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Trauma Flashcards

(59 cards)

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1
Q

Primary Survey

A 
A: Airway
B: Breathing
C: Circulation
D: Disability
E: Exposure
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2
Q

Disability

A

2 parts:
GCS
Pupillary exam
Looking for inc ICP

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3
Q

What component of GCS is most predictive?

A

Motor score

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4
Q

When to intubate based on GCS

A

<8

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5
Q

One pupil fixed and dilated

A

ipsilateral intracranial hemorrage -> compressing

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6
Q

Bilateral pinpoint pupils from brain injury

A

Pontine hemorrhage

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7
Q

Candidate for ICP monitor

A

GCS < 8 w/ abnormal head CT

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8
Q

Types of ICP monitor

A

Interventricular drain - ventriculostomy - allows to drain CSF
Bolt -> intraparenchymal

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9
Q

Which factor most affects outcome in brain injury?

A

Hypotension
Hypoxia
(Keep BP elevated and avoid desat)

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10
Q

Signs of inc ICP

A

Pupil dilatation
Cushing’s Triad - HTN, bradycardia, low RR
Motor posturing
Treat ICP based on exam

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11
Q

Treatment of inc ICP

A

1) Elevate head of bed, neck free of anything compressing flow
2) Ventilate to PCO2 of 35
3) Sedation and paralysis
Meds:
4) Mannitol and hypertonic saline (resuscitates while helping lower ICP, b/c osmotic diuretics -> hyperosmotic state
Then imaging and neurosurg

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12
Q

Epidural hematoma

A

MMA
hit in side of head
Lenticular shape
Lucid interval

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13
Q

Subdural hematoma

A

Bridging veins

Crescent shape

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14
Q

Does epidural or subdural have better outcome?

A

Epidural

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15
Q

Went through windsheild

A

Intraparenchymal contusion

Avoid secondary brain injury -> generally don’t go to surgery

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16
Q

Subarachnoid

A

Worst headache of life

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17
Q

CPP formula

A 
Cerebral perfusion pressure: MAP - ICP, adopt to any compartment
Tells amount of blood reaching cells
want 70 or better (60 is minimum)
Surrogate for blood flow to brain
Want ICP < 20
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18
Q

Major regulator of cerebral perfusion

A

pCO2 -> based on arterial dilatation (hyperventilate patient causes vasoconstriction of artery and decreased ICP)
If pCO2 rises -> hypoperfusion of brain due to vasodilation and inc ICP

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19
Q

Severe TBI can they autoregulate

A

No

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20
Q

Seizure prophylaxis

A

Give to trauma patient

Dilantin or keppra -> short term, 1 wk post injury, prevents early seizures

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21
Q

Feeding TBI pts?

A

Early feeding in 24-48 hours

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22
Q

Steroids in TBI pts?

A

NO! no benefit

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23
Q

Reversing coagulopathy

A 
Inc INR from coumadin:
PCC - prothrombin complex concentrate
Vitamin K
FFP
Pradaxa:
Dialysis
Epixaban/Rivaroxaban:
PCC - partial reversal
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24
Q

Clear spine clinically`

Study These Flashcards
A 
No distracting injuries - no other significantly painful injury distracting them
Must be examinable (GCS 15)
Not intoxicated
Not on sedating meds
No neurologic findings
No bony or midline tenderness
25
Clear c-spine imaging
CT scan | not x-ray in adults, but possibly in kid
26
Central cord syndrome
old lady, weakness in arms, maybe legs (cape and gloves), normal motor exam Spinal stenosis due to spinal cord contusion
27
Brown-sequard
Ipsilateral motor deficit, contralateral pain and temp loss below level of injury Hemidissection of cord - stab wound
28
Anterior cord syndrome
After aortic case Malperfusion to spine Exclusively motor deficits
29
SCIWRA -
Peds, can't move legs, normal imaging
30
Spinal shock vs neurogenic shock
Spinal - lose motor reflexes, dx by testing reflexes (bulbocavernosis, cremasteric) if not present then in spinal shock, will come back -> bad if they come back and have no other functioning Neurogenic - bradycardia, hypotension (hemodynamic), presents as warm extremities as well
31
Spinal shock vs neurogenic shock
Spinal - lose motor reflexes, dx by testing reflexes (bulbocavernosis, cremasteric) if not present then in spinal shock, will come back -> bad if they come back and have no other functioning (out of spinal shock whatever they have is permanent) Neurogenic - bradycardia, hypotension (hemodynamic), presents as warm extremities as well
32
Management of spinal injury
Stabilization | NO STEROIDS
33
Stability of fracture?
3 columns- 2/3 disrupted are unstable | Blunt injuries not penetrating
34
Respiratory issues with spinal cord injury
C 3,4,5 diaphragm alive High spinal cord injury but breathing okay not in distress -> using accessory muscles Will need to be intubated above C4
35
Zones of neck - ant/lateral
Zone 3: Angle of mandible to skull Zone 2: Cricothyroid to angle of mandible (carotid, esophagus, trachea) Zone 1: Sternum to cricothyroid
36
What structures to worry about in neck
Esophagus Carotids Jugulars Trachea
37
Hypotensive w/ penetrating neck injury managment
OR w/
38
Hard signs of vascular injury
OR w/
39
No hard signs of vascular injury
If has violated platysma: Full exam Other signs of injury - Motor deficit, hematoma nonexpanding, crepitus, air coming from wound, hemoptysis/hematemesis Need further eval - CT neck angio
40
If suspicion of esophageal injury
Esophagram or esophagoscopy
41
How to explore neck
Large incision on anterior border of SCM, base of ear to sternal notch
42
What do you explore
Vessels Trachea Esophagus - easier to explore on L
43
Swallow study with small leak of contrast, explore, no esophageal injury
Widely drain area and leave drains
44
Swallow study with small leak of contrast, explore, Find 4 cm laceration in esophagus
Extend myotomy to see entire mucosal defect then close in 2 layers
45
Which esophageal injuries can you manage non op
Small contained, not septic, endoscopic (dilation injury) to cervical, thoracic, flow back into lumen of esophagus, no connection to pleural space Tx: NPO, abx, non op management Cannot manage intraabdominal non op
46
High speed MVA, normal head CT, have altered mental status
Blunt cerebrovascular injury - Carotids, vertebrals
47
Who to screen for blunt head injury who has NO symptoms
``` Cervical spine, base of skull, mandible fractures (Le Fort) Seat belt sign above clavicle GCS < 8 Bruit or thrill Screen: CTA ```
48
Blunt cerebrovascular injurys
Distal carotid - hard to reach in OR | Tx: Antiplatelet or anticoagulation, possible stent esp if AV fistula
49
Flail chest
3 consecutive ribs with fractures in 2 places
50
Cause of hypoxia
Pain -> decreased respiration due to underlying pulmonary contusion, not the paradoxical motion
51
Tx of flail segment
``` Manage pain #1 Epidural If significant contusion -> intubation If signficant paradoxical motion -> consider plating ```
52
Car crash -> slam into steering wheel, hypotensive, sternal fracture w/ PVCs, no bleed
Blunt cardiac injury MC finding EKG abnormality (GET AN EKG) Dx: EKG then echo
53
Pulmonary contusion hx
Day 24-48 hrs blossoms w/ fluid mobilizing -> become hypoxic, like ARDS
54
Blunt aortic injury
Chest trauma, widened mediastinum, hemathorax, recurrent laryngeal nerve injury CXR finding Widened mediastinum Aortic knob obscured Apical cap Compress L mainstem bronchus R deviation of mediastinum Dx: CTA Tear is distal to L subclavian artery Tx: BP control w/ beta-blockers Options for repair: TEVAR, open thoracic graft Open repair, L posterolateral thoracotomy w/ L Heart Bypass Big risks of surgery = paralysis, worse w/ open
55
Who to repair endovascularly
Adequate inflow vessels | Stable
56
POD 1 from endovascular repair
L hand cold and turning dusky (Covered L subclavian) Tx: Carotid to subclavian bypass
57
Chest tube for trauma patient reason for OR
Hemodynamic instability Initial output > 1500 200 cc/hr for 4 hours, or 100cc/hr for 8 hours
58
Elderly, fell with 5 rib fractures
Admit to ICU | Rib block vs. Epidural
59
Thoracic trauma pt with diaphragmatic ruputre
Stabilize LAPAROTOMY, fix with permanent sutures May have a concomitant spleen injury

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