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Clinical Disciplines-ER > Trauma > Flashcards

Trauma Flashcards

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1
Q

Vital signs for trauma activation

A
  1. RR <8 or >20 per minute
  2. SBP <100mmHg
  3. Pulse <50 or >100
  4. GCS <13
  5. O2 sat <90%
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2
Q

Cushings reflex

A
  • Indicated increased ICP:
    1. HTN
    2. Bradycardia
    3. Depressed respiratory
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3
Q

What is aniscoria > 1mm associated with?

A

Intracranial lesion

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4
Q

What is the MCC TBI?

A

MVC

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5
Q

What is the best way to treat increased ICP?

A

Mannitol

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6
Q

Why do you want to avoid prophylactic hyperventilation to PaCO2 <35?

A

Increases ischemia

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7
Q

What does Phenytoin help with?

A

early seizures

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8
Q

Define concussion

A

Transient LOC occurring immediately following non-penetrating blunt head trauma

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9
Q

Basilar skull fracture sx’s

A
  1. Battle sign
  2. Raccoon eyes
  3. Hemotympanum
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10
Q

What does a positive halo sign indicate?

A

CSF leak after a basilar skull fracture

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11
Q

Whats the MCC of an epidural hematoma?

A

Skull fracture that tears the middle meningeal artery

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12
Q

Epidural hematoma clinical manifestation

A

Brief LOC–>Lucid interval–>Coma

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13
Q

CT findings in an epidural hematoma

A

Lens-shaped

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14
Q

does an epidural hematoma cross the suture line?

A

NO

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15
Q

does an epidural hematoma cross the midline?

A

YES

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16
Q

What is the MCC of a subdural hematoma?

A

Venous bleed secondary to tear of BRIDGING VEIN

Acceleration-Deceleration injury

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17
Q

What population are subdural hematoma common in?

A

Elderly

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18
Q

CT findings in a subdural hematoma?

A

Crescent shaped

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19
Q

does a subdural hematoma cross the suture line?

A

YES

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20
Q

does a subdural hematoma cross the midline?

A

NO

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21
Q

Physical exam findings in transtentorial/uncal herniation

A
  1. Fixed dilated pupil-d/t occulomotor nerve compression

2. Contralateral hemiparesis

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22
Q

Progression of sx’s in transtentorial/uncal herniation

A

Hyperventilation –> Decerebrate posturing –> Apnea–>Death

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23
Q

Orbital fracture clinical presentation

A
  1. Periorbital ecchymosis
  2. Lid edema
  3. Chemosis
  4. Subconjunctival hemorrhage
  5. Infraorbital numbness
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24
Q

What are warning signs in a blowout fracture?

A
  1. Enophthalmos
  2. Limited upward gaze
  3. Diplopia with upward gaze 4. Infraorbital anesthesia with inferior muscle entrapment
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25
Treatment in an orbital fracture if they have entrapment of of the inferior rectus muscle?
1. Emergent referral to ENT or OMF | 2. Abx
26
What is the MC facial fracture?
Nasal fracture
27
Treatment for nasal fractures
1. Drain septal hematoma/Control epistaxis bleeding | 2. Referral to ENT in 2-5 days
28
What are the MC causes of mandibular fractures?
1. Assault 2. MVC 3. Fall
29
Physical exam findings in a mandibular fracture?
1. Malaligned teeth | 2. Can't hold tongue depressor down
30
What is the MCC of spinal trauma?
Motor vehicle collisions
31
Define spinal shock
Sudden transient distal areflexia lasting hours to weeks
32
Signs/sx's of spinal shock
1. Flaccid quadriplegia: resolves within 24 hours 2. ↓BP (80-100 SBP) 3. Paradoxical ↓HR
33
Clinical findings in spinal shock
1. Paralytic ileus 2. Urinary retention 3. Fecal incontinence
34
Define central cord syndrome
Hyperextension injury
35
Who are central cord syndromes more common in?
Elderly
36
central cord syndromes clinical presentation
1. Weakness, arm > leg 2. Bladder dysfunction 3. Sensory loss
37
central cord syndromes treatment
Nonoperatively
38
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
39
Define Brown Sequard
Injury to ONE side of cervical spinal cord
40
Brown Sequard presentation
1. Paralysis 2. Loss of proprioception and vibratory sensation on lesion side 3. Loss of pain and temperature on contralateral side
41
Cause of Brown Sequard
Penetrating injury
42
Flexion Tear drop fracture MOA
Sudden forceful flexion | Diving injury
43
Jefferson burst fracture MOA
Axial loving injury causing vertebral inuries | C1 bust fx
44
Hangmans's fracture MOA
Extreme hyperextension injuries | C2 Pedicle Fx
45
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
46
What thoracolumbar fracture
Chance Fracture
47
Spinal Trauma Treatment
1. Inline immobilization/stabilization (not traction) | 2. 4 person log roll for emesis
48
What is the MC MOI in neck trauma?
Penetrating injury, injuring the platysma
49
List the anatomical structures in the anterior triangle of the neck
1. Carotid 2. Vertebral Artery 3. Jugular vein
50
What imaging would you get for neck trauma?
CT Angiography
51
What is the most initial treatment/assessment in neck trauma?
ABC's
52
blunt thoracic trauma accounts for what percentage of trauma related deaths?
25%
53
Causes for blunt thoracic trauma
1. Direct trauma 2. Compression 3. Acceleration/deceleration injuries
54
what blunt thoracic trauma patients have a poor outcome?
Cardiopulmonary arrest compared to penetrating trauma
55
When can you close a simple laceration in a blunt thoracic trauma?
If it does NOT penetrate pleural
56
What portion of the clavicle is MCly fractured?
Middle 1/3=80%
57
Clavicle Fracture treatment
1. Sling | 2. Figure-of-8 harness
58
When would surgery be indicated in a clavicle fx?
1. Significant Displacement | 2. Distal Fx
59
What is the MCC for sternal fractures?
MVC d/t Steering wheel impaction
60
What do sternal fractures have a very high association with? What diagnostics will you order for this?
Myocardial Contusion=91% Seria E's and EKG's q8 hrs for 24-36 hrs Echo: check for motion abnormalities
61
what is the MCC of scapular fractures?
1. High speed MVC | 2. Fall form height
62
Scapular Fracture Tx
1. Sling 2. Ice 3. Analgesics 4. Early ROM 5. Nonsurgical-Most
63
When is surgery indicated a scapular fx?
If it involves the: 1. Glenoid 2. Coracoid
64
What percentage of rib fractures are NOT seen on a CXR?
50%
65
What are you concerned about with fractures of ribs 10-12?
Intra-abdominal injury
66
What do you want to avoid with rib fracture treatment? Why?
Strapping | Increases risk of pneumonia
67
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
68
Flail Chest treatment
1. Sandbag or direct pressure over involved area | 2. Surgery Fixation
69
Define Pulmonary contusion
Direct injury to lung causing hemorrhage and edema, in the absence of pulmonary laceration
70
CXR findings in a pulmonary contusion
Pulmonary opacity within 6 hours of blunt trauma
71
Pulmonary Contusion Tx
1. Adequate ventilation 2. Pain control 3. Chest physiotherapy
72
Pneumothorax sx's
1. Pleuritic CP-Unilateral, non-exertional 2. SOB 3. Tachypnea/Tachycardia 4. Hypoxia
73
CT US findings in a Pneumothorax?
Barcode/stratosphere sign
74
When you can observe a pneumothorax?
Ptx < 10% that is not changed on 2 CXR 4-6 hrs apart
75
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
76
Tension Pneumothorax Dx
Clinically!!
77
Tension Pneumothorax treatment
1. Need Aspiration: Midclavicular line, 2nd ICS | 2. Chest Tube Insertion @ 5th ICS
78
Hemothorax sx's
1. Decreased BS 2. DULLNESS to percussion 3. Hypotension 4. Hypoxia 5. JVD
79
What is the best CXR view for a Hemothorax?
Upright
80
Define Hamman's crunch and what it indicates
Crunching sound heard over heart during systole | Pneumomediastinum
81
What clinical finding should raise your suspicion for a Pneumomediastinum?
Subcutaneous emphysema in neck
82
Beck's Triad
Cardiac Tamponade 1. JVD 2. Muffled Heart Sounds 3. Hypotension
83
Pulsus Paradoxus
Cardiac Tamponade sx | 10-15 decrease in SBP on inspiration
84
Kussmauls sign
Cardiac Tamponade sx | Paradoxical increase in venous distention and pressure during inspiration
85
Electrical Alterans findings on EKG
Decreased voltage
86
Cardiac Tamponda treatment
Pericardiocentesis
87
MCC of Myocardial Contusion
MVC >35 mph
88
Myocardial Contusion Sx's
1. Sternum Fx!! | 2. Arrhythmias
89
Myocardial Contusion treatment
1. Serial cardiac enzymes and EKG's 2. Oxygen 3. Analgesics
90
Traumatic Aorta Rupture
1. Retrosternal or interscapular pain made worse when BP ↑s 2. SOB 3. Dysphagia 4. Stridor 5. Hoarseness
91
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
92
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
93
How do you diagnose an aortic rupture?
1. TEE 2. CT 3. Aortography
94
Aortic rupture treatment
1. Avoid valsalva 2. Keep SBP < 120mmHG 3. Surgery
95
Kehr's Sign
Left shoulder pain classically associated with splenic rupture
96
What is the best diagnostic tool to evaluate retroperitoneal injuries?
CT
97
What is the MCly injured organ in blunt trauma?
Spleen
98
What are splenic injures commonly associated with?
Left lower rib fx
99
What is the MCly injured organ in penetrating trauma?
Liver
100
Penetrating live injury treatment
20% are controlled with suture or hemostatic agents
101
Renal Injury Diagnostics
1. IVP 2. CT 3. Angiography
102
Causes for pancreatic injuries
Compression of the organ against the spine 1. Lap belt injury 2. Bike injury in pads
103
Best imaging for dx of pancreatic injury
CT
104
Pancreatic injury Tx
1. Exploratory Laparotomy | 2. Intraoperative Pancreatography
105
What is the MCly injured organ with a pelvic fx?
Bladder
106
Bladder injury clinical presentation
1. Hematuria | 2. Peritoneal signs
107
Bladder injury imaging
1. Cystogram | 2. CT with IV contrast
108
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
109
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
110
What is the significance of blood at the urethral meatus, in the setting of a post-trauma patient?
Urethral injury | Pelvic fracture
111
How do you evaluate a urethral injury?
Retrograde urethrogram or CT with contrast

Clinical Disciplines-ER (4 decks)

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