traumatology

Question 1

What is the tx for spinal cord injury?

Answer 1

give IV steroids for 24 hrs if presenting within first 8 hrs after injury unless pt is a child, pregnant, or has isolated cauda equina syndrome

Question 2

What are the zones of the neck?

Answer 2

zone 1: below the cricoid. involves the thyroid, clavicles, aorta, etc
zone 2: extends from the cricoid to the angle of the mandible
zone 3: above the angle of the mandible
injuries to zones 1 and 2 often require bronchoscopy to assess airway

Question 3

How does zone affect management of neck injury?

Answer 3

1. penetrating trauma to neck with stable vital signs can be managed conservatively
2. zone 1 and 3 exploration is difficult- only do exploration if you suspect vascular injury
3. consider intubation with neck injuries
4. consider prophylactic abx given proximity to oropharyngeal flora

Question 4

What are serious complications of chest trauma?

Answer 4

aortic rupture (caused by sudden acceleration/deceleration injuries), tension pneumothorax, hemothorax, tamponade

Question 5

When is chest CT useful in chest trauma?

Answer 5

air leaks, hematoma formation, pulmonary collapse

Question 6

What are general rules for managing abd trauma?

Answer 6

penetrating trauma requires exploratory laparatomy, but blunt trauma may be treated conservatively as long as there are no peritoneal signs/signs of acute abdomen. In general, if pt had blunt trauma, exam should focus on signs of abdominal bleeding (decr BP, cyanosis, flank discoloration, severe abd tenderness, rigidity, shock). . Most centers start with a FAST scan for blunt trauma.
If uncertain, peritoneal lavage can be used to detect the presence of blood or fecal matter

Question 7

If a pt has significant blood loss that isn’t easily found on exam, where is the blood likely hiding?

Answer 7

significant blood loss is seen with losses >1500 cc.
Consider:
-blood lost at the scene of the accident
-pleural cavity bleeding
-pelvic bleeding
-bleeding into the thighs
-intrabdominal bleeds

Question 8

What are indications for surgical intervention in trauma pts?

Answer 8

• all penetrating abd injuries need exploratory lapartomy
• Diagnosed intra-abdominal bleeds or visceral damage from blunt trauma needs laparatomy for repair if pt is hemodynamically unstable; any blunt trauma pt who is hemodynamically unstable needs to go to OR
• Retroperitoneal hematomas in the upper abdomen (pancreas, kidneys) need laparatomy
• low retroperitoneal bleeding can be treated with angiography and embolization if caused by blunt trauma; laparatomy is needed if caused by penetrating trauma

Question 9

What exam is needed in a pt with possible or suspected GU/pelvic trauma?

Answer 9

• blood at urethral meatus
• rectal exam to assess “high-riding” prostate in men that could indicate urethral injury
• penile/scrotal exam in men to assess for hematomas
• pelvic exam in women
• Neurovascular exam if evidence of pelvic fracture

Question 10

How are GU/pelvic trauma cases managed?

Answer 10

• surgical exploration for penetrating trauma
• pelvic fracture: nonoperative tx OK if stable; otherwise, pt needs ORIF
• urethral, intraperitoneal bladder, and renal pelvic injuries need cystoscopy and surgical repair
• extraperitoneal bladder and renal parenchymal injuries can be treated non-operatively

Question 11

When should you definitely perform a fasciotomy based on risk?

Answer 11

pt swith combined bone and neurovascular extremity injury

Question 12

How are combined bone, vessel, and nerve injuries treated?

Answer 12

fracture repair, THEN vessel/neuro repair

Question 13

What criteria should be met in post-traumatic pregnant pts before discharge?

Answer 13

contractions no more frequent than every 10 minutes, no vaginal bleeding, no abd pain, and a normal fetal heart tracing

Question 14

What are key considerations in pregnant women vs. non-pregnant women following trauma?

Answer 14

• compression of IVC in pregnant pts makes them more susceptible to poor/inadequate cardiac output after trauma. place moms in left lateral decubitus position
• Decr risk of GI injury in lower abd trauma because intestines are pushed upward due to fetus- but greater risk of GI injury with upper abd trauma
• increased risk of placental abruption

Question 15

When are women in abusive relationships most likely to be killed by their abusers?

Answer 15

when trying to leave the abusive situation