Trauma Flashcards
This deck covers Chapters 33-41 in Rosens, compromising all of trauma.
List 5 predictors of mortality in penetrating head injury
- Low GCS
- Unreactive pupils
- Missile crossed midline
- Missile through ventricles
- Missile in posterior fossa
- High velocity weapon
- Self-inflicted
- Secondary injury
Outline management of high ICP in children
- HOB at 30 degrees
- Head midline without tight C-collar
- Hyperosmolar
- Mannitol 1 g/kg
- HTS 3 mL/kg
- Hyperventilate (30-35 mmHg for acute change)
- Intubation
- Paralysis
- Phenobarbital 10 mg/kg
- Decompressive craniectomy
- Avoid fever
- Maintain euvolemia
- Treat seizure
Outline the pathophysiology of compartment syndrome
- Tissue pressure increases above capillary pressure
- Damage causes edema, further increasing pressure
- Rarely does pressure exceed arterial pressure
- Pulses present until late
List 5 injuries associated with seat-belt signs
- Chance fracture
- Ruptured diaphragm
- Intestinal injury
- Mesenteric laceration
- Abdominal aortic dissection
What is your MAP target during spinal paralysis?
MAP >85 mmHg
List 5 complications of chest tube insertion
- Infection
- Intercostal artery injury
- Hemothorax
- Pulmonary injury
- Bronchopleural fistula
- Intra-abdominal placement
- Failure to re-expand PTX
- Re-expansion pulmonary edema
List 6 hard signs of ARTERIAL injury
- Bruit/Thrill
- Pulsatile bleeding
- Expanding hematoma
- Loss of distal pulses
- Cyanosis/temperature differences
- P’s of arterial insufficiency
- Pain on passive stretch
- Pulseless
- Paresthesias
- Pallor
- Paralysis
List 5 procedures you can do after a thoracotomy.
- Twist hilum
- Deliver the heart
- Repair heart laceration
- Clamp aorta
- Open cardiac massage
- Internal defibrillation
- Intracardiac epinephrine
What 2 things are necessary to rule out blunt cardiac injury?
What do you do if one is abnormal?
- Negative troponin
- Normal ECG
If either AbN, need 24h monitoring ;
If hypotensive, increasing trop, or AbN ECG, get echo
Name 6 indications for laparotomy after PENETRATING trauma
- Evisceration
- Peritonitis
- Diaphragm injury
- Massive GIB
- Knife insitu
- Free air on imaging
- Hypotension
Outline the CT Head rule
Avoid Driving if you Get Super Smashed And Vomit
Medium Risk (for injury)
- Amnesia >30m before impact
- Dangerous mechanism (peds struck, ejected, fall >3ft)
High Risk (for NSx intervention)
- GCS <15 at 2h
- Suspected open/depressed skull fracture
- Signs of basilar fracture
- Age >65
- Vomiting >=2 times
What is the shock index? What number predicts MTP?
SI = HR/BP
- SI >1.0 predicts MTP
Describe the Ellis classification system
Ellis I
- Enamel chipped
Ellis II
- Dentin exposed
- Pain
- Cover with calcium hydroxide paste
Ellis III
- Pulp exposed
- Need ABx for pulpitis (Amox/Clinda)
List 6 advantages and 4 disadvantages of CT for abdominal trauma patients
Advantages
- Non-invasive
- Sensitive for solid organ injury
- Sensitive for active bleeding
- Sensitive for GU tract injuries
- Evaluates retroperitoneum and spine
- Easily extends to include thorax/pelvis
Disadvantages
- Radiation exposure
- Contrast exposure
- Expensive
- Insensitive for pancreas/diaphragm/bowel/mesentery
- Leaving the ED to get scan
Define and differentiate the following:
- Caput succedaneum
- Subgaleal hematoma
- Cephalohematoma
- Caput succedaneum
- Hematoma in connective tissue layer
- Moves across suture lines
- Subgaleal hematoma
- Hematoma in loose areolar tissue
- Cephalohematoma
- Hematoma under periosteum
- Does NOT cross suture lines
List 5 C-spine injuries sustained via a FLEXION mechanism
AA-FOB
- Atlanto-axial dislocation
- Atlanto-occipital dislocation
- Flexion teardrop
- Odontoid fractures
- Bilateral facet fracture/dislocation
List 7 ANATOMIC differences between adults and children relevant to trauma
- Relatively larger head = more head injury
- Thinner skull = more head injury
- Anterior placement of liver/spleen = more injury
- Less muscle/fat to protect truncal organs
- Tachycardia w/ normal BP may represent shock in kids
- Kidneys less protected by ribs in kids
- Chest wall more elastic = lung injury without rib injury
- Salter-Harris ortho fracture patterns
- Tenuous spinal cord blood supply = more SCIWORA
List 6 clinical findings consistent with basilar skull fracture
- Raccoon eyes
- Battle Sign
- Rhinorrhea
- Otorrhea
- Hemotympanum (behind TM)
- Blood in ear canal
- CN7 palsy
- CN8 palsy
- Tinnitus
- Nystagmus
List and describe 5 herniation syndromes
-
Uncal Herniation
* Medial temporal lobe through the tentorium
* Ipsilateral blown pupil, contralateral hemiparesis -
Central Transtentorial
* Supratentorial herniation down
* Coma, Pinpoint pupils, Bilateral paralysis, Rigid -
Subfalcine (MCC)
* Cingulate gyrus under falx cerebri
* H/A, contralateral leg weakness -
Transcalvarial
* Out of head -
Upward Transtentorial
* Cerebellum up
* N/V, Coma, Pinpoint pupils, downward gaze -
Cerebellotonsillar
* Cerebellar tonsils through foramen magnum
* Coma, Pinpoint pupils, Bilateral paralysis, Apnea

What is your CPP target in severe head injury?
60 mmHg
<50 increases mortality
>70 increases ARDS
List 4 indications for prolonged (24h) tocography following minor/moderate trauma
- 3+ contractions per hour
- Uterine tenderness after 4h
- Vaginal bleeding
- Membrane rupture
- Abnormal 4h monitoring
- Serious maternal injury
List 7 ANATOMIC differences between adults and children relevant to AIRWAY management
- Larger head
- Larger tongue
- Larger tonsils
- Dynamic airway collapse with respiration
- Anterior larynx
- Larger/floppy epiglottis
- Narrowest at cricoid
- Shorter trachea
- Smaller airways
What are the anatomic borders of the ‘cardiac box’?
Clavicles
Nipples
Costal Margin
List 5 stable C-spine fractures
- Wedge fracture
- Clay Shoveler’s fracture
- Transverse process fracture
- Unilateral facet dislocation
- Burst fracture
- Isolated fracture of articular pillar/body


