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Flashcards in Trauma Deck (57):
1

Primary survey

Airway , breathing, circulation

2

Indications for nasotracheal intubation

conscious, + gag reflex

3

indications for orotracheal/ endotracheal intubation

unconscious or semi-conscious, +/- gag reflex, apnea, AMS, inhalation injury, hematoma, facial bleeding, soft tissue swelling or aspiration. AMS is most common reason for needing intubation

4

indications for cricothyroidotomy

it is a surgical airway, done when attempts to obtain endotracheal airway have failed. also indicated if extensive facial injuries make endotracheal impossible. Not indicated in its

5

indications for intubation

inadequate respiratory effort, severely depressed mental status, GCS

6

indications for decompression

tension pneumothorax, open pneumothorax, flail chest, hemothorax, traumatic diaphragmatic hernia, major airway injury

7

Carotid pulse should be

60 mmHg

8

Femoral pulse should be

70 mmHg

9

Radial pulse should be

80mmHg

10

Class I shock

Pulse 30 cc/hr

11

Class II shock

Pulse >100, BP Dec, RR 20-30, UOP 20-30cc/hr

12

Class III shock

Pulse 120, BP dec, RR 30-40, UOP 30-40 cc/hr

13

Class IV shock

Pulse >140, BP dec, RR >35, UOP scant

14

consider giving PRBC/blood

when you have given >4L crystalloid fluid, or if have given 2 L and still unstable or bleeding

15

RSI induction agent for normotensive pt

Thiopental 3-5mg/kg

16

RSI induction agent for hypotensive pt

Etomidate .3 mg/kg or Midazolam or ketamine. want smaller doses

17

signs of uncal herniation

ipsilateral unilateral sluggish and dilated pupil, contralateral hemiparesis

18

signs of central herniation

bilateral motor weakness, pinpoint pupils b/l, decreased consciousness

19

what to do if herniating

hyperventilated to PaCO2

20

Neck Zone I

subclavian vessels, brachiocephalic v. common carotid a, aortic arch, jugular v, trachea, esophagus, lung apices, C-spine, spinal cord, cervical nerve roots

21

Neck Zone II

carotid a. vertebral a. jugular v. pharynx, larynx, trachea, esophagus, C spine and spinal cord. Most carotid a. injuries are associated with zone II.

22

Neck Zone III

salivary and parotid glands, esophagus, trachea, vertebral bodies, carotid arteries, jugular veins, CN 9-12

23

sign of myocardial contusion

Ventricular dysrhythmias, atrial fibrillation, sinus bradycardia, bundle branch block.
Transient sinus tachycardia is NOT a sign of myocardial contusion

24

Becks triad

distended neck v, muffled heart sounds, hypotension

25

abdomen zone I

Central hematoma. retroperitoneal. includes the great vessels, pancreas and duodenum. goes to surgery.

26

abdomen zone II

flank hematoma. often secondary to renal parenchymal injury. if stable can just observe. expanding hematoma warrants OR

27

abdomen zone III

pelvic hematoma. observed in stable pt or in a blunt trauma. Exploration is warranted if there is a penetrating injury.

28

Stable patient with penetrating abdominal wound gets

a laparoscopy

29

unstable patient with penetrating abdominal wound gets

a laparotomy

30

An immediate positive DPL

aspiration of >10mL blood

31

If negative initial DPL

instill 1L NS, pt rocked side to side, gravity drain. + off >100k RBC/cubicmm, bile, fecal matter, or amylase

32

splenic injury that is ok to observe

Grade III and below

33

splenic injury that goes to OR

Grade IV and V

34

splenectomy pts need immunizations for

diplococcus, meningococcus, haemophilus

35

Grade V splenic laceration

completely shattered spleen

36

Grade V splenic vascular injury

hilar vascular injury or hematoma >2cm and expanding

37

Grade IV splenic hematoma

Ruptured intraparenchymal hematoma with active bleeding

38

Grade IV splenic laceration

involves segmental or hilar vessels- devascularization of >25% spleen

39

Grade III splenic or liver hematoma

Subcapsular, >50% surface area or ruptured sub capsular hematoma >2cm or intraparenchymal hematoma >2cm

40

Grade III splenic or liver Laceration

>3cm parenchymal depth or involving the trabecular vessels

41

Grade II splenic or liver hematoma

Sub capsular, not expanding, 10-50% of surface area or intraparenchymal not expanding and

42

Grade II splenic or liver Laceration

Capsular tear, active bleeding, 1-3 cm into the parenchyma

43

Grade I splenic or liver hematoma

sub capsular, non expanding,

44

Grade I splenic or liver laceration

Capsular tear, non-bleeding,

45

Grade VI vascular liver injury

hepatic avulsion

46

Grade V vascular liver injury

juxtahepatic venous injuries

47

Grade V liver laceration

Parenchymal disruption > 58% hepatic lobe

48

Grade IV liver hematoma

ruptured parenchymal hematoma with active bleeding

49

Grade IV liver laceration

parenchymal disruption involving 25-50% of lobe

50

Liver injury that can be observed

if pt is stable

51

Liver injury that goes to the OR

Ex-lap needed for Grade IV-VI

52

Hard signs of vascular injury

Absent pulses, pulsatile hemorrhage, thrill or bruit, acute ischemia

53

Soft signs of vascular injury

proximity to a known vessel, minor hemorrhage, small hematoma, associated nerve injury

54

if ABI >1

they are low risk for major vascular injury--> observation

55

If ABI

they are intermediate risk for major vascular injury --> Arteriography

56

Compartment syndrome

Pain, Pallor, Paresthesias, Paralysis, Pulselessness, Perishing cold

57

Non-operative criteria

Low-velocity injury, minimal arterial wall disruption, intact distal circulation, no active hemorrhage, focal narrowing