1 - Review Of Trauma

Question 1

Traumatic evaluation of chest - initial evaluation normally with:

Answer 1

CXR (get em naked, roll em over, shoot the film)

Follow-up with the donut of truth (CT scan)

Question 2

Must have a system when evaluating film in trauma:

Answer 2

A - adequacy 
B - bones
C - cardiac silhouette
D - densities
E - effusions 
F - foreign bodies

Question 3

Things to look for on CXR in trauma

Answer 3

Pneumothorax

Hemothorax

Subcutaneous emphysema

Pleural effusion

Tension pneumo

Diaphragmatic hernia

Check the mediastinum

Question 4

Lots of pics in this lecture

Answer 4

Might be beneficial for the test to be able to recognize them - films, scans, etc

Question 5

If you see widened mediastinum in trauma?

Answer 5

Bad bad bad

They’re probably exsanguinating into their chest

Surgery NOW

Question 6

For a c-spine film, ensure you can see:

Answer 6

The C7-T1 interface

If not visible, apply gentle traction on shoulders (don’t manipulate the neck!)

Question 7

When evaluating for soft tissue edema on a lateral c-spine, what is the upper limit of normal for C2 and C6?

Answer 7

C2 - 6mm

C6 - 22mm

Question 8

AP view (C-spine) is good for evaluating:

Answer 8

Tracheal deviation

Pedicle fx’s

First two ribs

Check for soft tissue and SQ air

Question 9

Odontoid view to evaluate:

Answer 9

C1-C2

Dens and C1 ring

Question 10

Loss of normal lordotic curve in c-spine suggests:

Answer 10

Muscle spasm and soft tissue swelling

Often secondary to whiplash

Question 11

Check the anterior alignment of the c-spine so you don’t miss:

Answer 11

Step deformity

Question 12

Common c-spine injuries:

Answer 12

Hangman
Jefferson
Clay Shoveler
Hyperflexion
Hyperextension
Odontoid
Atlanto-axial
Wedge / burst

Question 13

Hangman

Answer 13

Fx through the pedicels of C2 2/2 hyperextension

Question 14

Jefferson

Answer 14

C1 ring fx 2/2 axial loading

Question 15

Clay shoveler

Answer 15

Spinous process fx in c-spine

Question 16

Hyperflexion injury

Answer 16

Flexion of the neck causes injury to the spinal canal and tearing of the spinal ligaments

Question 17

Odontoid fx types

Answer 17

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)

Question 18

In which view is a compression fx best seen?

Answer 18

Lateral

Question 19

Transverse process fracture of the L-spine

Answer 19

Normally stable
Can be indicative of another injury

Best seen on AP view

Question 20

Wedge vs burst

Answer 20

Wedge - injury is anterior, but posterior elements intact - normally stable

Burst - worse - posterior elements damaged - considered unstable

Question 21

Evaluation of pelvis

Answer 21

Iliac wings
SI joints
Pubic rami
Symphysis pubis
Acetabula 
Femoral necks
Proximal femur

Question 22

What should you strongly consider with a pelvic dx:

Answer 22

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

Question 23

Air in hollow viscous organs will be displaced by:

Answer 23

Fluid (blood)

Question 24

Transverse processes fx - you should think:

Answer 24

Something bad enough to injure those bones , you should think possible severe trauma to the hollow organs

Question 25

CT abdomen great for:

Answer 25

Free air
Fluid
Solid organ injury

Question 26

CT abdomen is poor at:

Answer 26

Finding hollow viscous organ injury but can see secondary signs (free air, fat stranding)

Question 27

Slide 47

Answer 27

Fx types

Question 28

Epidural hematoma on CT:

Answer 28

Ellipse

Question 29

Subdural hematoma on CT

Answer 29

Crescent

Question 30

Intracerebral hematoma on CT:

Answer 30

In the parenchyma

Question 31

FAST exam

Answer 31

Focused abdominal sonography in trauma

Checks for blood (suspect solid organ injury) or air (suspect bowel injury)

Like a triage tool

Question 32

Looking for blood where with FAST?

Answer 32

Morrison’s pouch

Spleno-renal fossa

Douglas pouch

Pericardium

Question 33

Can February March?

Answer 33

No but April May!