Trauma

Question 1

Respiratory cause of ICP in trauma

Answer 1

Elevated CO2 → vasodilation of carotid a

Question 2

Cushings triad

Answer 2

HTN, bradycardia, irregular/low respirations

Question 3

Treat traumatic ICP

Answer 3

1. Immediate surgery
2. Elevate head of bed to 30
3. Hypertonic saline (250 ml over 10 minutes)
4. Mannitol

Question 4

Signs to indicate emergent thoracotomy

Answer 4

1. Initial output 1-1.5L
2. 150-200mL/hr for 2-4 hours
3. Failure to evacuate hematoma
4. Persistant hemodynamic instability

Question 5

Best dx of diaphragmatic injury

Answer 5

Direct visualization (endoscopy)

Question 6

Goals of adequate resuscitation

Answer 6

> .5 mL/kg/H urine output
CVP 8-12 mm Hg
MAP 65-90
ScvO2 >70%

Question 7

MTP

Answer 7

Usually initiated if >10 units needed/after 10 units given
1:1:1
PRBC, FFP and platelets

Question 8

Blood transfusion in peds

Answer 8

10 mL/kg PRBC

Question 9

Pain control in peds

Answer 9

fentanyl 1 μg/kg

morphine 0.05-0.1 mg/kg

Question 10

Describe needle decompression

Answer 10

14G, 4.5cm over the needle catheter into 2nd intercostal space at midclavicular line

Question 11

Size of tube for tube thoracostomy

Answer 11

24-28 F

Question 12

Assume what in trauma patient with subq emphysema

Answer 12

pneumothorax

Question 13

US finding in pneumothroax

Answer 13

Loss of sliding pleura

Question 14

Area at risk for diaphragm injury in penetrating trauma

Answer 14

Nipple to umbilicus

Question 15

Most common injured portion of heart in trauma

Answer 15

Rt ventricle

Question 16

Commotio cordis

Answer 16

Vfib with no myocardial injury usually due to direct trauma to chest

Question 17

Most common site of blunt aortic injury

Answer 17

Proximal descending between left subclavian and ligaments arteriosum

Question 18

Treat HTN in traumatic arotic injury

Answer 18

Narcotics
Esmolol titrated to 100-120 mm Hg, HR 60
Add Na nitroprusside if bradycardia w/ a BB for reflex tachycardia

Question 19

Lowest space for thoracentesis

Answer 19

Between 8 and 9th ribs

Preferred approach: posterior at midscapular line

Question 20

Trauma lethal triad

Answer 20

Hypothermia, coagulopathy, metabolic acidosis

Question 21

Prophylax open fractures

Answer 21

• <10 cm: cefazolin (1st gen cefa)

- extensive soft tissue injury, exposed bone, vascular injury: cefaolin + gent

Question 22

Tube thoracostomy placement in 3rd trimester

Answer 22

Never below 4th intercostal space

Question 23

Chance fx

Answer 23

Seatbelt fx: high impact flexion
All three columns
Associated with small bowel or pancreatic injury

Question 24

Meds that can go in an ET

Answer 24

Lidocaine
Atropine
Naloxone
Epi
\+vasopressin for adults