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Flashcards in trauma Deck (39)
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extreaperitoneal bladder injury

contusion or rupture of the neck, anterior wall or anterolateral wall of the bladder --> extravasation of urine into adjacent tissues causes localised pain in the lower abd and pelvic)
pelvis fracture is almost always present with, and sometimes a bony fragment can directly puncture and rupture the bladder
gross hematuria is also usually present, urinary retention may occur (esp if in the neck)


how can bladder injury causes peritonitis

rupture of the dome (upper, in contact with peritoneum) --> urine leaking into the peritoneal cavity --. chemical peritonitis


ureteral injury

The mcc is iatrogenic
- rare from trauma
MC site: uteropelvic junctio
- hematuria, fever, flank pain, renla mass (hydronephrosis)


urethral injury - characteristics

1. almost exclusively in men
2. suspect if blood seen at urethral meatus/ motile prostate
3. urethral catheterization is relatively contraindicated
4. perform retrograde urethrogram (x-ray during injection) --> extravasasion of inability to reach bladder confirm it


posterior urethra (membranous) trauma

prone to injury from pelvic fracture --> injury can cause urine to leak into retropubic space


anterior urethra bulbar and penile trauma

at risk of damage due to perineal straddle injury --> urine leak beneath deep fascia of Buck --> if fascia is torn, urine escapes into superficial perineal space


4% of patients with spinal cord injuries will develop

post-traumatic syringomyelia --> impaired strength and pain pain/Q sensation in the upper extremities
(MRI is diagnostic)


PCWP in tenstion pneumothorax






Bronchial rupture - manifestation

persistent pneumothorax and significant air leak following chest tube placement in a patient who has sustained blunt chest trauma
other findings: pneumodiastinum + subcuteaneous emphysema


Nowadays - indication of perit lavage

unstable patient with inconclusive FAST


prehospital management of cervical spine truma

1. spinal immobilization
2. careful helmet removal
3. airway oxygenation


emergency department management of cervical spine trauma

1. orotracheal incubation preferred unless significant facial trauma present
2. rapid-sequence intubation added for unconscious patients who are breathing but need ventilator support
3. in-line cervical stabilization suggested inless if interferes with intubation
4. Monitoring for neurogenic shock from spinal cord injury


how to carry amputated parts

wrapped in saline-mostiened gause, sealed in a plastic bag, placed on ice and brought to emergency department


Glascow coma scale - eye opening

spontaneous: 4
to verbal command: 3
to pain: 2
none: 1


Glascow coma scale - verbal response

oriented: 5
disoriented/confused: 4
inapprorpiate words: 3
incomprehensible sounds: 2
none: 1


Glascow coma scale - motor response

obeys: 6
localizes: 5
withdraws: 4
felxion posturing (dcorticate): 3
extension posturing (decerebrate: 2
none: 1


blunt trauma and unstable - management

(+) --> laparotomy
(-) --> signs of extraabdominal hemor (pelvic bone, long bone fracture): yes: stabilize, no: stabilize and then CT of abdomen
(-) inconclusive --> diagnostic perit lavage (if + laparatomy, if negative go to the negative pathway)


penetrating abd trauma - indications for urgent exploratory laparotomy

1. unstable
2. peritonitis
3. evisceration (eg. externally exposed intestines)
4. blood from NT tube or on rectal examination
(Any penetrating trauma below the nipples or 4th intercostal)


suspected splenic injury (blunt abd trauma, Left sided abd pain, anemia) - evaluation and management

1. stable: and alert --> FAST: if normal but high risk features (anemia or guarding) --> CT scan of abdomen
2. stable with altered mental status --> CT


flail chest findings

paradoxiccal chest wall motion with respiration
chest pain, tachypnea, rapid shallow breaths
CXR: rib fractures +/- contusion/hemothorax


Management of flail chest

pain control, O2
positive pressure ventilation if resp failure


spontaneous pneumothorax - management

2 cm or smaller: observation + O2
large + stable: needle aspiration or chest tube


positive pressure mechanical ventilation in a patient with hemor shock

increased intrathoracic pressure --> further decreased Venous return --> cardiac arrest


Diaphragmatic rupture?

more common in the lest
- resp distress and can have deviation of the mediastinal contents to the opposite side, elevation of the hemidiaphragm on the chest x-ray might be the only abnormal finding
- also nasogastric tube in the pulm cabity is diagnostic


important step in the management of ribs fracture

adequate analgesia --> prevent hypoventilation (and so atelectasis or pneumonia)


pulm contusion - management

pain control
pulm hygiene (eg. nebulizer treatment, chest PT)
O2 + ventilatory support
avoid fluids / use diuretics


chest xray suggestive for diaphragmatic rupture - next step

chest and abdominal CT


management of blunt abdominal trauma in hemodynamically stable patients

antered mental status?
NO: serial abd exams +/- CT
YES: FAST: if negative --> serial abd exams (+/- CT scan), if (+) do CT


blunt trauma and unstable - management

(+) --> laparotomy
(-) --> signs of extraabdominal hemor (pelvic bone, long bone fracture): yes: stabilize, no: stabilize and then CT of abdomen
(-) inconclusive --> diagnostic perit lavage (if + laparatomy, if negative go to the negative pathway)