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Flashcards in trauma Deck (46)
1

GCS

eye 4verbal 5motor 6best 15coma 8no resp 3

2

pulses + BP correlation

Radial (BP 80mmHg)Femoral (BP 70mmHg)Carotid (BP 60mmHg)

3

tachycardia + blood loss

(130’s-140’s) – 750-1000cc blood loss

4

hypotension + blood loss

500-2000cc blood loss

5

basilar skull fracture key signs

raccoon eyes (periorbital ecchymosis) - anterior fossabattle sign - middle fossa

6

battle sign

ecchymosis over mastoid process indicative of basilar skull fracture

7

indicative of spinal trauma

step offloss of rectal tone

8

when does LOC assessment occur in trauma survey?

secondaryAVPU, AOx#, GCS

9

Le Fort (and grades)

facial fracturesLe Fort I: maxillary rim & usually inferior nasal apertureLe Fort II: mid maxilla & inferior orbital rim & across bridge of noseLe Fort III: craniofacial dissociation & zygomatic arch

10

* grey turner sign *

bruising around flank & abdomen (injury to spleen)

11

* Cullen’s Sign *

blue discoloration around umbilicus (hemoperitoneum)

12

coopernail's sign

ecchymosis of scrotum or labia

13

spinal shock

hypotension from vasodilation & venous poolingall phenomena surrounding physiologic/anatomic transection of spinal cord resulting in temp loss/depression of all/most spinal reflex activity below level of injury

14

Basilar Skull Fracture: anterior fossa

Raccoon eyes & rhinorrhea

15

Basilar Skull Fracture: middle fossa

Battle sign & CSF – tympanic memb.

16

concussion vs contusion

concussion: diffuse brain inj assoc w gen or widespread neuro dysfxn- temporary LOC- retro/anterograde amnesiacontusion: bruising of brain @ site of impact or distal (contracoup)- prolonged LOC- monitor closely for edema, ↑in ICP, & possible herniation

17

epidural hematoma

bleeding btw inner table & dura mater- freq occurs w/ linear skull fracture- art bleed – middle meningeal art, assoc w temporal/parietal injury- rapid det w LOC & herniation

18

subdural hematoma

bleed btw dura mater & arachnoid meninges- most common hematoma- assoc w other injuries (contusions)- sx r/t area of injury, degree ↑ICP

19

intracerebral hematoma

bleeding into brain parenchyma from direct injury or shearing of small vesselsMechanism of injury: trauma, GSWPoor prog d/t associated injuries (↑ mortality)

20

supratentorial (uncal) herniation

shifting of lateral temporal lobe (uncas) → tentorial notch = compression of lateral midbrain, third cranial nerve, & posterior cerebral artery

21

early sign of hypoxia

change in LOC(could also be d/t ↑ ICP so assess neuro & resp)

22

change in LOC: THINK

assess neuro & resp consider ↑ ICP or hypoxia

23

aortic dissection/aortic arch tear s/s

U&L pulse differences, widened mediastinum CXRhemodynamic instability, expanding hematomaarteriogram = direct data about injury to aorta

24

#1 diagnostic test for abdominal trauma assessment

bedside US

25

abdominal deceleration + direct forces, see?

retroperitoneal hematomas

26

blunt trauma to abdomen?

often hidden, likely fatal

27

see hematoma in flank area, suspect

renal injury

28

liver vs splenic laceration grades

liver: 6, may take 48-72 hours to presentspleen: 5, most common organ for abd blunt trauma, delayed hemmorhage

29

liver lac presents in

48 - 72 hours

30

most common organ for abd blunt trauma

spleen! may have elayed hemmorhage

31

rib fx 8-10 think

SPLENIC INJURY!

32

overwhelming post-splenectomy infections (OPSI)

pneumococcal d/t loss of immune fxn- tx: Polyvalent Pneumococcal Vaccine w/in 72 hours

33

biggest infection risk w splenectomy

pneumococcal

34

pancreatic trauma presents in

evidence of injury may not be seen for 12 -24 hours bc masked by other injuries

35

pancreatic trauma s/s

* epigastric pain radiating to back* tenderness to deep palp * hyperglycemia↑ amylase & lipaseN&V, ileus

36

* epigastric pain rad to back* tender to deep palp * hyperglycemiaTHINK

pancreatic trauma

37

abdominal compartment syndrome

↑in intra-abd pressure gt 20mmHgresult of expanding abd contents:- bleeding → abd cavity- bowel edema from activation inflammatory mediators & reperfusion injury- fluid resuscitation (crystalloids)

38

abd perfusion pressure equation + goal

APP = MAP - IAPgoal: gt 60 mmHg

39

bladder pressure requiring emergency celiotomy

greater than 25 r/t abdominal compartment syndrome

40

reperfusion injury

sudden release of anaerobic toxins causing CV instability, usually r/t abdominal compartment syndrome fluid resuscitation

41

chest film finding with diaphragm rupture

unilateral ↑ of diaphragm

42

diaphragm rupture

50% pts also have pelvic fractureoften mistaken as ptxsuspect if: seat belt marks lower that expected on abdCXR: unilateral ↑ of diaphragm

43

why is AC more dangerous than DC

produces tetany

44

Zone of coagulation

area where tissue is not viable

45

Zone of stasis

surrounding zone of coag where ↓ perfusion & edema develop w/in 24-48hrs

46

Zone of hyperemia

surrounding zone of stasis, inflammatory response w ↑blood flow