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Trauma - Rosen's > Trauma > Flashcards

Trauma Flashcards

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1
Q

head on collision mechanism of injury associated with which potential injuries

A

facial injuries
lower extremity injuries
aortic injuries

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2
Q

rear end collision mechanism of injury associated with which potential injuries

A

hyperextension of C spine
C spine fractures
central cord syndrome

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3
Q

lateral T bone collision mechanism of injury associated with which potential injuries

A

thoracic injuries
abdominal injuries- spleen, liver
pelvic injuries
clavicle, humerus, rib fractures

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4
Q

rollover MVC mechanism of injury associated with which potential injuries

A

crush injuries
compression fractures of the spine

*significant mechanism of injury

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5
Q

MVC - ejected from vehicle mechanism of injury associated with which potential injuries

A

spinal injuries

*significant mortality

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6
Q

MVC with windshield damage (likely unrestrained) mechanism of injury associated with which potential injuries

A

closed head injuries, coup/contrecoup injuries
facial #s
skull #s
C-spine #s

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7
Q

MVC with steering wheel damage mechanism of injury associated with which potential injuries

A 
thoracic injuries
sternal and rib #s, flail chest
cardiac contusion
aortic injuries
hemothorax, pneummothorax
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8
Q

MVC with dashboard involvement or damage

A

pelvic and acetabular injuries

dislocated hip

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9
Q

MVC proper seat belt use associated wtih

A

sternal, rib #, pulmonary contusion

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10
Q

MVC use of lap belt only associated wtih

A

Chance fractures, abdominal injuries, head and facial injuries and #s

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11
Q

MVC use of shoulder belt only associated with

A

C spine injuries, and #s, “submarine” out of restraint devices, possible ejection

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12
Q

MVC with airbag deployment associated with

A

upper extremity soft tissue injuries and #s
lower extremity injuries and #s

not effect for lateral impacts, less severe head and upper torso injuries, more severe in children

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13
Q

trauma pedestrian vs. automobile at low speed mechanism of injury associated with which potential injuries

A

tibia and fibula fractures, knee injuries

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14
Q

trauma pedestrian vs. automobile at high speed mechanism of injury associated with which potential injuries

A

Waddels triad: tibia and fibula or femur #s, truncal injuries, craniofacial injuries

thrown pedestrians at risk for multi system trauma

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15
Q

bicycle vs. automobile trauma mechanism of injury associated with which potential injuries

A

closed head injuries

handlebar injuries: spleen or liver lac, additional intra-abdominal injuries, consider penetrating injuries

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16
Q

bicycle trauma - non-automobile related mechanism of injury associated with which potential injuries

A

extremity injuries

handlebar injuries

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17
Q

what height of fall has an LD50

A

36-60ft

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18
Q

fall trauma with vertical impact associated with what injrueis

A 
calcanea and lower extremity #s
pelvic #s
closed head injuries
C spine #s
renal and renal vascular injuries
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19
Q

fall trauma with horizontal impact associated with what injuries

A

craniofacial fractures
hand and wrist fractures
abdominal and thoracic visceral injuries
aortic injuries

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20
Q

what components of airway exam important in primary survey in trauma

A 
neck or maxillofacial injuries- sub Q emphysema, expanding hematoma, burns/signs of inhalation injury
GCS > 9
sufficient respirato effort
no active vomiting
no significant oropharyngeal bleeding
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21
Q

what components of breathing exam important in primary survey in trauma

A

assess for signs of injury that may compromise ability to oxygenate or ventilate
look for increased work of breathing, tachypnea, penetrating wounds, subQ emphysema, chest wall instability, flail segments, tracheal deviation and distended neck veins, equal breath sounds, O2 sat, cyanosis, tracheal deviation

identify and treat flail chest, cardiac injury, pulmonary contusion, tension pneumothorax, open or massive pneumothorax

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22
Q

what components of circulation exam important in primary survey in trauma

A

mental status, skin color and temp, heart rate, BP, capillary refill

2 large bore 14 or 16G IVs

if patient in shock – non hemorrhagic: tension pneumothorax, cardiac tamponade, cariogenic, neurogenic, septic vs. hypovolemic: hemorrhagic or fluid loss

locate hemorrhage: physical exam: external, thoracic, abdomen, pelvis, long bone

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23
Q

what history is important in secondary survey

A

AMPLE

allergies
medications
PMHX
last meal
environment and events leading up to trauma
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24
Q

treatment/workup of trauma patient with shock

A

resuscitation: 1-2L isontic funds, 1:1:1 ratio of PRBCs, platelets FFP
prevent hypothermia
TXA 1g IV bolus, followed by 1g infusion over 8 hours

direct pressure/tourniquet for localized hemorrhage
reduce/splint long bone #s
wrap pelvis, angioembolization in pelvic #
internal hemorrhagE: laparotomy or thoracotomy

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25
airway considerations for blunt trauma patients
severe maxillofacial injuries maintain C spine in line immobilization, consider awake intubation for C spine injuries assess for laryngeal / tracheal injury anticipate blood/emesis in the airway
26
airway considerations in penetrating trauma
watch for expanding hematoma anticipate significant bleeding impaired video/fiberoptic techniques
27
breathing considerations in blunt trauma
chest contusions flail segment bowel sounds in chest
28
breathing considerations in penetrating trauma
chest injury significant bleeding sucking chest wound
29
circulation considerations in blunt trauma
positive FAST unstablie pelvis long bone # signs of retroperitoneal bleeding
30
circulation considerations in penetrating trauma
obvious vascular injury | external hemorrhage
31
confounding factors to consider which may be causing altered mental status other than head injury in trauma
hypoglycemia hypertension meds can cause bradycardia/hypotension use of diuretics/anticholinergics can cause hyponatremia seizure/postictal anticoagulants - neuroimaging needed intoxication - drugs or alcohol
32
laboratory evaluation of the trauma patient
lytes, liver function, INR, UA, blood type and screen, lactate levels or base deficit B-hCG in females
33
what test is used in massive transfusion or extensive bleeding in trauma patents to aid in early diagnosis of coagulopathies
TEG - thrombestrography | ROTEM - thromboelasometry
34
important examination/ diagnoses to pick up during trauma secondary survey - general
exam: LOC, GCS, any specific complaints | critical diagnoses: GCS < 8, focal motor deficit
35
important examination/ diagnoses to pick up during trauma secondary survey - head
exam: pupils, visual fields, contusions, lacerations evidence of skull fracture (hemotympanum, racoon eyes, battle sign, palpable defects) critical diagnoses: herniation syndrome emergent diagnoses: globe rupture, open skull fracture, CSF leak
36
important examination/ diagnoses to pick up during trauma secondary survey - face
exam: contusions, lacerations, midface instability, malocclusion critical diagnosis: airway obstruction due to bleeding emergent diagnoses: facial fractures, mandibular fracture
37
important examination/ diagnoses to pick up during trauma secondary survey - neck
exam: penetrating injury, lacs, JVD, subQ emphysema, hematoma, midline cervical tenderness critical diagnoses: carotid injury, pericardial tamponade, tracheal/laryngeal fracture, vascular injury, cervical fracture, dislocation
38
important examination/ diagnoses to pick up during trauma secondary survey - chest
exam: resp effort, excursion, contusions, lacerations, focal tenderness, crepitus, subQ emphysema, heart tones, breath sounds critical diagnoses: impending respiratory failure, flail chest, cardiac tamponade, tension pneumothorax emergent diagnoses: cardiopulmonary injury, intrathoracic injury, rib #s, pneumothorax, hemothorax
39
important examination/ diagnoses to pick up during trauma secondary survey - abdomen, flank
exam: contusions, penetrating injury, lacerations, tenderness, peritoneal signs critical diagnoses: intra-abdomainl hemorrhage, abdominal catastrophe emergent diagnoses: solid, hollow viscous injury
40
important examination/ diagnoses to pick up during trauma secondary survey - pelvis, GU
contusions, lacerations, stability, symphyseal tenderness, blood (urethral meatus, vaginal bleeding, hematuria), rectal exam critical diagnoses: pelvic hemorrhage, unstable pelvic fracture, colorectal injury (bleeding), urethral injury
41
important examination/ diagnoses to pick up during trauma secondary survey - neuro/spinal cord
exam: midline bony spinal tenderness, mental status, paresthesias, sensory level, motor function, including sphincter tone critical diagnoses: spinal fracture, dislocation, epidural or subdural hematoma emergent diagnoses: cerebral contusions, shear injury, SCI, contusion, nerve root injury
42
important examination/ diagnoses to pick up during trauma secondary survey - extremities
exam: contusions, lacerations, deformity, focal tenderness, pulses, cap refill, eval of compartments critical diagnoses: compartment syndrome, vascular injury, neurovascularinjury, arterial injury, hemorrhage shock emergent diagnoses: rhabdomyolysis, fracture
43
what imaging needed in patients with blunt trauma with significant chest pain, sternal tenderness, or abnormal thoracic US or CXR findings
CT chest
44
recommended imaging in patients with penetrating chest trauma, after normal CXR and thoracic US, asymptomaticc
repeat CXR in 1 hour, does not need a CT
45
do you need pelvic Xray on alert, hemodynamically stable stables who are asymptomatic
no
46
who in blunt trauma gets a CT abdo
``` abdo pain or tenderness significant mechanism of injury abnormal eFAST gross hematuria unreliable exam (altered, distracting injury, head injury) ``` seat belt sign associated with internal abdominal injury
47
who in blunt trauma can forego abdominal CT
GCS 15, normal abdominal physical exam, negative eFAST, normal laboratory results
48
in blunt trauma patients not getting an abdominal CT, what monitoring do they need
repeat FAST and Hb
49
surgeon should be present in ED on trauma patient within 15 mins of arrival if any of the following criteria
confirmed hypotension (SBP < 90) +GSW to neck, chest, abdo, or proximal extremities OR intubated patents transferred from scene respiratory compromised requiring emergent airway penetrating GSW to neck, chest abdo or pelvis GCS < 8 attributed to trauma
50
define flail chest
three or more adjacent ribs are fractured at 2 points, allowing free segment of chest wall to move in paradoxical motion with flail moving inward on inspiration and outward with expiration
51
which ribs are less likely to fracture
1-3 are short and protected 9-12 are longer and more mobile at anterior end 4-8 most likely to fracture
52
findings suggestive of clinical diagnosis of rib fracture
severe point tenderness, bony crepitus, ecchymosis, muscle spasm over the rib bimanual compression of thoracic cage remote from injury produces pain at site of fracture
53
NEXUS CT rule for CT chest after blunt trauma
if does not meet any of this criteria, do not need CT chest ``` abnormal CXR rapid deceleration mechanism (fall >20 feet or MVC > 65km/h) distracting painful injury chest wall tenderness sternal tenderness Tspine tenderness scapular tenderness ```
54
indicatins for operative fixation of flail chest
pts unable to wean from ventilator secondary to mechanics of flail chest, persistent t pain, severe chest wall instability, progressive decline in pulmonary function
55
treatment of flail chest
pulmonary physiotherapy effective analgesia selective use of ETT and mechanical ventilation close observation for respiratory compromise
56
what work up needed if suspect sternal fracture
if minimal trauma e.g. fall to ground or punch to chest, CXR if more significant trauma, or when CXR shows displaced # or evidence of intrathoracic injury - CT chest
57
clinical manifestatiosn of pulmonary contusion
dyspnea, tachypnea, cyanosis, tachycardia, hypotension, and chest all bruising -rales or absent breath sounds on asucultation
58
diagnosis of pulmonary contusion
CXR- patchy, irregular alveolar infiltrate ABG- widening A-a gradiane tindicates decreasing pulmonary diffusion capacity of patient's contused lung
59
what is difference between pulmonary contusion and ARDS
contusion occurs within minutes of initial injury, isolated to segment or lobe ARDS develops 48-72 hours later, more diffuse
60
treatment of pulmonary contusion
IV fluids restricted to maintain intravascular volume withn strict limits and comprehensive supportive care consisting of tracheobroncial toilet, suctioning, pain relief avoid intubation because increase morbidity if 1 lung severely contused and causing significant hypoxemia can intubate and ventilate lungs separately
61
types of pneumothorax
simple communicating tension occult
62
indications for tube thoracostomy
traumatic cause (expect asymptomatic, apical pneumothorax) moderate to large size resp Symptoms regardless of sitze increase size of pneumothorax after conservative therapy recurrence of pneumothorax after removal of initial chest tube patient requires ventilator support pt requires GA associated hemothorax bilateral pneumothorax regardless of siez tension pneumothraox
63
complications of tube thoracostomy
formation of hemothorax, pulmonary edema, bronchopleural fistula, pleural leaks, empyema, subQ emphysema, infection, intercostal artery laceration, contralateral pneumothorax, and parenchyma injury
64
placement site for tube thoracostomy
4th or 5th intercostal space at midaxillary line
65
causes of hemothorax
hemorrhage for injured lung parenchyma body vommon | intercostal, internal mamary arteries more often than hilarious or great vessels
66
indicaitons for thoracotomy
initial thoracotomy drainage more than 20cc/kg of blood or more than 1500mL or 200mL/hr for 3 hours persistent bleeding more than 7cc/kg/hr increasing hemothorax on CXR pt remains hypotensive despite adequate blood replacement and other sites of bleeding have been ruled out pt decompensated after initial response to resuscitation
67
clinical features suggestive of tracheobronchial injury
massive air leak through a chest tube, hemoptysis, or increasing subQ emphysema Hamman's crunch if air tracks to mediastinum continuous bubbling into chest tube hooked to suction
68
what diagnostic test used if tracheobronchial injury suspected
bronchoscopy
69
which patients may be okay with conservation mgmt for tracheobronchial injury
tracheal tears less than 2cm without esophageal prolapse, mediasitnitis, or massive air leakage
70
CT findings consistent with diaphragmatic injury
diaphragmatic discontinuity, intrathoracic herniation of abdominal contents, waist-like constriction of abdominal viscera (collar sign)
71
treatment of diaphragmatic injury
surgery
72
potential complications after blunt cardiac trauma
life threatening dysrhythmias, conduction abnormalities, CHF, cardiogenic shock, hemopericardiaum with tamponade, cardiac rupture, valvular rupture, intraventricular thrombi, thromboembolic phenomena, coronary artery occlusion, ventricular aneurysms and constrictive pericarditis
73
what is myocardial concussion
commotio cordis acute form of blunt cardiac trauma usually produced by sharp, direct blow to mid anterior chest that stuns the myocardium and results in brief dysrhythmia, hypotension and LOC no structural heart damage
74
recommended monitoring of patient after commotio cords who are not found mohave more severe traumatic cardiac injury
observe 6-12 hours on telemetry | when D/C, no return to play until additional outpatient cardiac testing performed if indicated
75
part of heart most likely to get myocaridal contusion
RV - anterior position and close to sternum
76
how to assess for myocaridal contusion
if negative 12 lead ECG + negative troponin, can rule out myocardial contusion
77
treatment of suspected myocardial contusion
``` similar to MI saline lock IV if fluids not otherwise indicated cardiac monitoirng O2 if hypoxic analgesic agents ``` dysrhythmias usually transient adndont require tx; if VT or A Flutter treat as per ACLS guidelines treat and prevent any conditions that increase myocardial irritability lytics & asa contradincated in trauma
78
disposition of pt with myocardial contusion
telemetry observation or in-hospital monitoring, depending in patients other injuries markedly abnormal ECG, troponin elevation or hypotension warrant echocardiography and cardiology consult
79
proposed mechanisms of myocardial rupture in trauma
1. deceleration stearin stresses on fixed attached of IVC and SVC to RA 2. upward displacement of blood and abdominal viscera from blunt abdominal injury causes sudden increase in intracardiac pressure 3. direct compression of the heart between sternum and vertebral bodies 4. laceration from a fractured rib or sternum 5. complications of a myocardial contusion, necrosis, and subsequent cardiac rupture
80
what determines survival in patients with cardiac rutpuree
if pericardium remains in tact, protected from immediate exsanguination
81
auscultation revealing harsh murmur known as bruit de moulin
pneumopericardium - seen in rupture
82
imaging in myocardial rupture
FAST bedside US reveals pericardial effusion CXR may be helpful to note the presence of other intrathoracic injuries (eg. hemothorax, pneumothorax, and signs of possible aortic dissection)
83
indications for ED thoracotomy
penetrating traumatic cardiac arrest - cardiac arrest at any point with initial signs of life in the field (less than 10 mins of CPR) - SBP < 50 after fluid resus - severe shock with clinical signs of cardiac tamponade blunt trauma -cardiac arrest in the ED
84
indications for central line
(1) IV access (especially if difficult peripheral access) (2) CVP monitoring (3) ScvO2 monitoring/sampling (4) Infusions of irritant substances (e.g. vasoactive agents, chemotherapy or TPN administration) (5) Renal replacement therapy, olasmapheresis and apheresis (6) Transvenous pacing
85
contraindications for central line
CONTRAINDICATIONS coagulopathy respiratory failure raised ICP (cannot tilt head down) -> can use femoral approach in all the situations above obstructed vein (e.g. thrombus, or tumour) overlying skin infection, burn or other disease process hemorrhage from target vessel uncooperative patient

Trauma - Rosen's (1 decks)

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