06 - Trauma and Burns Flashcards
1
Q
Identify the sign: periorbital ecchymosis
A
raccoon eyes
2
Q
Eponym:
jaw thrust (for airway maintenance in trauma patients)
A
Esmarch maneuver
3
Q
Where is the needle inserted in needle thoracostomy?
A
2nd IC in the MCL
4
Q
Site for tube thoracostomy:
A
4th or 5th ICS MAL
5
Q
- Enumerate: Beck’s triad
- What is the diagnosis?
A
- distended neck veins
- hypotension
- muffled heart sounds
cardiac tamponade
6
Q
Identify the sign: ecchymosis behind the ear
A
Battle sign
7
Q
Explain: halo sign
A
dried blood surrounded by a halo of dried CSF -> (+) CSF
8
Q
Identify: intraabdominal organ that is most commonly injured after blunt trauma
A
liver
9
Q
- Clamping of the hepatoduodenal ligament is called _______
- Why is the purpose of this maneuver?
- What structures (3) are found inside the hepatoduodenal ligament?
A
- Pringle maneuver
- to halt hemorrhaging of the liver
- hepatic artery, portal vein, and common bile duct
10
Q
Identify: Second most commonly injured intraabdominal organ after blunt abdominal trauma
A
splee
11
Q
Enumerate: postplenectomy vaccine prophylaxis
A
- polyvalent pneumococcal
- quadrivalent pneumococcal or diphtheria conjugate
- quadrivalent meningococcal polysaccharide
- Haemophilus B conjugate
12
Q
Identify the sign: perineal or scrotal hematoma
A
Destot sign
13
Q
Explain: Boari flap
A
flap surgery done to bridge the gap in distal ureteral injuries
14
Q
Identify: fracture of the distal radius with the fragment displaced dorsally
A
Colle’s fracture
15
Q
Identify: fracture of the distal radius with the fragment displaced volarly
A
Smith’s (reverse Colle’s)
16
Q
Identify: fracture of the radial styloid
A
Hutchinson’s / Chauffeur’s
17
Q
Identify: fracture of the ulna with dislocation of the radial head
A
Monteggia fracture
mUnteggia = Ulnar fracture!!!!
18
Q
Identify: fracture of the radius with dislocation of the distal radio-ulnar joint
A
Galeazzi fracture
19
Q
Identify: horizontal fracture running through the maxilla superior to the maxillary alveolar process
A
Le Fort I
20
Q
Identify: horizontal fracture passing through the superior orbital fissure, resulting in a complete separation of the facial bones from the cranium
A
Le Fort III
21
Q
Identify: pyramidal fracture through the maxilla and orbit, outlining the nose
A
Le Fort II
22
Q
Enumerate (5): major complications of Le Fort fractures:
A
- facial anesthesia
- malocclusion
- trismus (lockjaw)
- globe malposition, vision changes, and ectropion
- midfacial distortion and nasal obstruction
23
Q
Describe: zone 1 of penetrating neck injury:
A
-from the thoracic outlet to the cricoid cartilage superiorly
24
Q
Describe: zone 2 of penetrating neck injury:
A
-from the cricoid cartilage to the angle of the mandible
25
Describe: zone 3 of penetrating neck injury:
-above the angle of the mandible
26
Zones of penetrating trauma: enumerate: most common common types?
zone 2 (but associated with lower morbidity and mortality)
27
Zones of penetrating trauma: enumerate: types with greatest risk for morbidity and mortality?
zone 1 and 3 (because they obstruct the airways)
28
Second most common facial fracture
Mandibular fracture
29
Most common facial fracture
nasal fracture
30
Confirmatory test for CSF leak
B-2 transferrin test
31
Most common cause of burn injury requiring hospital admission:
flame burn
32
Type of burn injury with the highest mortality
flame burn
33
Enumerate: guidelines for referral to a burn center
34
another name for the rule of nines:
rule of Wallace
35
Most accurate method of estimating burn size:
Lund and Browder chart
36
Parkland's formula
4 mL pLR /kg/%TBSA
* 1st half given in the first 8 hours
* 2nd half given in the next 16 hours
37
Curreri formula
25 kcal/kg/day + 40 kcal/TBSA/day
38
Most common cause of death in burns
burn wound sepsis
39
Another name for stress ulcers
Curling ulcers
40
Classes of hemorrhagic shock and estimated blood loss:
41
These spinal tract control motor function:
Where do these tracts decussate?
* lateral and anterior corticospinal tracts (pyramidal tract)
* level of the medulla
42
These spinal tract convey protopathic sensation:
What are the components of protopathic sensation? (3)
Where do these tracts decussate?
* anterior and lateral spinothalamic tracts
* temperature, pain, and crude touch
* only at the segmental level or shortly above
43
Hyperextension injury often results to this type of incomplete spinal cord syndrome:
central cord syndrome
44
occlusion of anterior spinal artery often results to this type of incomplete spinal cord syndrome:
anterior cord syndrome
45
occlusion of the posterior spinal artery often results to this type of incomplete spinal cord syndrome:
posterior cord syndrome
46
Spinal cord compression often results to this type of incomplete spinal cord syndrome:
another name for this syndrome:
Brown-Sequard syndrome
a.k.a. hemisection syndrome
47
Injuries below the L1 vertebral level often result to this type of incomplete spinal cord syndrome:
Cauda Equina syndrome:
48
Identify the type of incomplete spinal cord injury: ipsilateral loss of proprioception, vibration, and tactile discrination, with spastic paralysis below the level of the lesion, and contralateral loss of pain and temperature sensation one or two levels below the lesion:
Brown-Sequard syndrome
49
Identify the type of incomplete spinal cord injury: bilateral paresis, upper \> lower extremity
Central cord syndrome
50
Identify the type of incomplete spinal cord injury: ipsilateral loss of proprioception, vibration, and touch sensation below the level of the lesion
posterior cord syndrome
51
Identify the type of incomplete spinal cord injury: flaccidity, areflexia, and impairment of bowel and bladder function
cauda equina syndrome
52
Identify the type of incomplete spinal cord injury: bilateral motor paralysis, loss of pain and temperature sensation
anterior cord syndrome
53
These spinal tract convey epicritic sensation and proprioception:
What are the components of epicritic sensation? (3)
Where do these tracts decussate?
* gracile and cuneate fasciculi (posterior column)
* fine touch, vibration, and pressure
* level of the medulla
54
55
Enumerate (3): penetrating injuries (trauma) can cause the following incomplete cord syndromes:
* anterior cord syndrome
* posterior cord syndrome
* Brown-Sequard syndrome
56
Yes or no: All patients with blunt trauma require cervical spine immobilization
Yes
57
most common indication for intubation
altered mental status
58
What is the indication of emergent tracheostomy
laryngotracheal separation or laryngeal fractures
59
Treatment of flail chest with underlying pulmonary contusion
require presumptive intubation and mechanical ventilation
60
treatment of tension pneumothorax
CTT
61
treatment of open pneumothorax
closure of pneumothorax and CTT
62
What is the direction of insertion of a CTT
directed superiorly and posteriorly 36F Chest tube
63
where is the incision of a CTT
4th - 5th ICS MAL
64
pressure of carotid pulse
60 mmHG
65
pressure of femoral pulse
70 mmHg
66
pressure of radial pulse
80 mmHg
67
Definition of massive hemothorax
1. \>1500 ml blood loss 2. 1/3 of blood volume in pediatrics
68
what is the incision on emergency department thoracotomy
left anterolateral thoracotomy
69
Indication of emergency department thoracotomy
1. witnessed penetrating trauma with \< 15 mins of prehospital CPR 2. witnessed blunt trauma with \< 5 mins of prehospital cpr Persistent severe post injury hypotension BP \<60 mmHg 3. cardiac tamponade 4. hemorrhage 5. air embolism
70
Layers of the body passed by CTT
1. skin 2. suuperficial fascia 3. serratus anterior 4. external intercostal 5. internal intercostal 6. innermost intercostals 7. endothoracic fascia 7. parietal pleura
71
What is the most common cause of cardiogenic shock in a trauma patient
tension pneumothorax
72
Areas in the body in performing physical exam that needs special attention
1. axilla 2. back 3. perineum
73
The big three radiographs in BLUNT trauma
1. lateral cervical spine 2. chest 3. pelvic
74
Radiograph for truncal gunshot wound
1. anteroposterior and lateral chest and abdomen
75
Target INR and PTT of trauma patients
INR \< 1.5 PTT \< 45 seconds
76
What are the zones of the neck?
zone 1 - up to the level of cricoid zone 2 - cricoid up to the angle of mandible zone 3 - above the mandible
77
What is the 5 plain radiograph views of the cervical spine
1. lateral 2. anteroposterior 3. transoral odontoid 4. bilateral oblique views
78
Treatment of penetrating neck injury that is asymptomatic
zone I -CT scan neck and chest, CTA esophagogram, bronchoscopy zone II a.transcervical GSW - like zone 1 b. all others - observe zone III -observe
79
Treatment of penetrating neck injury that is symptomatic, stable
zone I -CT scan neck and chest, CTA esophagogram, bronchoscopy zone II a. operative exploration zone III -angiography - Interventional radiography embolization
80
Treatment of GSW/Stab wound in the abdomen of stable patient
A. GSW 1. Anterior abdomen - explore lap 2. RUQ, tangential, back or flank - CT scan B. Stab wound 1. back, flank - CT scan 2. AASW + LWE - DPL, CT or Serial Exam
81
Positive Result of DPL
1. WBC \> 500 ml 2. Amylase \> 19 3. ALP \> 2 4. Bilirubin \>0.01 5. RBC a. AASW \> 100,000 b. Thoraco abdominal \>10,000 if between 1,000 - 10,000 do laparoscopy or thoracoscopy
82
Areas of FAST
1. subxiphoid 2. morison's pouch/ hepatorenal recess 3. LUQ/ perisplenic 4. pelvis \>250 ml blood
83
What age is cricothyroidotoy is contraindicated
\< 8 years old can cause subglottic stenosis
84
What is the immediate management of air embolism
Trendelenberg position to trap air in the left ventricle
85
What is the blood loss of a rib fracture
100 to 200 ml
86
What is the blood loss of a pelvic fracture
\>1000 ml
87
What is the blood loss of a tibial fracture
300 to 500 ml
88
What is the blood loss of a femur fracture
800 to 1000 ml
89
Most common cause of burn
flame burn - thermal burn
90
What are jackson's three zones of tissue injury following a burn
1. zone of coagulation - necrosis (needs excision and grafting)
2. zone of stasis - questionable viability
3. zone of hyperemia - heals with minimal or no scarring
91
What degree of burns are not included in calculating %TBSA
superficial (first degree) burns
92
What does cyanide poisoning inhibit
cytochrome oxidase which in turn inhibit cellular oxygenation
93
what is the treatment of cyanide poisoning
1. sodium thiosulfate 2. hydroxycobalamin 3. 100% oxygen
94
what is tha parkland formula
4 mg/kg x %TBSA
95
how do you give the parkland formula
1/2 of total fluid for first 8 hours 1/2 of total fluid for the next 16 hours
96
Target of fluid resuscitation in burn victims
1. MAP = 60 mmHg 2. UO = 30 cc/hr or 1 - 1.5 cc/kg/hr
97
Children under 20 kg should be given additional treatmen in burn
glucose supplementation
98
What is the side effect of silver sulfadiazine
neutropenia
99
Formic acid burns are associated with
chemical burn hemoglobinuria and hemoylsis
