Flashcards in Trauma 3 Deck (15):
Classification and management of retroperitoneal hematomas?
Zone 1 – central hematoma – abdominal exploration (preoperative angiogram it's unstable)
Zone 2 – kidney hematoma – no exploration unless hematoma expanding or patient with penetrating trauma
Zone 3 – pelvic hematoma – no expiration with a blunt trauma. Angiographic embolization and pelvic fracture reduction are appropriate. Exploration if penetrating trauma to exclude vascular injuries.
Patient presents after a head injury in MVA. Evaluation?
2. Rapid neurologic exam (pupillary, cranial nerves, peripheral motor/sensory function)
3. Assess consciousness – Glasgow coma scale
4. Examine head for depressed skull fracture or scalp laceration
5. Determine state of consciousness during accident
Signs that suggest a basal skull fracture?
#Loss of consciousness
#Blood from ear, (raccoon) eyes, mastoid bone (Brattle's sign)
Patient presents after trauma. Change that warrants CT scan? Normal CT scan of head and the kids?
Any neurologic change
Normal CT virtually eliminates possibility of serious head injury and patient can be discharged
Danger of severe head injury?
Temporary, immediate Maneuvers to mitigate this?
Edema of the brain, increasing ICP and decreasing cerebral perfusion
#Elevation of head to 30°
#Hyperventilation 26-28 PCO2 (Stop hyperventilation after CT scan and neurologic evaluation)
#Manitol to dehydrate brain
Use of hyperventilation in brain injury?
Useful immediately after injury and for patients with signs of impending brain herniation
Routine hyperventilation they worsen neurologic outcome
Signs of impending brain herniation?
Blown pupil or lateralizing
Management of patient with Glasgow coma scale less than 8?
#Maneuvers to minimize cerebral edema (elevate head, limits, hyper)
#CT scan and if necessary, evacuation
Patient posttrauma with Glasgow coma scale of 10 and dilated right pupil that sluggishly reacts to light – Suspected diagnosis? Management?
Space occupying lesion (epidural hematoma, Temporel lobe intracerebral hematoma)
Patient post, develops sodium level of 125 – suspected diagnosis? Could lead to? Management? Overcorrection may lead to? To avoid this?
SIADH from brain injury
water restriction or hypertonic saline
Central Pontine Myelinosis; correct half of Na deficit over 24 hours
Patient post trauma presents with sodium level of 160 – suspected diagnosis? Mechanism? Treatment?
Diabetes insipidus; failure of release of ADH
subcutaneous vasopressin and free water
Importance of postoperative body temperature? Temperature can affect what lab values?
Hypothermia is a predictor of poor outcome (leads to coagulopathy from platelet dysfunction and prolongation of PT and PTT)
When to transfuse platelets in postoperative patient with continuing hemorrhage?
Keep platelet count above 60,000
Effect of multiple injuries on fluid management?
Increased injuries = increased inflammation = more fluid loss into third space
Need greater fluid replacement