1 Trauma Flashcards
which dermatomes are these:
thumb, middle finger, pinky, nipple, umbilicus, inguinal
c6,7,8
t4,10
L1
You intubate a trauma pt because unstable. On CXR has very small PTX
Think what
Still put in chest tube for any PTX in intubated pt
to prevent positive pressure induced tension ptx
Chest trauma:
indications for OR thoracotomy
- 1500 ml output immediately chest tube
- 200 ml/h output
- unstable
neck penentrating trauma
-hard and soft signs
“HARD Bruit”
Hypotension, Arterial bleeding, Rapid expanding hematoma, Deficit (pulse/neuro), Bruit
everything else is soft!
-e.g. hoarse voice, Stridor, subQ emphysema
Hard goes to OR, soft do CTA
Lumbar fractures
which 3 to know, what are they?
-lap belt injury causes which one
Wedge, Burst, Chance
wedge: compression fx of anterior column
burst; body crushed into multiple fx, involves anterior/middle columns
chance: flexion/distraction injury–transverse through all columns, assoc lap belt injury
blast injuries:
- what are primary, secondary, 3rd, 4th injuries
- what is biggest killer in blast injuries? how to dx?
1: blast shock wave (eg TM rupture)
2. debris from explosion (shrapnel)
3. blunt trauma from body (body flies into wall)
4. burns, radiation, smoke inhalation, etc
- biggest killer: Blast lung
get CXR–may see b/l central patchy opacities in butterly pattern
Urethral injuries
- anterior vs posterior
- how to dx
- straddle injury causes what
anterior: “something’s wrong!” (It’s obvious)
posterior: “something’s wrong?” (subtle, penis looks normal)
anterior: distal to urogenital diaphragm
RUG: anterior will extravasate locally or bladder
posterior extravasates into pelvis
straddle injury, think anterior
NEXUS c spine criteria
NSAID
neuro deficit
spinal midline ttp
AMS
intoxication
distracting injury
High speed MVC with chest seatbelt sign and SOB
CXR is neg. remember to think what
If suspect Pulmonary contusion,
Get repeat CXR 6h after injury for delayed presentation
central cord syndrome
- sxs/signs
- mech
mech: hyperextension in elderly
sxs: cape distribution neuro sxs, upper ext > lower ext
Blunt abdominal trauma
think what internal organ damage:
- bike handlebar
- lap belt
- pancreas/duodenum
- small bowel
delayed presentation of hollow viscus injury is common, so caution even if CT neg. should get admitted with serial exams. also consider in abdominal seat belt sign for hollow viscus injury
blunt abd trauma
what 3 injuries are hard to dx on CT?
pancreas, diaphragm, hollow viscus (bowel)
Perimortem C Section
-physical exam how can you tell if mother has viable fetus
>24 weeks
gravid uterus >4 finger breadths above umbilicus
Finger tendon injuries:
which ones to remember (3)
- jersey finger–flexor tendon avulsion (FDP)
- mallet finger–extensor tendon avulsion
- central slip injury
- specific type of extensor tendeon injury, causes boutinierre deformity
Flail chest:
definition
tx
3 adjacent ribs that have been fx’ed into segments
intubate now, chest tube
monitor for pulm contusions
Driver rear-ended in MVC. Has seat belt sign to neck and neuro deficit in arm
-think what
Think carotid dissection. Get CTA
Blunt neck trauma + neuro deficit = carotid dissect until proven otherwise
Unstable C spine injuries:
mechs, clinical presentation, images
“Jefferson Bit Off A Hangman’s Tit”
see image
finger amputation
- what are contraindications to reimplantation to know (3)
- what to place ampuated finger in
>6h, no fingertip phalanx exposure, severely crushed/mangled
Keep part in saline-soaked gauze in separate bag, then place in bag with ice. (no direct ice/water)
mandibular fracture
-most common site broken
condyle, not coronoid process
Hemorrhagic shock classes, differences between each
15, 30, 40
- vs wnl
- tachycardic, pulse pressure decreased
- hypotension
- AMS
penile amputation
-until how long is reimplantation possible
up to 8-12 h
Types of traumatic brain herniation to know (3)
draw it out
sxs
- subfalcine
- frontal lobe under falx, abnormal gait (think humunculus) - uncal
- CN 3, ipsilateral down and out. beware pending brainstem herniation - tonsillar
- death, coma
Le fort fxs
- what bones, draw it out
- CSF rhinorrhea assoc with which one?
- Palate (below nose)
- Nose - inferior orbits
- Face - zygomatic arch, CSF rhinorrhea possible
Aortic dissection on CXR:
other than medistinal widening, which important thing to look for
loss of aortic knob contour
