Flashcards in Trauma Deck (111)
Vital signs for trauma activation
1. RR <8 or >20 per minute
2. SBP <100mmHg
3. Pulse <50 or >100
4. GCS <13
5. O2 sat <90%
*Indicated increased ICP:
3. Depressed respiratory
What is aniscoria > 1mm associated with?
What is the MCC TBI?
What is the best way to treat increased ICP?
Why do you want to avoid prophylactic hyperventilation to PaCO2 <35?
What does Phenytoin help with?
Transient LOC occurring immediately following non-penetrating blunt head trauma
Basilar skull fracture sx's
1. Battle sign
2. Raccoon eyes
What does a positive halo sign indicate?
CSF leak after a basilar skull fracture
Whats the MCC of an epidural hematoma?
Skull fracture that tears the middle meningeal artery
Epidural hematoma clinical manifestation
Brief LOC-->Lucid interval-->Coma
CT findings in an epidural hematoma
does an epidural hematoma cross the suture line?
does an epidural hematoma cross the midline?
What is the MCC of a subdural hematoma?
Venous bleed secondary to tear of BRIDGING VEIN
What population are subdural hematoma common in?
CT findings in a subdural hematoma?
does a subdural hematoma cross the suture line?
does a subdural hematoma cross the midline?
Physical exam findings in transtentorial/uncal herniation
1. Fixed dilated pupil-d/t occulomotor nerve compression
2. Contralateral hemiparesis
Progression of sx's in transtentorial/uncal herniation
Hyperventilation –> Decerebrate posturing –> Apnea-->Death
Orbital fracture clinical presentation
1. Periorbital ecchymosis
2. Lid edema
4. Subconjunctival hemorrhage
5. Infraorbital numbness
What are warning signs in a blowout fracture?
2. Limited upward gaze
3. Diplopia with upward gaze 4. Infraorbital anesthesia with inferior muscle entrapment
Treatment in an orbital fracture if they have entrapment of of the inferior rectus muscle?
1. Emergent referral to ENT or OMF
What is the MC facial fracture?
Treatment for nasal fractures
1. Drain septal hematoma/Control epistaxis bleeding
2. Referral to ENT in 2-5 days
What are the MC causes of mandibular fractures?
Physical exam findings in a mandibular fracture?
1. Malaligned teeth
2. Can't hold tongue depressor down
What is the MCC of spinal trauma?
Motor vehicle collisions
Define spinal shock
Sudden transient distal areflexia lasting hours to weeks
Signs/sx's of spinal shock
1. Flaccid quadriplegia: resolves within 24 hours
2. ↓BP (80-100 SBP)
3. Paradoxical ↓HR
Clinical findings in spinal shock
1. Paralytic ileus
3. Fecal incontinence
Define central cord syndrome
Who are central cord syndromes more common in?
central cord syndromes clinical presentation
1. Weakness, arm > leg
2. Bladder dysfunction
3. Sensory loss
central cord syndromes treatment
Cervical Spinal Cord injury presentation
1. Complete motor paralysis 2. Loss of pain and temperature sensation distal to lesion
3. Preserved light touch, motion, vibration, and proprioception
Define Brown Sequard
Injury to ONE side of cervical spinal cord
Brown Sequard presentation
2. Loss of proprioception and vibratory sensation on lesion side
3. Loss of pain and temperature on contralateral side
Cause of Brown Sequard
Flexion Tear drop fracture MOA
Sudden forceful flexion
Jefferson burst fracture MOA
Axial loving injury causing vertebral inuries
C1 bust fx
Hangmans's fracture MOA
Extreme hyperextension injuries
C2 Pedicle Fx
What would you see on an x-ray in a Hangmans's fracture
C2 slipping forward-Anterior displacement of vertebral body
Fx of pedicle @ C2
What thoracolumbar fracture
Spinal Trauma Treatment
1. Inline immobilization/stabilization (not traction)
2. 4 person log roll for emesis
What is the MC MOI in neck trauma?
Penetrating injury, injuring the platysma
List the anatomical structures in the anterior triangle of the neck
2. Vertebral Artery
3. Jugular vein
What imaging would you get for neck trauma?
What is the most initial treatment/assessment in neck trauma?
blunt thoracic trauma accounts for what percentage of trauma related deaths?
Causes for blunt thoracic trauma
1. Direct trauma
3. Acceleration/deceleration injuries
what blunt thoracic trauma patients have a poor outcome?
Cardiopulmonary arrest compared to penetrating trauma
When can you close a simple laceration in a blunt thoracic trauma?
If it does NOT penetrate pleural
What portion of the clavicle is MCly fractured?
Clavicle Fracture treatment
2. Figure-of-8 harness
When would surgery be indicated in a clavicle fx?
1. Significant Displacement
2. Distal Fx
What is the MCC for sternal fractures?
MVC d/t Steering wheel impaction
What do sternal fractures have a very high association with? What diagnostics will you order for this?
Seria E's and EKG's q8 hrs for 24-36 hrs
Echo: check for motion abnormalities
what is the MCC of scapular fractures?
1. High speed MVC
2. Fall form height
Scapular Fracture Tx
4. Early ROM
When is surgery indicated a scapular fx?
If it involves the:
What percentage of rib fractures are NOT seen on a CXR?
What are you concerned about with fractures of ribs 10-12?
What do you want to avoid with rib fracture treatment? Why?
Increases risk of pneumonia
Define Flail Chest
1. Fx of > 2 segments of > 3 adjacent ribs= Floating segment of ribs
2. Unstable injury
3. Impairs ventilation by producing pulmonary contusion
Flail Chest treatment
1. Sandbag or direct pressure over involved area
2. Surgery Fixation
Define Pulmonary contusion
Direct injury to lung causing hemorrhage and edema, in the absence of pulmonary laceration
CXR findings in a pulmonary contusion
Pulmonary opacity within 6 hours of blunt trauma
Pulmonary Contusion Tx
1. Adequate ventilation
2. Pain control
3. Chest physiotherapy
1. Pleuritic CP-Unilateral, non-exertional
CT US findings in a Pneumothorax?
When you can observe a pneumothorax?
Ptx < 10% that is not changed on 2 CXR 4-6 hrs apart
Tension Pneumothorax sx's
1. Severe respiratory distress
2. Decreased BS
3. Hyperessonance to percussion
4. Distended neck veins
5. Tracheal deviation to opposite side
Tension Pneumothorax Dx
Tension Pneumothorax treatment
1. Need Aspiration: Midclavicular line, 2nd ICS
2. Chest Tube Insertion @ 5th ICS
1. Decreased BS
2. DULLNESS to percussion
What is the best CXR view for a Hemothorax?
Define Hamman's crunch and what it indicates
Crunching sound heard over heart during systole
What clinical finding should raise your suspicion for a Pneumomediastinum?
Subcutaneous emphysema in neck
2. Muffled Heart Sounds
Cardiac Tamponade sx
10-15 decrease in SBP on inspiration
Cardiac Tamponade sx
Paradoxical increase in venous distention and pressure during inspiration
Electrical Alterans findings on EKG
Cardiac Tamponda treatment
MCC of Myocardial Contusion
MVC >35 mph
Myocardial Contusion Sx's
1. Sternum Fx!!
Myocardial Contusion treatment
1. Serial cardiac enzymes and EKG's
Traumatic Aorta Rupture
1. Retrosternal or interscapular pain made worse when BP ↑s
Clinical findings in aortic rupture
1. Acute onset of UE ↑BP
2. Difference in pulse amplitude between UE and LE
3. Harsh systolic murmur over pericardium or interscapular areas
CXR findings in aortic rupture
1. Superior mediastinal widening > 8cm=MC finding
2. Deviation of esophagus
3. Blurring of aortic knob
4. Tracheal deviation to R
5. Left pleural effusion
How do you diagnose an aortic rupture?
Aortic rupture treatment
1. Avoid valsalva
2. Keep SBP < 120mmHG
Left shoulder pain classically associated with splenic rupture
What is the best diagnostic tool to evaluate retroperitoneal injuries?
What is the MCly injured organ in blunt trauma?
What are splenic injures commonly associated with?
Left lower rib fx
What is the MCly injured organ in penetrating trauma?
Penetrating live injury treatment
20% are controlled with suture or hemostatic agents
Renal Injury Diagnostics
Causes for pancreatic injuries
Compression of the organ against the spine
1. Lap belt injury
2. Bike injury in pads
Best imaging for dx of pancreatic injury
Pancreatic injury Tx
1. Exploratory Laparotomy
2. Intraoperative Pancreatography
What is the MCly injured organ with a pelvic fx?
Bladder injury clinical presentation
2. Peritoneal signs
Bladder injury imaging
2. CT with IV contrast
You identify that your patient has an open chest wound. What is the significance of this injury?
Air moves in and out of wound without exchange of gas
Ineffective ventilation and oxygenation
Open wound treatment
1. Cover with 3-sided occlusive dressing-If covered on all 4 sides, then can create tension pneumothorax
2. Chest tube insertion
What is the significance of blood at the urethral meatus, in the setting of a post-trauma patient?