Trauma

Question 1

CT classification of splenic trauma

Answer 1

1. Haematoma - less than 10% subcapsular
Laceration - less than 1 cm parenchymal
2. Haeamtoma subcapsular 10-50%
Laceration 1-3 cm 
3. Haematoma >50% or ruptured 
Laceration >3cm
4. Active contrast blush - laceration involving hilar vessels
or >25% segment of devascularised spleen
5. Shattered spleen, active intraperitoneal bleeding

Question 2

Define the lumbar triangles

Answer 2

petit - inferior
iliac crest, border of ext oblique and lat dorsi

grynfeldt - superior
12th rib, internal oblique and quadratus lumborum

Question 3

Liver Trauma classification

Answer 3

1 - haematoma <10% surface, subcapsular
Laceration <1cm parenchymal
2 - haematoma - 10-50% non expanding subcapsular
or <2cm intraparenchymal non expanding
laceration <3cm parenchymal depth with <10cm length
3 - Haematoma >50% subcapsular or expanding or ruptured with bleeding or intraparenchymal >2cm
lac- >3cm depth
4 - haematoma - ruptured central haematoma
lac - parenchymal destruction of 25-75% of a lobe
5- lac - >75% lobe parenchymal destruction
Vascular - juxtahepatic venous injury- retrocaval/major hepatic vein
6 - hepatic avulsion (usually RIP)

Question 4

Hard signs of vascular injury

Answer 4

Active pulsatile arterial bleeding
Expanding haematoma
Loss of peripheral pulse
Signs or symptoms of ischemia 
Active bleeding and haemodynamically unstable
Bruit or thrill

Question 5

Soft signs of vascular injury

Answer 5

Decreased pulse
Overlying haematoma
Injury of anatomically related structure
Multiple close fractures and extensive soft tissue injury
Injury in anatomical area of vessel

Question 6

What are the BP goals in damage control resuscitation

Answer 6

Enough to allow organ perfusion but not normotension

80mmHg systolic
80mmHg MAP in case of severe TBI

Coincides with the need for haemorrhage control

Question 7

grading severity of head injury

Answer 7

Mild - 13-15
mod - 9-12
severe -3-8