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X Emergency Med Exam 3 > Trauma > Flashcards

Trauma Flashcards

1
Q

Most common cause of preventably mortality in trauma

A

Hemorrhage!! (CNS injury is most common cause in all trauma deaths tho)

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2
Q

When is there an increased chance of mortality in trauma?

A

Lower Glascow coma scale and older age

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3
Q

Standard of care for trauma patients

A

ATLS (advanced trauma life support)

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4
Q

SALT

A

Sort
Assess
Life saving
Treatment

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5
Q

How to sort in the triage algorithm

A

Walk: assess third
Wave/purposeful movement: assess 2nd
Still/obvious life threat: assess 1st

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6
Q

Lifesaving interventions to try with trauma pt

A

Control major hemorrhage
Open and position airway
Chest decompression
(antidotes maybe)

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7
Q

Levels of trauma center

A

1: high levels of care with leaders in research
2: definitive care in wide range of complex traumas
3: provides initial stabilization, can care for uncomplicated trauma
4/5: initial stabilization and transfer all traumas to definitive care

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8
Q

Primary eval of trauma patient

A 
PPE
Airway
Breathing
Circulation
Disability
Exposure
FAST exam
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9
Q

How to assess consciousness of patient (airway too)

A

Ask simple questions like WHATS YOUR NAME, what happened, where hurt etc

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10
Q

Components of airway assessment in trauma

A

Observe
Inspect
Inspect and palpate (anterior neck)
Unconscious pt (airway and cervical spine protection)

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11
Q

Definitive airways

A 
Endotracheal intubation (in line cervical stabilization)
Surgical cricothyroidtomy
*definitive b/c protects the airway
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12
Q

When to do cricothyroidotomy?

A

Attempt ET intubation first and then cric

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13
Q

Components of breathing assessment in trauma

A

Inspect chest wll
Palpate
Immediate threats to life
Unstable pts get CXR

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14
Q

Signs of pneumothorax

A

Hypotension, dyspnea, ipsilateral decreased breath sounds

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15
Q

Where to do needle decompression with pneumothorax?

A

5th intercostal space, anterior to mid axillary line in adults!!!!
(kids is 2nd intercostal space, MCL)

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16
Q

What do to after needle decompression?

A

Tube thoracostomy

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17
Q

What to do with unstable trauma patient

A 
Anticipate hemo and pneumothorax
Tube thoracostomy (5th intercostal space at midaxillary line)
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18
Q

Components of circulation assessment in trauma

A

Palpate central pulses
Observe (exsanguinating external injury)
Don’t need exact BP (permit to SBP 80-100)
IV catheters (16 gauge)

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19
Q

Treatment of shock

A

1 L crystalloid NS or LR
1-2 units O neg PRBC
Start massive transfusion protocol
1:1:1 PRBC:fresh frozen plasma: platelets

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20
Q

Components of disability and neuro assessment in trauma

A

LOC/mental status (GCS)
Pupils
Motor/sensory (lateralize extremity movement and level of sensation/sensory deficits)
Imaging (motor deficit, spinal cord sensory level)

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21
Q

When to intubate with GCS?

A

< or equal to 8 (max for intubated pt is 10)

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22
Q

Components of exposure assessment in trauma

A 
Visualize body (completely undressed)
Hypothermia <35 C (warm blankets, IVF and blood, warming devices etc)
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23
Q

Lethal triad and acute coagulopathy of trauma/shock

A

Hypothermia (remove wet clothes and warm pt_
Coagulopathy (permit hypotension and give blood products over the crystalloids)
Acidosis (stop the bleeding and treat shock)

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24
Q

What is the secondary survey?

A

Done after primary survey is complete
Head to toe exam
Detailed history and physical exam
Adjunct studies

25
AMPLLE history for secondary survery
Allergies Meds PMH Last meal LMP Events that lead to trauma Antiplatelet or anticoagulation (blood thinners) Pregnant?
26
What are you looking for in secondary survey: skin
Lacerations, abrasions, ecchymosis, hematoma
27
What are you looking for in secondary survey: head and face
Inspect and palpate entire bony structure
28
What are you looking for in secondary survey: neck
All blunt trauma, assume injury Distended neck veins Evaluate C spine
29
What are you looking for in secondary survey: chest
Inspect and palpate entire chest wall | Careful auscultation
30
What are you looking for in secondary survey: abdomen
Inspect and palpate entire abdomen, can be unreliable
31
What are you looking for in secondary survey: rectum and GU
Inspect rectum and perineum | Sign of pelvic injury
32
What are you looking for in secondary survey: MSK
Inspect entire length of all 4 extremities: tenderness, deformity,
33
What are you looking for in secondary survey: neuro
Serial exams | Status can change over time
34
Nexus C spine rule
``` Xray unnecessary is pt satisfies ALL of the low risk criteria: No midline cervical tenderness No focal neuro deficits Normal alertness No intoxication No painful distracting injury ```
35
PECARN rule for CT of head in kids younger than 2 YO
AMS or GCS<15 or palpable skull fracture is automatic CT If not: LOC>5 sec, nonfrontal hematoma, not acting normally or severe mechanism then discharge (must decide observation or CT if have either)
36
PECARN rule for CT of head in kids older than 2 yrs
AMS or GCS<15 or signs of basilar skull fx is automatic CT If not: history of LOC, history of vomiting, severe HA or severe mechanism then discharge (must decide observation or CT if have either)
37
What injuries to look for with shoulder seat belt?
Blunt carotid or strangle injury
38
Chance fracture
Seatbelt pulled the vertebrae back and fractured
39
Diagnostics for secondary survey of abdomen
CT with contrast abd and pelvis | FAST u/s
40
Bruising signs to look for in abdomen
``` Cullens sign (internal abd bleeding can cause bleeding around umbilicus) Gray turners (flank) ```
41
Most frequently injured organ in penetrating trauma
Liver (2nd most in blunt abd trauma)
42
Most frequently injured organ in blunt trauma in adults
Spleen
43
Indications for rectal exam during secondary survey of trauma patient
Spinal cord injury (assess sacral sparing) Pelvic fracture (assess for open fracture) Penetrating abd fracture (assess for gross blood)
44
When to not use foley in trauma pt
Urethral injury so either blood at meatus or pelvic fracture
45
Hard signs of vascular injury from penetrating trauma to extremity
``` Active or pulsatile bleeding Expanding hematoma Pulseless limb Shock (attributed to vascular injury-no other injury to explain shock) Compartment syndrome Bruit thrills (rare) ```
46
Soft signs of vascular injury from penetrating trauma to extremity
Small non expanding hematoma Venous oozing History of pulsatile bleeding Unexplained neuro deficit (Sensory or motor)
47
Abnormal ABI used in lower extremity injury
48
Hard vs soft signs indicating tx of extremity penetrating trauma
Hard: OR! Soft: if ABI>.9 the no arterial injury but if ABI
49
Management for fractures (open or closed)
Assess neuro and vascular (reduce and get better alignment if cold and pulseless) Pressure or tourniquet if bleeding Immobilize to prevent further bleeding Tetanus and abx
50
6 Ps of compartment syndrome
``` Pain (worse on passive stretch) Paresthesia Pallor Pulselessness Poikilothermia Paralysis ```
51
Trauma PAN SCAN
Non contrast CT of head, maxillary-face, cervical/thoracic/lumbar spine (bony stuff) CT with contrast chest/abd/pelvis
52
HIV/severe immunodeficiency patients needing tetanus prophylaxis
If have contaminated wound (even minor) should get also get TIG regardless of history of tetanus immunizations---all patients <3 or with unknown history of vaccinations will need TIG with all other wounds that aren't clean and minor
53
What kind of fluids for burn pt?
Lactated ringers based on parkland formula
54
How to lay pregnant trauma pt
Left lateral decubitus position
55
Perimortem cesarean section after how long of maternal arrest
Baby has best survival rate if delivered within 5 min of maternal arrest (remove fetus and continue resuscitation of both mother and fetus)
56
Geriatric considerations for trauma
Meds: consider bleeding and hemodynamics (warfarin will increase risk of mortality after trauma significantly) Must determine if MI or MVC came first Might have hidden injury
57
How long should you prescribe an opioid for?
3 days (other options like gapapentin or lidocaine patches)
58
Inpatient tx
Caution with NSAIDs | Augment opiates with non opiods

X Emergency Med Exam 3 (5 decks)

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