Trauma

Question 1

What is triphasic dz?

Answer 1

1) sec to min - death d/t major or severe injuries
2) min to hrs - death d/t treatable but life threatening injuries
3) days to wk - death d/t multiple organ system failure/infxn

Question 2

What is the fatal triad?

Answer 2

hypothermia
coagulopathy
acidosis

Question 3

What is the primary survey?

Answer 3

ABCDE

Question 4

What is secondary survey?

Answer 4

a finger in every orfice
procedures
head to to exam

Question 5

What is tertiary survey?

Answer 5

f/u w/in 24hrs

Question 6

What do you use FAST?

Answer 6

unstable pt in ED

Question 7

What are initial xrays?

Answer 7

Cpsine
CXR
pelvi

Question 8

When to use CT scans?

Answer 8

CTA of chest and other vascular injuries

Question 9

What to watch out for in head injuries?

Answer 9

one ep of systolic BP less than 70

Question 10

What is GCS for intubation?

Answer 10

8

Question 11

What to look for w/ scalp injuries?

Answer 11

basilar skull fx - battle sign, hemotympanum, raccoon eyes

Question 12

What is cushing reflex? What does this indicate? vs cushing triad?

Answer 12

slow HR but high BP
thalamic injury
triad: slow HR, high BP, widening pulses - incr diff between systolic and diastolic

Question 13

How to tx ICP?

Answer 13

HYPERtonic saline
mannitol
HYPERventilation
chemical parlysis - to reduce cerebral O2 demand
surgical procedures

Question 14

What must be r/o in eye trauma?

Answer 14

ruptured globe
orbital fracutre
EOM entrapment

Question 15

What is retrobulbar hematoma? Tx?

Answer 15

complication of eye and eyelid surgery (orbital compartment sx)
tx: lateral canthotomy

Question 16

What to consider for face trauma?

Answer 16

unstable midface = LeFort fx

mandible fx

Question 17

When can you r/o C spine fx?

Answer 17

NEXUS rules:

• no midline tenderness
• no neurologic deficits
• no intoxicants
• no distracting injury
• normal mental status

Question 18

What is chance fracture?

Answer 18

complete anterior-posterior spinal fx

Question 19

What is associated with chance fracture?

Answer 19

mesenteric or bowel injury

Question 20

Wht are vascular neck injuries?

Answer 20

external hemorrhage
rapidly expanding hematoma
bruit
palpable thrill

Question 21

Young adult w/ sudden CVA sx? Tx?

Answer 21

carotid artery dissection

tx: anticoag to prevent embolic stroke

Question 22

Cx of aortic disruption? Tx?

Answer 22

rapid deceleration - occurs at the ligamentum arteriosum

tx: surgery asap

Question 23

Aortic disruption - imaging?

Answer 23

widening mediastinum
apical capping
tracheal displacement

Question 24

Open pneumothorax vs tension pneumothorax?

Answer 24

open: no air movement
tension: one way valve injury

Question 25

What are late signs of tension pneumothorax?

Answer 25

JVD and tracheal deviation

Question 26

How to tx open vs tension pneumo?

Answer 26

open: cover hole w/ 3 sides tension: needle decompression

Question 27

Pt has PEA, what to think of?

Answer 27

pericardial tamponade

Question 28

What to think of w/ splenectomy or grade III laceration?

Answer 28

immunization against: h flu menigococcus pneumoccus

Question 29

How is the liver injured in trauma?

Answer 29

cracks then BREAKS - NO rupture

Question 30

Pt is hypotensive, low urine output, firm abdomen, and high bladder pressure (30)? Tx?

Answer 30

abdominal compartment sx | laparotomy

Question 31

What labs to run if pt fell from ht?

Answer 31

ENTIRE spine + bilateral calcanei

Question 32

How to tx open fx?

Answer 32

abx | triple abx if gross or farm injury

Question 33

How to tx clavicle fx?

Answer 33

surgery

Question 34

Where can adult blood vol be lost? half of the blood vol?

Answer 34

whole blood vol: pelvic fx | half blood vol: femur

Question 35

How to tx pelvic fx?

Answer 35

close the book

Question 36

Blood at meatus, high riding prostate, perineal ecchymosis? What to check for first?

Answer 36

urethral injury 1) retrograde urethrogram 2) urinary catheter

Question 37

What ABI needs further check up?

Answer 37

less than 0.9

Question 38

Pt has petechial rash, confusion, hypoxia, bilateral pulm infiltrates, microfat in urine?

Answer 38

fat emobli from extremity injury

Question 39

What are trauma complications? Sx? Tx?

Answer 39

``` compartment sx P-allor P-ulslessnes - late finding P-arathesis P-aralysis P-ain out of proportion tx: fasciotomy ```

Question 40

In what areas can pts bleed to death?

Answer 40

``` C-hest A-bdomen R-Retroperitoneum T-high S-treet/S-cene ```

Question 41

What emboli to worry about in extremity injury?

Answer 41

fat emboli

Question 42

What are the fluid types?

Answer 42

cyrstalloid colloid blood/products

Question 43

What is the ratio for fluids?

Answer 43

1:1:1

Question 44

How to tx ped trauma re: fluids?

Answer 44

1) 10-20ml/kg bolus x 2 | 2) blood products

Question 45

How to tx pregnant pt in trauma?

Answer 45

treat the mother = save the fetus | -prop the mom up to get off the vena cava

Question 46

What are the stages of shock?

Answer 46

early late irreversible

Question 47

What haps in early shock?

Answer 47

normotesnive tachycardi tachypnea

Question 48

What haps in late shock?

Answer 48

hypotensive tahcy cardi tahcypnea

Question 49

What is irreversible shock?

Answer 49

ypotensive HR drops RR drops

Question 50

What are the types of shock?

Answer 50

distributive obstructive cardiogenic

Question 51

What is distributive shock?

Answer 51

septic neurogenic anaphylactic adrenal

Question 52

What are obstructive shock?

Answer 52

PE tamponade constrictive pericaditis

Question 53

What is the equation for BP?

Answer 53

CO x SVR | -CO depends on preload, afterload, an dcontractility

Question 54

Low SVR sx?

Answer 54

distributive shock | pink, warm bounding pulses

Question 55

High SVR sx?

Answer 55

low CO = pale, cool, thready puslses

Question 56

Sx for hypovolemic shock?

Answer 56

dec CO, Cardiovenous pressure | incr SVR

Question 57

Sx for cadiogenic shock?

Answer 57

Dec CO, LV stroke vol | incr SVR

Question 58

Sx for neurogenic shock?

Answer 58

paralysis of sympathetic shock = dec SVR, bradycardia, hypotension pink/warm

Question 59

How to tx neurogenic shock?

Answer 59

vasopressors | O2

Question 60

What are the stages of septic shock?

Answer 60

1) SIRS 2) sepsis - infxn 3) severe sepsis - organ failure 4) shock - hypotension

Question 61

How to tx septic shock?

Answer 61

iv abx vasopressor transfusions