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Flashcards in Trauma Deck (46):
1

A method to eval airway

1- have pt speak- patency and to evaluate for voice change and stridor
2- evidence of pooling secretions or cyanosis

2

GCS for intubation

GCS of 8 or less requires intubation

3

Important note for intubation

ALWAYS MAINTAIN C-SPINE IMMOBILIZATION

4

A patent airway DOES NOT mean adequate ventilation! Ventilation requires:

lung fxn
chest wall
diaphragm

5

Percussion with hyper-resonance

pneumothorax

6

Percussion with dullness

hemothorax

7

subcutaneous emphysema might indicate

airway injury

8

JVD in trauma may indicate

tension pneumothorax or cardiac tamponade

9

Tension Pneumothorax presents as

worsening of a simple pneumothorax

formation of a 1-way valve at the point of a rupture in the lung

10

Hypotension in a Tension Pneumothorax is due to

↑ intrathoracic pressure ↓ preload
Loss of left heart blood flow due to loss of pulmonary vasculature to affected lung
Compression of mediastinum

11

Tension pneumothorax is a CLINICAL diagnosis and _______ are not appropriate in this setting.

Xrays

If tension pneumothorax is suspected, immediate needle decompression is undertaken

12

Tension Pneumothorax needle decompression treatment details

-4-16 gauge long angiocath
-midclavicular line, 2nd intercostal space
-over the rib to avoid neurovasculature

13

Massive Hemothorax definition

A systemic or pulmonary vessel disruption leads to:

> 1500 mL blood loss initially
> 400 cc per hour for 2 hours

14

Consider a massive hemothorax with?

pts in shock w/ no breath sounds and/or percussion dullness.

15

massive hemothorax treatment

placing a large (36 f) chest tube
possibly a trip to the OR for hemorrhage control.

16

If a radial pulse is palpable, it suggests a systolic blood pressure of at least?

80 mm Hg

17

if femoral or carotid are palpable, these suggest a systolic blood pressure of at least?

60 mm Hg

18

ATLS Classifications of hemorrhagic shock considers?

HR
BP
Blood loss

19

ATLS Class of hemorrhagic shock that requires blood products

Class 3 and Class 4 (blood loss 30%, >40%)

20

Reasons in shock--> dont mount a tachycardic response

-Neurogenic shock
-Beta blockade/ Calcium channel blockade
-Elderly
-Children/ young adults
-Conditioned athletes

21

Assess mental status via the AVPU scale

Alert.
Voice
Pain
Unresponsive

22

_________ will present as a “blown pupil.” .

Uncal herniation

Paralysis of parasympathetic fibers of CN III

23

Lowest GCS score

3

24

Adjuncts to the Primary Survey

Standard Trauma X-rays
FAST Exam (Focused Assessment Sonography in Trauma)

25

FAST Exam four views

subxiphoid cardiac
spleno-renal
hepato-renal
bladder views

26

Any blood detected during the FAST exam may represent

peritoneal penetration

*negative FAST does not exclude injury

27

Primary Survey address

-A: Airway Maintenance with CERVICAL SPINE protection

-B: Breathing and Ventilation

-C: Circulation with hemorrhage control / shock assessment

-D: Disability: Neurological

-E: Exposure/Environmental

The 2o Survey not started until all aspects of the 1o survey addressed + vitals addressed

28

Secondary Survey history

Start with the AMPLE history:

Allergies
Medications
Past illnesses
*Last meal
Events / Environment / Mechanism of injury

29

Secondary Survey physical

head to toe directed assessment

30

Motor/ Strength Grading

0: Total paralysis
1: Palpable/visible contraction
2: FROM w/gravity eliminated
3: FROM against gravity
4: FROM, less than normal strength
5: Normal strength

31

A __________ is most important lab in trauma patient

Type and Crossmatch

32

Type O blood rules

-Type O Negative- women
-Males may receive O Positive blood

33

Type-specific blood processing time/ details

ABO and Rh only tested
10 minute processing

34

Standard Trauma X-rays

AP chest + AP pelvis cxr as adjuncts to the 1o survey

C-Spine X Rays: lateral view (detects 80% fractures), AP, open mouth “Odontoid” view, and obliques

35

EKG is especially important for?

fall, drowning, syncope or single car MVA

36

_________ imaging if concern for urethral injury.

Retrograde-urethrogram

37

Diagnositic Peritoneal Lavage

-98% sensitive for bleeding /detect bowel injury (often missed on CT)
-replaced by US
-performed when intra-abdominal bleeding

38

Diagnositic Peritoneal Lavage is considered positive if it returns

Gross blood (10 ml)
> 100,000 RBCs/mm3
> 500 WBCs/mm3
+ Gram stain
Food fibers
Bacteria, bile, feces

39

To clear the cervical spine/ remove collar, they must have the following:

-Alert, not intoxicated
-Absence of neck pain
-Absence of midline neck tenderness
-Absence of distracting injury
-Absence of sensory /motor complaint

40

A tracheobronchial tree disruption will present on physical as....

-subcutaneous emphysema.

-may notice that after placing a chest tube, the lung refuses to inflate

41

A pulmonary contusion may initially present as

-mild hypoxia
-IV fluids--> pulmonary edema and hypoxia worsens
-Rx by proper O2 and ventilation + maintaining normovolemia.

42

blunt cardiac injury

difficult to ddx.
only sign may be an abnormal ECG
-Echocardiography may show a hypokinetic heart.
-Rx= medicating dysrhythmias that affect hemodynamics

43

immediately fatal, but those who survive may show a widened mediastinum on CXR.

traumatic aortic disruption caused by rapid acceleration/ deceleration causing a tear

44

Cullen’s sign / Grey-Turner’s sign are both associated with __________

-retroperitoneal hemorrhage

Cullen’s sign =periumbilical bruising
Grey-Turner’s sign = flank bruising

45

compartment syndrome presentation

5 P’s:
-Pallor
-Pain
-Paresthesia
-Poikilothermic
- Pulseless (late finding).

46

Injuries prone to developing compartment syndrome include

-forearm / tibial injuries
-tight dressings with swelling
-prolonged external pressure
-crush injuries
-circumferential burns.