Trauma Flashcards
(30 cards)
Replete fluids
Isotonic fluids are repleted in trauma in a 3:1 ratio (fluids:blood loss)
Indications for a Foley in trauma
Hemodynamically unstable patients
Those receiving fluid resuscitation
Those undergoing major surgery
Likely cause of death in patient with penetrating chest trauma who was stable, but suddenly dies
Air embolism
New diastolic murmur after chest trauma suggests?
Aortic dissection
Most important next step in contaminated wounds?
First they need early wound irrigation and tissue debridement
Then give IV anbx and tetanus propylaxis
Rapid deceleration causes what kind of head injury?
Coup-contecoup: a bleed is noted at the site of impact and across from the point of impact
CT findings of diffuse axonal injury
Blurring the punctate hemorrhaging along the gray-white matter junction
Appearance of epidural vs subdural hematoma
Football vs. crescent shaped
Patient in ED after head trauma with no sx and normal head CT. Next step in management?
Discharge
Patients with mild-moderate head trauma and a normal CT can go home
Presentation of myocardial contusion (blunt cardiac injury)
New bundle branch block, dysrhythmia, hypotension
Pulmonary contusion: presentation, imaging, tx
Presentation: hypoxia 2/2 damage to capillaries and leakage of intra and extravascular fluid
Hypoxia worsens with fluid hydration
CXR: patchy alveolar opacities
Aortic disruption
Usually due to rapid deceleration injury
Patients who can live with it usually have a tamponading hematoma
Most common location: just proximal to ligamentum arteriosum
Presentation and diagnosis of aortic disruption
Upper extremity HTN and a hoarse, quiet voice (impingement of recurrent laryngeal nerve)
CXR: widened mediastinum (>8cm), loss of aortic knob, pleural cap, deviation of trachea and esophagus to the right, and depression of the left main stem bronchus
Fever, respiratory distress, and a rash consisting of small red and purple 1-2 mm macules covering arms and shoulders
Fat embolism. Usually after long bone fx (usually femur)
Kehr’s sign
Referred shoulder pain 2/2 diaphragmatic irritation
Usually on the left due to a splenic rupture
Diagnosis of urethral injury
Retrograde urethrogram
Causes of cardiac arrest
5Hs and Ts Hypovolemia Hypoxia Hydrogen ions: acidosis Hyper/Hypokalemia and other metabolic issues Hypothermia
Tablets: drugs OD, ingestion Tamponade: cardiac Tension pneumothorax Thrombosis: coronary Thrombosis: pulmonary embolism
How to treat asystole or PEA (aka cardiac arrest)
CPR with epinephrin and vasopressin
Look for etiology (5Hs and Ts)
Treatment of v-fib or pulselss v-tach
Initiate CPR
Defibrillate with 200 J immediately -> defibrillate again -> epi -> defibrillate -> amiodarone -> defibrillate -> epi
Treatment of SVT
Unstable: synchronized electrical cardioversion
Stable: control rate with vagal maneuvers, carotid sinus massage, AV nodal block agents (CCB, B-block)
Treatment of a-fib or a-flutter
Unstable: synchronized electrical cardioversion
Stable: control rate and anticoagulate if > 48 hours
Cardioversion if <48 hours, if anticoagulated for 4-6 weeks, or if TEE is negative for thrombus
Do not give nodal blockers if there is e/o AVRT (ie WPW)
Hamburger’s sign
If a patient wants to eat, it’s probably not appendicitis
Psoas sign
Passive extension of the hip leads to RLQ pain
Obturator sign
Passive internal rotation of the flexed hip leads to RLQ pain
