Trauma Flashcards by Clyde Silverio

hard cervical collar can be applied to both sides of the neck except when___

there is a penetrating neck trauma

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Esmarch maneuver is also known as the

jaw thrust

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Indications for emergency ET intubation

Acute airway obstruction
Hypoventilation
Severe hypoxemia
Altered mental status
Cardiac arrest
Severe hemorrhagic shock

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This type of endotracheal intubation is not applicable in severe apnea, severe midface trauma and suspicion of basilar skull fracture

Nasotracheal

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[type of ET intubation]

for patients with craniofacial trauma

Do cricothyroidectomy

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[type of ET intubation]

for patients with laryngeal fractures

tracheostomy

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[type of ET intubation]

what is a know complication of cricothyroidectomy if performed in children?

subglottic stenosis

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[diagnosis: Inadequate ventilation]

Respiratory distress 
Hypotensive
tracheal deviation
subcutaneous emphysema
 decreased breath sounds

tension pneumothorax

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What is the Immediate treatment for tension pneumothorax

needle thoracostomy

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where will you insert the needle in needle thoracostomy in tension pneumothorax of an adult patient

4th or 5th ICS MAL

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where will you insert the needle in needle thoracostomy in tension pneumothorax of a child?

2nd ICS MCL

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In tension pneumothorax, which comes first (after needle thoracostomy)

CTT or CXR

CTT

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[diagnosis: Inadequate ventilation]

full thickness loss of chest wall
atmospheric pressure same as the pleural pressure

open pneumothorax or Sucking chest wound

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what is the initial treatment for open pneumothorax?

occlusion of the wound at its 3 sides

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what is the definitive treatment for open pneumothorax?

closure of the chest wall

CTT remote from the wound

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[diagnosis: Inadequate ventilation]

paradoxical movement of the free floating segment of fracture chest wall (3 or more contiguous ribs are fractured)

flail chest with underlying pulmonary contusion

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What is the initial treatment for flail chest with underlying pulmonary contusion?

Presumptive intubation and mechanical intubation (PEEP)

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Prior to doing the definitive management of flail chest with underlying pulmonary contusion, what will you rule out first?

tension pneumothorax

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[Type of tracheobronchial injury]

if its within 2 cms of carina

type I

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[Type of tracheobronchial injury]

Injury to tracheobronchial tree with pneumothorax

type II

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Where will you insert the CTT tube in doing a thoracostomy?

4th or 5th ICS MAL

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[What is the estimated SBP]

if the carotid pulse is felt

more than or equal to 60 mmHg

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[What is the estimated SBP]

if the femoral pulse is felt

more than or equal to 70 mmHg

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[What is the estimated SBP]

if the radial pulse is felt

more than or equal to 80 mmHg

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[What will you do] patient is hypovolemic, noted tissue hypoperfusion, fluid nonresponder

send the patient to the operating room

[What will you do] patient is hypovolemic, noted tissue hypoperfusion, transient fluid responder

Do diagnostic laparotomy and or thoracotomy then OR

fluid resuscitation for patients in shock

20mL/kg bolus PLR

[Estimate the blood loss] ``` patient is anxious, confused HR 122 RR 33 UO 10 BP 80/60 ```

1500 to 2000 mL Class III treat with PLR + Blood Remember: CLASS III - anxious (remember ALL 3) 1. 30% blood loss 2. RR is 30 3. 1.5L blood loss (half of 3) 4. 15 is the limit UO 4. HR >120 (multiple of 3)

[Estimate the blood loss] ``` patient is mildly anxious HR 122 RR 33 UO 22 BP 90/60 ```

750 to 1500 mL Class II give crystalloid

[Estimate the blood loss] ``` patient is slightly anxious HR 100 RR 20 UO 35 BP 90/60 ```

<750 mL Class I

[diagnose] multiple rib fractures severed intercostal arteries or injury to pulmonary hilar vessels

massive hemothorax

[diagnose] penetrating injury dilated neck veins muffle heart sounds decline in arterial pressure

cardiac tamponade

when will you do an emergency department thoracotomy in a case of cardiac tamponade?

if the SBP <70

in air embolism management, if vigorous massage is unsuccessful, aspiration of air can be dene using a tuberculin syringe. Where will you aspirate the air?

Right coronary artery

[GCS score] Decorticate posturing incoherent/inappropriate eye opening to name calling

GCS 9 | E3, V3, M3

[GCS score] decerebrate posture incomprehensible eye opening to pain

GCS 6 E2 V2 M2

The gold standard in determining the presence of blood in CSF

CSF will test positive for beta 2 transferrin

[neurosurgical trauma] lentiform and hyperdense limited by suture lense

Acute epidural hematoma craniotomy if >30mL

[neurosurgical trauma] crescenteric hyperdense not limited by suture lines

Acute subdural hematoma

[neurosurgical trauma] elderly alcoholic cresenteric, hypodense

Chronic Subdural hematoma burr hole

[neurosurgical trauma] focal regions of brain edema hypodense

Contusion Do surgical evacuation

[neurosurgical trauma] focal regions of brain edema hyperdense

paranchymal hemorrhage

Diffuse axonal injury is commonly due to severe ____

angular acceleration-deceleration

[neurosurgical trauma] depressed sensorium punctate hemorrhage in the grey white matter junction, corpus callosum and brainstem

diffuse axonal injury

[ASIA score] No motor No sensory

ASIA A

[ASIA score] No motor With sensory

ASIA B

[ASIA score] MMT <3 With sensory

ASIA C

[ASIA score] MMT >3 sensory intact

ASIA D

[diagnose] hyperextension injury bilateral paresis UE>LE

Central cord syndrome Bilateral CST and lateral SPT

[name the tract] originate: cerebral cortex, ventral horn of the spinal cord decussates at the medulla

pyramidal tract

[diagnose] burst fracture, occlusion of the anterior spinal artery bilateral motor paralysis, loss of pain and temperature sensation, autonomic dysfunction below the level of the lesion

anterior cord syndrome

[diagnose] penetrating injury, occlusion of the spinal artery (or multiple sclerosis also) ipsilateral loss of proprioception, vibration, and touch sensation below the level of the lesion

posterior cord syndrome

[diagnose] spinal cord compression ipsilateral loss of proprioception, vibration, and tactile discrimination, Contralateral loss of pain and temp sensation on one or two levels below lesion

brown-sequard

[diagnose] injuries below the L1 vertebral level; flaccidity, areflexia, and impairment of bowel and bladder function

cauda equina

most frequently injured intraabdominal organ after blunt trauma

liver

second most frequently injured organ following blunt abdominal trauma

spleen

Cite the criteria for colostomy post trauma

1. BP <90/60 2. Blood loss >1L 3. fecal spill 4. >8h after injury 5. colon wound so destructive 6. mejor loss of substance in the AAW

what are the vaccines indicated for post splenectomy patients?

pneumococcal, meningococcal, Haemophilus B

what is the cut-off value for intraabdominal hypertension?

>12mmHg

what is the cut-off calue for abdominal compartment syndrome?

>20mmHg

perineal or scrotal hematoma is also called ___

Destot sign

[Signs of vascular injury] Cite the soft signs of vascualr injury

1. History of moderate hemorrhage 2. Injury 3. Diminished but palpable pulse 4. Peripheral nerve deficit

[ED Thoracotomy] What is the cut off for salvagable postinjury cardiac arrest for a witnessed penetrating trauma?

<15 min prehospital CPR

[ED Thoracotomy] What is the cut off for salvagable postinjury cardiac arrest for a witnessed blunt trauma?

<10min of prehospital CPR

[ED Thoracotomy] What is the cut off for salvagable postinjury cardiac arrest for a witnessed penetrating neck trauma?

<5 min of prehospital CPR

[ED Thoracotomy] contraindications in penetrating trauma

CPR > 15 mins and no signs of life

[ED Thoracotomy] contraindications in blunt trauma

CPR >10 minuts, no signs of life or asystole

Bloody vicious cycle components

1. Refractory hypothermia 2. profound acidosis (pH <7.2, base deficit >15mmol/L 3. Refractory coagulopathy

[Antibiotic of choice: Ortho trauma] Gustilo I

cefaxolin

[Antibiotic of choice: Ortho trauma] Gustilo II

Cefazolin + Aminglycoside

[Antibiotic of choice: Ortho trauma] Gustilo III

Cefazolin, Aminoglycoside, penicillin

[Ortho trauma: fracture] distal radius, displaced dorsally

colles

[Ortho trauma: fracutre] | distal radius displaces volarly

smith

[Ortho trauma: fracture] reverse colles

smith

[Ortho trauma: fracture] radial styliod

hutchinson/Chauffeur

[Ortho trauma] ulna with dislocation of the radial head

monteggia

[Ortho trauma] distal radius, with dislocation of DRJ

Galeazzi

[Ortho trauma] radial shaft at the junction of the middle and distal thirds without ulnar fracture

Piedmont

Cite the indications for fasciotomy

1. Gradient pressure <30 mmHg 2. Absolute compartment pressure > 30mmHg 3. Ischemic periods >6hours 4. combined arterial and venous injuries

bones involved in le fort type 2

maxilla and orbit

most common facial fracture (bone involved)

mandible

[type of fracture] trapdoor pattern with associated extraocular muscle entrapment

orbital blowout fracture

Trauma Flashcards

(82 cards)