Trauma Flashcards
1
Q
First step when assessing trauma?
A
ABCs
2
Q
How to tell if airway patent vs urgent vs emergent
A
Patent if patient is speaking in full sentences, bilateral breath sounds
Urgent if impending airway collapse like expanding hematoma or cutaneous emphysema
Emergent intubation if gurgling, stridor, GCS
3
Q
Goal RR when assessing trauma
A
12-20
4
Q
Stepwise escalation in breathing for patient
A
Supplemental O2, Bag mask, ET tube, cricothyrotomy
5
Q
Signs of circulatory shock?
A
SBP
6
Q
Equation to determine MAP?
A
MAP=COxSVR
7
Q
How to determine CO?
A
CO=HRxSV
8
Q
How to determine SV?
A
Preload x contractility
9
Q
Conditions that decrease preload?
A
Hemorrhage or obstruction (pericardial tamponade/tension pneumothorax).
10
Q
How to diagnose hemorrhage?
A
FAST (focused assessment with sonography for trauma)
11
Q
How to treat hemorrhage?
A
2 large bore IVs, IVF, type and screen, give blood, fix the hole.
12
Q
Patient presentation with tension pneumo?
A
Engorged neck veins, absent lung sounds, deviated trachea, hyperresonant cavity.
13
Q
Treatment for tension pneumo
A
Immediate needle decompression at anterior second intercostal space.
14
Q
Patient presentation with percardial tamponade?
A
Engorged neck veins, clear lungs, distant heart sounds, hypotension, pulsus paradoxus
15
Q
How to diagnose pericardial tamponade?
A
FAST
16
Q
How to treat pericardial tamponade?
A
Pericardiocentesis
17
Q
Signs and cause of basilar skull fracture
A
Significant trauma causes raccoon eyes or battle sign. Perhaps CSF leak from ear or nose.
18
Q
How to diagnose basilar skull fracture
A
CT scan
19
Q
How does an epidural hematoma occur?
A
Side of head trauma causes middle meningial artery bleed
20
Q
How does patient with epidural hematoma present?
A
Unconscious -> lucid interval -> death
21
Q
How to diagnose epidural hematoma?
A
Lens shape on CT scan
22
Q
Treatment for epidural hematoma
A
Craniotomy
23
Q
What type of patients get acute subdural hematomas?
A
Shaken babies or teens in a HUGE trauma like an MVA.
24
Q
How to diagnose subdural hematoma?
A
CT scan shows crescent
25
How to treat a patient with subdural hematoma?
Decrease intracranial pressure so elevate head of bed, hyperventilate patient, give mannitol.
26
What type of patients get chronic subdural hematomas?
Elderly, alcoholics. Bridging veins tear.
27
How to treat concussion?
Send patient home, keep patient awake so they don't slip into coma.
28
What types of patients get diffuse axonal injury?
Angular trauma, patient will slip into coma.
29
How to diagnose diffuse axonal injury?
CT shows blurring of grey-white junction with punctate hemorrhages.
30
How to work up gsw to upper neck, middle neck, lower neck?
Upper neck - arteriogram
Middle neck - surgery
Lower neck - bronch, endoscopy, arteriogram
Then get a CT of the C-spine
31
How to work up knife wound to upper neck, middle neck, lower neck?
Arteriogram and ultrasound to all three.
Then get a CT of the c-spine
32
When to go right to surgery after GSW or knife wound to the neck?
GSW to middle neck or any time a patient is gurgling, has a hematoma, and is in shock.
33
Spinal cord tracts DCML, pain+temp, motor
Pain and temp cross immediately, DCML and motor fibers cross in medulla. So injury on one side will affect ipsilateral proprioception and movement but contralateral pain and temp perception.
34
How to treat any cord syndrome with urinary or fecal incontinence or erectile dysfunction?
Immediate high dose dexamethasone. Diagnose with MRI.
35
What types of patients get anterior cord lesion? What is the pathogenesis and what are the symptoms?
Elderly patients, patients in MVA. From hyperextension of neck.
Symptoms are paralysis and burning pain in extremities.
36
What causes rib fractures?
Blunt trauma.
37
Symptoms of rib fracture? Consequence of symptoms?
Chest pain and splinted breathing. Causes atelectasis and eventually pneumonia.
38
How to treat rib fracture?
With pain control.
39
Signs of pneumothorax
Dyspnea, hyperresonant lung sounds, decreased breath sounds.
40
How to diagnose pneumothorax?
CXR shows vertical lung shadow.
41
How to treat pneumothorax?
Thoracostomy at apex
42
Signs of hemothorax
Dullness to percussion, dyspnea, decreased breath sounds
43
How to diagnose hemothorax?
CXR shows horizontal air fluid level.
44
How to treat hemothorax?
Thoracostomy at base of lung. Must check output to see if bleed is from peripheral vasculature or pulmonary vasculature.
If >1500 ml or >600cc/hour, then GO TO SURGERY.
45
How to treat a tension pneumothorax
Occlusive dressing taped x 3.
46
What causes flail chest?
Huge blunt trauma where 2 or more ribs break in 2 or more places.
47
How to tell if a patient has flail chest?
Paradoxical movement, breathing out causes segment to move in, viceversa.
48
How to treat flail chest?
Weights/binders.
49
How do patients get a pulmonary contusion?
Scapular fracture, sternal fracture, or flail chest.
50
What will the CXR show for pulmonary contusion?
CXR will be normal until 48 hours after the trauma at which point it will show bilateral white out.
51
Symptoms of pulmonary contusion?
Dyspnea, pulmonary edema.
52
How to treat pulmonary contusion?
Avoid crystalloids, give colloids, PEEP.
53
How to patients get a myocardial contusion?
Scapular fracture, sternal fracture, flail chest.
54
How to diagnose myocardial contusion?
12 lead EKG and trop?
55
How to treat myocardial contusion?
Prevent HF and treat arrhythmias. Give MONABASH
56
How to patients get a traumatic aortic dissection?
Trauma causes aorta to rip of ligamentum arteriosum. Patient will be DOA or will have a adventitial hematoma.
57
How to diagnose an aortic dissection?
Based on index of suspicion. Get a CXR. Then get CT scan, if negative and index of suspicion is still high, then get an angiogram.
58
How to treat traumatic aortic dissection?
Surgical repair and decrease BP.
59
How to treat GSW to abdomen?
Surgery, ex-lap
60
How to treat knife wound to abdomen?
If evisceration, shock, or peritoneal signs present? Surgery
If not, probe the wound, if not through peritoneum, watch and wait. If though, surgery.
61
How to diagnose blunt trauma?
FAST or CT, then take to surgery.
62
How much blood can be stored in the body?
See book.
63
Most common cause of bleeding after abdominal trauma?
Ruptured liver.
64
Pathogenesis of ruptured liver?
Rips on ligamentum teres.
65
How to stabilize a patient with ruptured liver?
Pringle maneuver.
66
How to treat ruptured liver?
Repair or lobectomy.
67
Which is more serious, ruptured spleen or ruptured liver?
Ruptured liver is more serious because spleen has a capsule, so can be repaired.
68
What needs to be done to patients who have been splenectomized?
Vaccinate against encapsulated organisms.
69
How to diagnose ruptured diaphragm?
Bowel sounds in chest. Patient also has Kehr's sign which is pain referred to shoulder.
70
Kehr's sign
Pain referred to shoulder from ruptured diaphragm
71
How do patients get pelvic trauma?
From a fall or an MVA
72
How to diagnose pelvic trauma?
Hip rocking will cause extreme pain.
73
How to treat pelvic fracture?
External fixation, will tamponade any vasculature that is bleeding. Do not open.
74
Why are pelvic fractures so dangerous?
Because they are a gateway injury. Ureteral and urethral injuries can occur as a result.
75
Urethral injury signs/ symptoms
Causes high riding prostate and blood at meatus.
76
How to diagnose urethral injury?
Retrograde urethrogram.
77
Place foley during urethral trauma?
NO WAY!
78
How to diagnose ureteral injury?
IV pyelogram or methylene blue injection.
79
What is a first degree burn?
Only epidermal involvement. Like a sunburn. Patient has erythema, lesion is warm and tender, no blisters.
80
What is a second degree burn?
Epidermal and dermal involvement. Erythematous, tender, with blisters.
81
What is a third degree burn?
Deeper than dermis, painless, surrounded by second degree burn. White or charred lesion.
82
Which is a worse chemical burn? Alkali or acid?
Alkali
83
How to treat a skin chemical burn?
Do not buffer, just irrigate like crazy
84
How to treat a swallowed chemical burn?
Do not induce vomiting, can neutralize.
85
How does a patient get a respiratory burn?
In a closed fire or explosion.
86
How to tell a patient has a respiratory burn?
Soot on nostrils or mouth
87
How to diagnose a respiratory burn?
Bronchoscopy
88
How to treat respiratory burn?
Prophylactic intubation to prevent airway closure from laryngeal edema.
89
What does an electrical burn do to patients?
Arrhythmias, heats up bones to cause rhabdo from muscle burn, posterior dislocation of shoulder.
90
How to diagnose electrical burns?
CK and creatinine
91
How to treat electical burns
IVF and mannitol to prevent kidney damage
92
How to treat circumferential burn?
Eschar surrounds vascular supply and cuts it off. Treat by cutting eschar.
93
Parkland formula
Rule of 9's, 5050 8-16.
```
Head 9
Front chest 9
Back chest 9
Abdomen 9
Back abdomen 9
Leg 9 x2
Back of leg 9x2
Arm 9x2
Genitals 1
```
%BSAx4ccxKG + 2000
94
How to treat burn
Early movement, early grafting pain control, sulfadiazine and mafenide ppx!
95
Rabies algorithm
Animal bite, if wild, kill/capture.
If not wild, observe.
If animal has rabies or isn't caught, give vaccine and igg, if not, do nothing.
96
How to treat bee sting?
Give subq epinephrine 1:1000 if in anaphylaxis with H1 and H2 blockers.
If not in anaphylaxis, remove stinger.
97
How to tell if snake is venomous?
If slit like eyes, if rattles, cobra cowl.
98
How to tell if a snake is venomous from just looking at the bite?
If skin changes color, if erythematous, if patient has severe pain.
99
How to treat snake bite?
Antivenom
100
Symptoms of black widow spider bite?
Bite and severe abdominal pain. Can cause pancreatitis.
101
How to treat black widow spider bite?
IVF, keep iv calcium nearby just incase of life threatening hypocalcemia from saponification.
102
Brown recluse spider bites happen when...
Southern us, in attic with boxes.
103
How to brown recluse spider bites appear?
Necrotic ulcer with ring erythema.
104
How to treat brown recluse spider bite?
Debridement over and over and over.
105
When to be suspicious of human bite?
Shady story, fight, sex act.
106
How to treat human bite?
Debridement, exploration, irrigation, amoxicillin.
107
How to secure airway in patient with neck emphysema?
Fiberoptic laryngoscope
108
How to treat penetrating injury of skull?
Go to surgery
109
How to treat skull fracture with closed wound?
No surgery
110
How to treat skull fracture with open wound
Close the wound.
111
Who has anterior cord syndrome?
People with vertebral burst fracture or syrinx.
112
How to treat rib fracture?
Nerve block
113
Type of injury that causes aortic rupture?
Deceleration injury.
114
How do air embolisms occur?
In a respirator patient or if subclavian vein is open to air (like during an LN biopsy, central line).
115
How to treat air embolism
Cardiac massage in L lateral decub
116
How to prevent air embolism
Put patient in trendelenberg
117
Symptoms of fat embolism
Long bone fracture with axillary petechial rashes, low platelets, and respiratory collapse.
118
How to prevent intraoperative coagulopathy?
FFP and platelets
119
How to treat patient with intraoperative coagulopathy, hypothermia, and acidosis?
Stop laparotomy, pack wounds, and close until coagulopathy and hypothermia are treated
120
Abdominal compartment syndrome. Treatment?
When tissues are swollen after lap and prevent closure. Abdominal Mesh is treatment
121
How to treat abdominal compartment syndrome if it presents on PO day 2 with hypoxia and renal failure?
Open abdominal wound.
122
How to treat leaky bladder after injury?
Surgical repair and suprapubic cystomy.
123
How to treat penis fracture? Consequence of not treating?
Emergency surgical repair, otherwise impotence can ensue.
124
First step in treating penetrating injury to extremity?
Check for vascular injury
125
Treatment if no vascular injury in penetrating trauma to extremity?
Clean wound, tetanus vaccine
126
Treatment if obvious extremity vascular injury?
Surgery
127
Treatment if vascular injury to extremity possible?
Doppler or CT angio
128
Order of treatment if extremity bone, artery, nerve all injured?
Stabilize bone first, then repair artery, leave nerve for last. May need fasciotomy to prevent compartment syndrome.
129
How to treat high velocity GSW (hunting rifle, etc.)?
Debride or amputate
130
How to treat extremity crush injury?
Fluids, diuretics, alkalinize urine to prevent renal failure from myoglobinemia.
131
How to treat chronic subdural hematoma vs acute?
Acute is to elevate head of bed. Chronic is to do a craniotomy!
