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ABSITE 2019 > Trauma > Flashcards

Trauma Flashcards

1
Q

Glasgow Coma Scale

A 
Motor  (ARM+LEG) = 6 
6 - follows commands
5 - localizes pain
4 - withdraws from pain
3 - flexion w/ pain (decorticate) 
2 - extensionw / pain (decerebrate)
1 - no response

VERBAL (VOICE) = 5
5 - oriented
4 - confused
3 - inappropriate words
2 - incomprehensible sounds
1 - no response

Eye opening (EYES) = 4 
4 - spontaneous opening
3 - open to command
2 - open to pain
1 - no response
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2
Q

Most important prognostic indicator from GCS

A

motor score

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3
Q

Lenticular (lens-shaped) deformity on head CT

A

epidural hematoma

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4
Q

Cause of epidural hematoma

A

middle meningeal artery

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5
Q

Diagnosis of abdominal compartment syndrome

A

bladder pressure >25-30

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6
Q

When to do ED thoracotomy:
Blunt Trauma
Penetrating Trauma

A

Blunt: if pressure/pulse lost in ED
Penetrating: if pressure/pulse lost in route to or in ED

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7
Q

How to perform ED thoracotmy

A

Through 4th/5th intercostal spaces using anterolateral approach
Pericardium opened anterior to phrenic nerve
Heart rotated out of the way
Cross clamp aorta (watch for esophagus which is anterior to aorta)

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8
Q

Cause of subdural hematoma

A

Tearing of briding veins

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9
Q

Head CT finding for subdural hematoma

A

cresent shaped deformity

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10
Q

Cerbral perfusion pressure

A

CPP = MAP - ICP

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11
Q

Normal ICP

A

10

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12
Q

Elevated ICP

A 
>20
Sedation, parlaysis 
Raise head of bed
Relative hyperventilation 
Mannitol
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13
Q

Cushin’s triad

A

bradycardia
HTN
low respiratory rate

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14
Q

Cause of dilaed pupil (blown pupil)

A

IL temporal lone pressure on CN III

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15
Q

Raccoon eyes

A

Anterior fossa fracture

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16
Q

Battle’s sign

A

Middle fossa fracture (can injure facial nerve CN VII)

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17
Q

Most common site of facial nerve injury

A

Geniculate ganglion

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18
Q

Coagulopathy w/ TBI due to

A

release of tissue thromboplastin

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19
Q

Jefferson Fracture

A

C1 burst

caused by axial loading

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20
Q

Hangman’s fracture

A

C2
caused by distraction and extension
TX: traction + halo

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21
Q

Fracture of dens

A

Type I: above base, stable
Type II: at base, unstable –> fusion/halo
Type III: extends into vertebral body –> fusion/halo

22
Q

3 columns of spine

A

Anterior: anterior 1/2 of vertebral body and anterior longitudinal ligament
Middle: posterio 1/2 of vertebral body and posterior longitudinal ligament
Posterior: facet joints, lamina, spinous processes

23
Q

Spine is considerd unstable when

A

more than 1 spinal column is disrupted

24
Q

Le Fort Type I

A

Maxillary fracture straight across

Tx: reduce, stabilize, intramaxillary fixation, orbital rim suspension wires

25
Le Fort Type II
Lateral to nasal bone, underneath eyes towards maxilla | Tx: reduce, stabilize, intramaxillary fixation, orbital rim suspension wires
26
Le Fort Type III
Lateral orbital walls | Tx: suspension wiring to stable frontal bone
27
Persistent nose bleed
Likely posterior, try balloon tamponade then angioembolization of internal maxillary artery
28
Neck Zone 1
Clavicle to cricoid cartilage Need angiography, bronchoscopy, esophagoscopy, barium swallow May need median sternotomy to repair injury
29
Neck Zone 2
Cricoid to angle of mandible | Need neck exploration
30
Neck Zone 3
Angle of mandible to base of skull | Need angiography and laryngoscopy
31
Contained esophageal injury
can be observed
32
Small noncontained w/ minimal contamination esophageal injury
primary closure
33
neck noncontained esophageal injuries
just place drains
34
chest noncontained esophageal injuries
chest tubes to drain injury, place spit fistula in neck | will eventualy need esophagectomy
35
Approach to esophageal injuries
Neck: left side Upper 2/3 of thoracic esophagus: right thoracotomy (avoids aorta) Lower 1/3: left thoracotomy
36
Thyroid injury
conrol bleeding w/ sutrue ligation and drainage
37
Chest Tube to Thoracotmy indications
>1500 after initial insertion >250cc/h for 3 hours >2500cc/24h
38
Persistent pneumothorax despite 2 well placed chest tubes
Dx: bronchoscopy to look for mucsu plug or tracheobronchial injury
39
Worse oxygenation after chest tube placement
May be tracheobroncial injury
40
Where is tear for aortic transection
ligamentum arteriosum (just distal to subclavian takeoff)
41
Aortic Transection Tx
covered stent endograft (disal transections) | left thoracotomy and repair
42
Penetrating "box" chest injury
clavicles, xiphoid process, nipples (boundaries) | need pericardial window, bronchoscopy,esophagoscopy, barium swallow +/- angiogram
43
Penetrating "out of box" chest injury
w/o pneumothorax or hemothorax --> chest tube and serial CXR
44
1st and 2nd rib fractures should make you think of
aortic transection
45
Anterior Pelvic fracture source of bleeding
venous (pelvic venous plexus)
46
Duodenal trauma repair
1st, 3-4th segment: segmental resection w/ primary end to end closure 2nd segment: jejunal serosal patch, pyloric exclusion, gastrojejunosotomy
47
Stacked Coins or Coiled Spring on CT scan
paraduodenal hematomas
48
Right & Transverse colon injury treatment
primary repair or resect and anastomosis
49
Left colon injury treatment
1: Primary repair 2: left sided colectomy for destructive lesions 3: diverting ileostomy for gross contamination, >6h since injury, >6 units pRBC given 4: if patient is in shock and primary repair can't be completed --> end colostomy and Hartmann's pouch
50
Rectal trauma (intra peritoneal) injury treatment
LAR + diverting loop colostomy is always indicated
51
Rectal trauma (extra peritoneal) injury treatment
High rectal: primary repair + diverting loop colostomy Middle rectal: difficult to reach, place end colostomy only Low rectal: primary repair w/ transanal approach
52
Most common organ injury w/ blunt trauma
liver

ABSITE 2019 (8 decks)

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