Trauma

Question 1

Primary survey

Answer 1

Airway , breathing, circulation

Question 2

Indications for nasotracheal intubation

Answer 2

conscious, + gag reflex

Question 3

indications for orotracheal/ endotracheal intubation

Answer 3

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

Question 4

indications for cricothyroidotomy

Answer 4

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

Question 5

indications for intubation

Answer 5

inadequate respiratory effort, severely depressed mental status, GCS

Question 6

indications for decompression

Answer 6

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

Question 7

Carotid pulse should be

Answer 7

60 mmHg

Question 8

Femoral pulse should be

Answer 8

70 mmHg

Question 9

Radial pulse should be

Answer 9

80mmHg

Question 10

Class I shock

Answer 10

Pulse 30 cc/hr

Question 11

Class II shock

Answer 11

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

Question 12

Class III shock

Answer 12

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

Question 13

Class IV shock

Answer 13

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

Question 14

consider giving PRBC/blood

Answer 14

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

Question 15

RSI induction agent for normotensive pt

Answer 15

Thiopental 3-5mg/kg

Question 16

RSI induction agent for hypotensive pt

Answer 16

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

Question 17

signs of uncal herniation

Answer 17

ipsilateral unilateral sluggish and dilated pupil, contralateral hemiparesis

Question 18

signs of central herniation

Answer 18

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

Question 19

what to do if herniating

Answer 19

hyperventilated to PaCO2

Question 20

Neck Zone I

Answer 20

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

Question 21

Neck Zone II

Answer 21

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

Question 22

Neck Zone III

Answer 22

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

Question 23

sign of myocardial contusion

Answer 23

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

Question 24

Becks triad

Answer 24

distended neck v, muffled heart sounds, hypotension

Question 25

abdomen zone I

Answer 25

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

Question 26

abdomen zone II

Answer 26

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

Question 27

abdomen zone III

Answer 27

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

Question 28

Stable patient with penetrating abdominal wound gets

Answer 28

a laparoscopy

Question 29

unstable patient with penetrating abdominal wound gets

Answer 29

a laparotomy

Question 30

An immediate positive DPL

Answer 30

aspiration of >10mL blood

Question 31

If negative initial DPL

Answer 31

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

Question 32

splenic injury that is ok to observe

Answer 32

Grade III and below

Question 33

splenic injury that goes to OR

Answer 33

Grade IV and V

Question 34

splenectomy pts need immunizations for

Answer 34

diplococcus, meningococcus, haemophilus

Question 35

Grade V splenic laceration

Answer 35

completely shattered spleen

Question 36

Grade V splenic vascular injury

Answer 36

hilar vascular injury or hematoma >2cm and expanding

Question 37

Grade IV splenic hematoma

Answer 37

Ruptured intraparenchymal hematoma with active bleeding

Question 38

Grade IV splenic laceration

Answer 38

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

Question 39

Grade III splenic or liver hematoma

Answer 39

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

Question 40

Grade III splenic or liver Laceration

Answer 40

>3cm parenchymal depth or involving the trabecular vessels

Question 41

Grade II splenic or liver hematoma

Answer 41

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

Question 42

Grade II splenic or liver Laceration

Answer 42

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

Question 43

Grade I splenic or liver hematoma

Answer 43

sub capsular, non expanding,

Question 44

Grade I splenic or liver laceration

Answer 44

Capsular tear, non-bleeding,

Question 45

Grade VI vascular liver injury

Answer 45

hepatic avulsion

Question 46

Grade V vascular liver injury

Answer 46

juxtahepatic venous injuries

Question 47

Grade V liver laceration

Answer 47

Parenchymal disruption > 58% hepatic lobe

Question 48

Grade IV liver hematoma

Answer 48

ruptured parenchymal hematoma with active bleeding

Question 49

Grade IV liver laceration

Answer 49

parenchymal disruption involving 25-50% of lobe

Question 50

Liver injury that can be observed

Answer 50

if pt is stable

Question 51

Liver injury that goes to the OR

Answer 51

Ex-lap needed for Grade IV-VI

Question 52

Hard signs of vascular injury

Answer 52

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

Question 53

Soft signs of vascular injury

Answer 53

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

Question 54

if ABI >1

Answer 54

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

Question 55

If ABI

Answer 55

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

Question 56

Compartment syndrome

Answer 56

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

Question 57

Non-operative criteria

Answer 57

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