1 - Review Of Trauma Flashcards
Traumatic evaluation of chest - initial evaluation normally with:
CXR (get em naked, roll em over, shoot the film)
Follow-up with the donut of truth (CT scan)
Must have a system when evaluating film in trauma:
A - adequacy B - bones C - cardiac silhouette D - densities E - effusions F - foreign bodies
Things to look for on CXR in trauma
Pneumothorax
Hemothorax
Subcutaneous emphysema
Pleural effusion
Tension pneumo
Diaphragmatic hernia
Check the mediastinum
Lots of pics in this lecture
Might be beneficial for the test to be able to recognize them - films, scans, etc
If you see widened mediastinum in trauma?
Bad bad bad
They’re probably exsanguinating into their chest
Surgery NOW
For a c-spine film, ensure you can see:
The C7-T1 interface
If not visible, apply gentle traction on shoulders (don’t manipulate the neck!)
When evaluating for soft tissue edema on a lateral c-spine, what is the upper limit of normal for C2 and C6?
C2 - 6mm
C6 - 22mm
AP view (C-spine) is good for evaluating:
Tracheal deviation
Pedicle fx’s
First two ribs
Check for soft tissue and SQ air
Odontoid view to evaluate:
C1-C2
Dens and C1 ring
Loss of normal lordotic curve in c-spine suggests:
Muscle spasm and soft tissue swelling
Often secondary to whiplash
Check the anterior alignment of the c-spine so you don’t miss:
Step deformity
Common c-spine injuries:
Hangman Jefferson Clay Shoveler Hyperflexion Hyperextension Odontoid Atlanto-axial Wedge / burst
Hangman
Fx through the pedicels of C2 2/2 hyperextension
Jefferson
C1 ring fx 2/2 axial loading
Clay shoveler
Spinous process fx in c-spine
Hyperflexion injury
Flexion of the neck causes injury to the spinal canal and tearing of the spinal ligaments
Odontoid fx types
1 - just the tip
2 - the body
3 - way down into the body
On exam, probably either 1 or 3 (bc 2 can be debatable)
In which view is a compression fx best seen?
Lateral
Transverse process fracture of the L-spine
Normally stable
Can be indicative of another injury
Best seen on AP view
Wedge vs burst
Wedge - injury is anterior, but posterior elements intact - normally stable
Burst - worse - posterior elements damaged - considered unstable
Evaluation of pelvis
Iliac wings SI joints Pubic rami Symphysis pubis Acetabula Femoral necks Proximal femur
What should you strongly consider with a pelvic dx:
Urethral injury
Do NOT cannulate the bladder until you’re sure there’s no tear
Do a RUG to evaluate prior to insertion of foley cath
Air in hollow viscous organs will be displaced by:
Fluid (blood)
Transverse processes fx - you should think:
Something bad enough to injure those bones , you should think possible severe trauma to the hollow organs
CT abdomen great for:
Free air
Fluid
Solid organ injury
CT abdomen is poor at:
Finding hollow viscous organ injury but can see secondary signs (free air, fat stranding)
Slide 47
Fx types
Epidural hematoma on CT:
Ellipse
Subdural hematoma on CT
Crescent
Intracerebral hematoma on CT:
In the parenchyma
FAST exam
Focused abdominal sonography in trauma
Checks for blood (suspect solid organ injury) or air (suspect bowel injury)
Like a triage tool
Looking for blood where with FAST?
Morrison’s pouch
Spleno-renal fossa
Douglas pouch
Pericardium
Can February March?
No but April May!
