Trauma pt eval Flashcards Preview

Q4 EM Surg > Trauma pt eval > Flashcards

Flashcards in Trauma pt eval Deck (37)
Loading flashcards...
1
Q

Most common causes of Trauma Mortality?

A
CNS injury (1/2)
Exsanguination
2
Q

Exacerbating factors in Trauma Mortality? (3)

A

Warfarin
Low Glascow Coma rating
Old age

3
Q

Immediate death from Trauma U result of? (4)

A
(death at scene)
Disruption of:
Great vessels
Heart
Lungs
Major body cavity
4
Q

Early death from trauma U result of?

A

(w/i 4 hrs of injury)

CV or pulmonary collapse

5
Q

Late death from trauma U result of?

A

(days to wks post)
sepsis
multiorgan failure

6
Q

Level I Trauma Center provides?

A

Tertiary care

24 hr in-house surgeons + promptly available specialists

7
Q

Level II Trauma Center provides?

A

Initiates definitive care

24 hr surgeon + specialty except for cardiac or microvascular surgery, dialysis

8
Q

Level III Trauma Center provides?

A

Assessment, resuscitation, stabilization, intensive care

24 hr ER docs and general surgeons

9
Q

Level IV Trauma Center provides?

A

Advanced traumatic life support prep for transfer

24 hr ED and labs

10
Q

Level V Trauma Center provides?

A

Eval, stabilization, diagnostics, prep for transport

After hr protocols

11
Q

ATLS includes? (4)

A

1) initial eval
2) resuscitation
3) stabilization
4) transfer

12
Q

Initial Eval of trauma includes? (4)

A

Stabilization
Identification of life-threat injury
Initiate support
Rapid organization of definitive care or transfer

13
Q

Primary Eval must assess and address?

A
Airway
Breathing
Circulation
Disability
Exposure
14
Q

End-organs are? (4)

A

Brain
Heart
Kidneys
Eyes

15
Q

Airway management includes? (5)

A

1) Assess conscious pt (w/ question)
2) Protect airway/cervical spine of unconscious pt
3) Observe (signs of difficulty)
4) Inspect mouth/throat (obstacles)
5) Inspect/palp anterior neck

16
Q

Tracheal Intubation used to?

How?

A

Mechanical ventilation

Endotracheal tube passed b/w vocal cords,
Requires direct visualization of cords,
Tube tip placed 1/2 b/w clavicle and carnia (trach spit into bronchi)

17
Q

Cricothyroidotomy is?

A

insertion of tube thru incision in cricothyroid membrane

18
Q

Breathing/Ventilation management includes? (6)

A

1) O2
2) Chest wall inspection (asymm/paradox mvmt)
3) Auscultate (apices and axillae)
4) Palpate (crepitus/deformity)
5) CXR for unstable pt
6) r/o pneuom/hemothorax, tamponade

19
Q

Treatment when signs of pneumothorax?

A

hypoTN, dyspnea, ipsilateral ↓ breath sounds

Needle Decompression:
2nd ICS @ MCL
5th ICS @ MAL

Tube thoracostomy:
immediately follows needle decomp
5th ICS, MAL

20
Q

Vent treatment when unstable pt?

A

anticipate pneuno/hemothorax

Tube thoracostomy

21
Q

Circulation management includes? (5)

A

1) Palpate central pulses (carotid/femoral)
2) Observe for external hemorr
3) Place IV catheters
4) Blood typing
5) Determining exact BP not necessary

22
Q

Arterial Hemorrhage management?

A

Manual pressure
Proximal compression
Elevation
Hemostatic agents

23
Q

Venous hemorrhage management?

A

Direct pressure

24
Q

Tx for pts w/o central pulse?

A

emergency thoracotomy

25
Q

Disability/Neuro management includes? (4)

A

1) Eval level of consciousness / Mental status
2) Pupil size, symm, light response
3) Motor/Sensory
4) Imaging

26
Q

Exposure/Environment Control includes?

A

1) Visualize entire body

2) Hypothermia

27
Q

If pt is hemodynamically unstable, next step after primary survey?

A

Skip 2° survey

Send right to angio or major trauma center

28
Q

2° Survey in trauma includes? (3)

A

Head to toe exam (fingers and tubes in every hole)

Detailed hx (of traumatic event and of pt’s medical hx)

X-Ray/CT

29
Q

Common Misses in trauma:

Blunt Abd?

Penetrating Abd?

Thoracic?

Extremity?

A

Blunt abd trauma:
hollow viscus
pancreatoduo
diaphrag

Penetrating abd trauma:
rectal or urethral

Thoracic trauma:
pericardial tamponade
aortic injuries
esophageal perf

Extremity trauma:
fractures
vascular disruption
compartment synd

30
Q

2° Survey: C-Spine management

A
Clear (no x-ray needed) if:
non-tender
alert
not intoxicated
no distracting injury

If can’t clear, do CT
*neg CT AND tenderness, still cannot clear

31
Q

2° Survey: Tube considerations?

A

Foley:
blood at meatus
pelvic fracture

NG Tube:
mid face fractures

32
Q

2° Survey: Abdomen?

A

Diagnostic Peritoneal Lavage
CT
US

33
Q

Most frequently injured organ w/ penetrating trauma?

A

liver

34
Q

Most frequently injured organ w/ blunt abd trauma in adults?

A

Spleen

35
Q

What vaccines recommended w/ loss of spleen?

A

pneumo
h. flu
meningococc

36
Q

Common result of splenectomy?

A

thrombocytosis

37
Q

2° Survey: Chest? (6)

A
Crepitus
Tenderness
JVD (SVC compression)
Tracheal deviation (tension pneumothorax)
Respiratory effort
CXR