What is a potential sequela of injury to the renal pedicle
AV fistula leading to CHF
60
Tx of crushing injuries
Fluids, osmotic diuretics, alkalinize urine | Possible fasciotomy
61
What organ dysfunction can crushing injuries cause
Renal failure
62
Describe fluid resuscitation technique in burn patients
1L lactated Ringers without sugar over 1 hr | Adjust next fluid infusion to achieve urine output of 1-2 mL/kg/hr
63
Tx for limited third degree burns
Early excision and grafting
64
When is rabies prophylaxis indicated
Unprovoked bites, or if animal shows signs of rabies Not necessary in provoked bites
65
Tests ordered if patient has snakebite
Blood for typing and crossmatch | Coags, liver and renal function tests
66
Antidote for snakebite, bee sting, black widow spider bite
Snake: CROFAB Bee: epinephrine BW: IV calcium gluconate
67
Anatomic criteria for trauma team activation
``` Penetrating injury head, neck, torso, extremities above knee and elbow Open or depressed skull fx Chest wall deformity At least 2 long bone fx Amputation above wrist or ankle Crushed, mangled or pulseless extremity Unstable pelvis fx Paralysis or any spinal cord injury ```
68
Mechanistic criteria for trauma team activation
Fall > 20 ft High speed MVC Motorcycle crash > 20 mph
69
Mechanistic criteria for MVC for trauma team activation
Intrusion > 12 inches in passenger compartment or > 18 inches at any site Ejection Death inside compartment Pedestrian thrown, run over or hit > 20 mph
70
High risk patients requiring trauma team activation
``` Extremes of age Pregnant patient Bleeding disorder or anticoagulated Burns Hypothermia ```

Surgery (17 decks)

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