Trauma Flashcards
(23 cards)
What is TRISS?
TRISS(Trauma and injury severity score) - it determines the probability of survival of a trauma patient using a following variables:
a. ISS( injury severity score)
b. RTS( revised trauma score)
c. Age
what is Revised trauma score
Revised trauma score is made up of combination of results from 3 categories:
- Glasgow Coma scale
- Systolic BP
- Respiratory rate
what is MESS?
MESS(mangled extremity severity score) is a scoring system that can be applied to mangled extremities and help to determine which mangled limbs will eventually go for amputation and which can be salvaged.
On what basis does MESS system grades the injury?
- the energy that caused the injury
- limb ischemia
- shock
- patients age
what is Glasgow Coma scale
GCS is used to determine the conscious level of the patient.
In severe head injury, eye opening, the best motor response of the limbs, and verbal output has been found to be roughly predictive of outcome. they are summarised using GCS
what is METTAG system?
METTAG ( Medical Emergency Triage Tags) system uses color-coded tags to identify patients and to designate their triage category
METTAG Categories or Triage color code
Black- dead or expectant
Red- critical (first priority)
Yellow- serious (second priority)
Green - not serious (Minor/Ambulatory also k/a walking wounded and these patients can be used to assist in treatment of those patients tagged as red)
First preference to venous access is- upper or lower extremity veins? why?
First preference is always upper extremity veins.
Lower extremity veins are avoided for 2 reasons:
- to prevent deep vein thrombosis
- to preserve the long saphenous vein, as it is used for arterial grafting in case of vascular injury
Mention the phases of metabolic and neuroendocrine response to trauma or surgery?
- Injury phase or phase of catabolism
- Turning point
- Early anabolic phase
- Late anabolic phase
Harmones that increased during metabolic and neuroendocrine response to trauma or surgery?
Stress Harmones:
- Cortisol
- catecholamines
- Glucagon
volume- control hormones:
- Renin-angiotensin
- Aldosterone
- ADH
average protein intake in healthy young adults is?
80-120 g/day
with trauma all over body or with injury , amount of nitrogen lost/day ?
to the level in excess of 30g/d
most commonly injured organs in blunt trauma?
solid organs like:
Spleen(most common)
Liver
Kidney
In addition extreme blunt force to upper abdomen may fracture the Pancreas
mechanism of injury of small bowel by blunt injury
there are 3 postulated mechanisms:
- Crushing of the bowel between the vertebral bodies and the blunt object, such as steering wheel or handle bar
- deceleration shearing of the small bowel at points where it is such as ligament of Treitz(duodenojejunal jn), the ileocecal junction and around the mesenteric artery
- closed loop rupture caused by sudden increase in intra-abdominal pressure
what is FAST?
FAST(Focused assessment with sonography for trauma) is a preferred triage method for determining the presence of hemoperitoneum in blunt trauma patients or cardiac tamponade in blunt and penetrating trauma patients
goal of FAST examination
goal of FAST examination is the identification of abnormal collections of blood and fluid
The primary focus is on the peritoneal cavity but attention is also directed to the pericardium and to pleural space
Areas scanned in standard FAST examination?
4 areas are scanned in sequential order:
- subxiphoid area(for pericardial space)
- right upper quadrant (for perihepatic region)
- left upper quadrant ( for perisplenic region)
- pelvis
what is eFAST ?
eFAST(extended FAST) allows for examination of both lungs by adding bilateral anterior thoracic sonography to the FAST exam.
This allows detection of pneumothorax or hemothorax
most commonly damaged organs in penetrating injury of abdomen?
Small intestine > Liver
treatment of choice or management of colonic injuries?
currently 3 methods for managing of colonic injuries are used:
1. Primary repair( it includes lateral suture repair or resection of damaged segment with reconstruction by ileocolostomy or colocolostomy)
- End colostomy
- Primary repair with diverting ileostomy
various trails have proven that the Primary repair is safe and effective in virtually all patients with penetrating wounds
what is seat belt injury?
sudden break will cause acute flexion of body over the lap strap of seat belt. This kind of injury can give rise to seat belt syndrome which includes:
- small intestine avulsions
- intestinal, omental and mesenteric lacerations
- intestinal contusions and perforations
Rupture of spleen,liver, pancreas,ceacum and bladder occurs due to compression b/w belt and vertebrae.
Abdominal aorta can be crushed
seat belts reduce risk of death by 40%. it restrains body against severe deceleration keeping away from windscreen, steering
physical signs present in splenic injury?
- Ballance’s Sign - a fixed area of percussive dullness in the LUQ due to coagulation of blood from the injured spleen
- Kehr’s sign - pain referred to the left shoulder
- Cullen’s Sign - Bluish discoloration or ecchymosis
- Grey Turner sign - ecchymosis of the flanks
3 & 4 - both these signs are classically seen in acute hemorrhagic pancreatitis but may also rarely seen in splenic rupture
management of spleen injury in blunt trauma to abdomen?
It is managed in 2 ways:
1. Non-operatively: currently >70% of adults with blunt splenic injuries are managed non-operatively But the Primary requirement for it is- HEMODYNAMI STABILITY
- Operative management: Patients who are hemodynamically unstable or are failing non-operative management (eg: continuing transfusion) should undergo operative management. It consists of Splenic salvage procedures or partial or complete splenectomy
