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Clinical Disciplines-ER > Trauma > Flashcards

Flashcards in Trauma Deck (111):
1

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%

2

Cushings reflex

*Indicated increased ICP:
1. HTN
2. Bradycardia
3. Depressed respiratory

3

What is aniscoria > 1mm associated with?

Intracranial lesion

4

What is the MCC TBI?

MVC

5

What is the best way to treat increased ICP?

Mannitol

6

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

Increases ischemia

7

What does Phenytoin help with?

early seizures

8

Define concussion

Transient LOC occurring immediately following non-penetrating blunt head trauma

9

Basilar skull fracture sx's

1. Battle sign
2. Raccoon eyes
3. Hemotympanum

10

What does a positive halo sign indicate?

CSF leak after a basilar skull fracture

11

Whats the MCC of an epidural hematoma?

Skull fracture that tears the middle meningeal artery

12

Epidural hematoma clinical manifestation

Brief LOC-->Lucid interval-->Coma

13

CT findings in an epidural hematoma

Lens-shaped

14

does an epidural hematoma cross the suture line?

NO

15

does an epidural hematoma cross the midline?

YES

16

What is the MCC of a subdural hematoma?

Venous bleed secondary to tear of BRIDGING VEIN
Acceleration-Deceleration injury

17

What population are subdural hematoma common in?

Elderly

18

CT findings in a subdural hematoma?

Crescent shaped

19

does a subdural hematoma cross the suture line?

YES

20

does a subdural hematoma cross the midline?

NO

21

Physical exam findings in transtentorial/uncal herniation

1. Fixed dilated pupil-d/t occulomotor nerve compression
2. Contralateral hemiparesis

22

Progression of sx's in transtentorial/uncal herniation

Hyperventilation –> Decerebrate posturing –> Apnea-->Death

23

Orbital fracture clinical presentation

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

24

What are warning signs in a blowout fracture?

1. Enophthalmos
2. Limited upward gaze
3. Diplopia with upward gaze 4. Infraorbital anesthesia with inferior muscle entrapment

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