Trauma Flashcards
(100 cards)
1
Q
Fill out the hemorrhagic shock table
A
ok (http://lifeinthefastlane.com/ccc/major-haemorrhage-in-trauma/)
2
Q
Beck’s triad
A
HypoTN, muffled heart sounds, JVD (for cardiac tamponade)
3
Q
Cushing’s reflex
A
HTN, bradycardia, irregular breathing (reaction when having high ICP)
4
Q
Likely treatment answer when pt has cushing’s reflex?
A
Intubate and call neurosurgery
5
Q
Cerebral perfusion pressure equation
A
MAP - ICP
6
Q
EDH vs SDH: altered
A
SDH
7
Q
EDH vs SDH: more common
A
SDH
8
Q
EDH vs SDH: assoc temporal bone fx
A
EDH
9
Q
EDH vs SDH: dilated ipsilateral pupil
A
EDH
10
Q
EDH vs SDH: higher mortality
A
SDH
11
Q
EDH vs SDH: worse prognosis
A
SDH
12
Q
EDH vs SDH: elderly
A
SDH
13
Q
EDH vs SDH: alcoholic
A
SDH
14
Q
Most common herniation type
A
Subfalcine
15
Q
Most common herniation presentation
A
Abnormal gait (think of the humunculus to remember this)
16
Q
Uncal herniation presentation
A
CN3 damage, dilated pupil, down/out (if total CN3 compression), ipsilateral hemiparesis, coma/death from brainstem compression
17
Q
Uncal herniation description
A
Temporal lobe (uncus) goes under the tentorium
18
Q
Tonsillar herniation presentation
A
Coma/death from brainstem compression
19
Q
Red flags of basilar skull fxs
A
Temporal bone fx, raccoon eyes (with sparing of tarsal plates), hemoTM, battle’s sign, CSF leak/ring sign, hearing problems, vertigo
20
Q
Usual answer when you have basilar skull fx concern
A
CT (not always diagnostic), it’s a clinical dx, consult to neurosurg (if there is a choice for CT and neurosurg as next best step, get CT to ensure nothing else intracranially is going on first)
21
Q
Orbital fx red flags
A
Globe injury, diplopia, proptosis, limited EOM, decreased VA
22
Q
Most common orbital fx
A
Orbital floor fx
23
Q
Which le fort can cause CSF rhinorrhea?
A
3
24
Q
When to give ppx abx in orbital fxs?
A
If it involves the sinuses
25
Most common neck zone injury
2
26
Barrier between neck zone 1/2
Cricoid cartilage
27
Barrier between neck zone 2/3
Angle of mandible
28
Hard signs of penetrating neck wounds
HARD BRUIT/thrill (Hypotension, Arterial bleeding, Rapid expanding hematoma, Deficit pulse or neuro)
29
Soft signs of penetrating neck wounds
Hoarse, stridor, subcutaneous emphysema
30
Most common soft sign of penetrating neck wounds
Hoarse
31
Dxs to look for in blunt neck trauma
Pseudoaneurysms, CA dissection, tracheal injury
32
Blunt neck trauma + neuro findings (which can be delayed) think what first?
Carotid artery dissection
33
CXR findings in aortic dissection
Mediastinal widening, obscured aortic knob, normal (up to 1/3rd)
34
Red flags of cardiac contusions
Sinus tachycardia, dysrhythmias, cardiogenic shock (notably more of a clinical finding, most studies are non-specific)
35
Red flags of pulmonary contusions
Hemoptysis, dyspnea, ARDS, hypoxia
36
Management of pulmonary contusions
Repeat CXR 6 hours (can be delayed), supportive care, avoid aggressive IVF
37
Most common problem of pulmonary contusions?
PNA
38
Associated findings of flail chest
>=3 rib fx, pulmonary contusion, paradoxical motion during breathing
39
Tx for flail chest
Intubate
40
Imaging for sternal fx
Lateral CXR
41
Which rib fxs are associated with liver/spleen injuries?
9th-11th
42
How much blood for supine vs upright CXR layering with hemothorax
>100cc, 200-300cc
43
When to switch from chest tube to thoracotomy?
>1.5L out initially, >200mL/hr, persistent air leak, unstable
44
Which XR is best for PNX?
Decubitus CXR
45
Tx for small simple PNX?
O2, repeat CXR
46
Tx for pt with PNX and needs intubation?
Chest tube first
47
Where to make pericardial incision in thoracotomy?
5th ICS, vertical, parallel, anterior to phrenic nerve
48
Most commonly injured organ in GSW
Small bowel
49
Most commonly injured organ in stab wound
Liver
50
What makes abd pain worse usually in a diaphragmatic injury?
Laying down
51
Diaphragmatic injuries are more common on which side?
L > R
52
Is imaging good in diaphragmatic injuries?
No, they suck. Need direct visualization
53
Is imaging good in hollow viscus injuries?
No, they suck.
54
When is a DPL +?
10cc gross blood/bile/feces back, 10k RBCs in penetrating, 100k RBCs in blunt (after instilling 1L NS)
55
Anterior vs posterior urethral injury: straddle and pelvic fx?
Straddle = anterior, pelvic fx = posterior
56
Anterior vs posterior urethral injury: distended bladder and hematuria?
Hematuria = anterior, distended bladder = posterior
57
Anterior vs posterior urethral injury: swollen and normal penis/scrotum?
Swollen = anterior, normal = posterior
58
Anterior vs posterior urethral injury: complication of impotence/incontinence and fistula/stricture?
fistula/stricture = anterior, impotence/incontinence = posterior
59
Pelvic fx + suprapubic pain, inability to void, gross hematuria = ?
Think bladder rupture
60
Intra vs extraperitoneal bladder rupture treatments
Intra = OR, extra = catheter, no OR likely
61
6 P's of compartment syndrome
POOP, paresthesias, pallor, pulselessness, paralysis, poikilothermia
62
Equation to decide when to take pt to OR based on compartment measurement?
DBP - compartment pressure. If <30 take to OR
63
Tx of high pressure injection soft tissue injury?
OR
64
Extensor tendon of finger disruption fx name
Mallet finger
65
Central strip of extensor tendon disruption name?
Boutonniere deformity (laterals slip down and proximal phalynx pops up)
66
Jersey finger problem?
Flexor digitorum profundus avulsion (can't flex finger)
67
Normal FHR
120-160
68
How much blood can pregnant woman loose before they manifest VS abnormalities?
2L
69
Requirements to do a perimortem c-section?
Within 4-5in of witnessed arrest, fundus >4 fingers above umbilicus (~24wks)
70
Most common cause of death in explosion accidents
Blast lung
71
NEXUS criteria
CPAIN (cervical ttp, pain from distracting injury, altered MS, intoxicated, neuro deficit)
72
List the unstable c-spine fractures
Jefferson, BL facet dislocation, odontoid (types 2/3), atlanto-occipital/axial dissociation, hangman, teardrop (Jefferson Bit Off A Hangman's Tit)
73
What is a Jefferson fx?
A burst fracture of C1, usually axial loading injury
74
What are the different types of odontoid fx?
C2 odontoid process fractures, type 1 = tip of hat, type 2 = neck, type 3 = body
75
What is a hangman's fracture?
C2 pedicular fracture
76
Chance fractures are commonly with what injury?
Seat belt, split posterior column in lumbar spine, all columns (ant, mid, post) involved
77
50% of all spinal fractures are where?
T11-L2 (thoracolumbar junction)
78
Red flags of central cord syndrome?
Elderly, hyperextension, UE > LE (Centenerian clipped his chin now with a cape distribution - loss of movement and sensation, incomplete loss below)
79
Red flags of anterior cord syndrome?
Hyperflexion, loss of movement/pain/temp below
80
Brown-Sequard symptoms?
Motor loss from lesion and below, pain/temp loss just below (Hot knife cuts muscle and half a cord - knife cut the muscle on the one side, so that side will have motor loss, the other side couldn't "feel" the hot knife so it lost it's pain/temp sense)
81
C6 dermatome
"six shooter"
82
C7 dermatome
middle finger
83
C8 dermatome
pinky
84
T4 dermatome
nipple
85
T10 dermatome
umbilicus
86
L1 dermatome
inguinal
87
Compare neurogenic and spinal shock.
Think neurogenic is SHOCK and spinal is STUN. In shock you usually have CV changes, so in neurogenic shock you get hypoTN and bradycardia. So you get warm and dry skin because you vasodilate everything leading to that hypoTN. In spinal stun you don't have any changes in CV but you are "stunned" so you loose your reflexes and they may come back.
88
Le Fort type: palate is mobile
1
89
Le Fort type: nose is mobile
2
90
Le Fort type: face is mobile
3
91
Le Fort type: fracture right below the nose (right along alveolar process of maxilla)
1
92
Le Fort type: involves inferior orbits
2
93
Le Fort type: involves zygomatic arch
3
94
Most common mandibular fx
Condyles
95
Red flags for mandibular fxs
Malocclusion, trismus, decreased TMJ ROM, paresthesia to lower lip
96
Imaging to eval for mandibular fx
Panorex, XR, CT
97
When to give abx in mandibular fxs? Which abx?
Open fx, PCN/clinda
98
All mandibular fxs are ______ except for which types?
Open, condyles
99
Nasal septal hematoma management?
Incise and pack
100
Ottowa Knee Imaging Rules
Age over 55 years old, isolated patella tenderness, tenderness at head of fibula, inability to flex knee 90 degrees, and inability to bear weight (4 steps) immediately after injury or in the ED
