11 - Trauma Flashcards

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1
Q

When a trauma comes in what are some important questions to ask the ambulance crew?

A
  • Location of injury
  • Events before injury
  • Mechanism of injury
  • Ability to walk after injury?
  • Last meal eaten?
  • PMHx?
  • Tetanus status?
  • Normal mobility status?
  • Occupation?
  • Dominant hand?
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2
Q

What are some questions to ask paramedics specifically if there has been a RTA?

A
  • Collision speed?
  • Airbags deployed?
  • Wearing seatbelt?
  • What seat in car?
  • Injuries/fatalities of other passengers?
  • What stopped the car?
  • Was the patient trapped?
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3
Q

What are some worrying signs with trauma?

A
  • Shock
  • Tachypnea
  • Reduced GCS
  • Significant mechanism
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4
Q

Before/during examination of trauma patients what is important to consider?

A

Pain relief!!!!

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5
Q

What is a significant mechanism of injury in trauma?

A
  • Fall >1m or 5 stairs
  • Axial load to head e.g diving
  • High speed RTA
  • Rollover RTA
  • Ejection from a vehicle
  • Bicycle collision
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6
Q

What trauma injuries require immediate senior input?

A
  • Neurovascular compromise
  • Involving deep structures e.g tendons
  • Wounds in cosmetic/sensitive areas
  • Open fracture
  • Displaced fractures
  • Fractures with skin tenting
  • Dislocation of major joints
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7
Q

What is the likely cause of death following trauma?

A

Immediately: brain or high spinal injuries, cardiac or great vessel damage.
Early hours:splenic rupture, sub dural haematomas and haemopneumothorax
Days: sepsis or multi organ failure

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8
Q

Before inserting an NG tube or nasopharyngeal airway, what contraindication do you need to check for?

A

Basal skull fracture

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9
Q

What are the different ways of describing simple wounds?

A

- Puncture
- Incisional (sharp objects)
- Laceration(blunt trauma)
- Abrasion

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10
Q

When taking a history for a simple wound what are some questions to ask?

A
  • Mechanism
  • Foreign bodies
  • Contamination with naure
  • Tetanus status
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11
Q

What do you need to look at when examining a simple wound?

A
  • Site, size, type of wound
  • Distal senssation
  • Cap refill
  • Movements
  • Depth
  • Foreign bodies

Use local anaesthetic when examining

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12
Q

What investigation should be done if you suspect a foreign body in a wound?

A

X-ray

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13
Q

How should you manage a simple wound?

A
  • Clean with saline or sterile water
  • Consider antibitoics and tetanus boost
  • Primary closure (glue, steristrips, sutures)
  • Delayed primary closure (if likely infected)
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14
Q

What are some common thoracic injuries in trauma patients?

A
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15
Q

How do you treat a haemothorax in a trauma patient?

A
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16
Q

How do you investigate a cardiac contusion in a trauma patient and what are the risks with this?

A
17
Q

What are some common organs injured in the abdomen in trauma?

A

- Liver (stab)
- Spleen
- Abdominal aorta (deceleration)
- Small bowel (gun shot wound)

18
Q

What is the first imaging done for trauma?

A

US!!

FAST scan to look for internal bleeding

19
Q

What is the difference between concussion and a contusion?

A

Localised damage that can be viewed on imaging with contusion. Concussion is wide spread

20
Q

What symptoms have to be present to diagnose concussion?

A
  • No structural damage
  • General neuro symptoms
  • NO focal neuro symptoms
21
Q

What are the symptoms of concussion and what is the likely recovery period?

A
  • Confusion (e.g unaware of surroundings, delay in answering questions, blank expression)
  • Headache
  • Dizziness
  • Nausea
  • Loss of balance
  • Visual changes/photophobia
  • Memory issues

Can take 1-4 weeks to resolve

22
Q

What is post-concussion syndrome?

(Think scott)

A

Persisting symptoms >1 month of concussion beyond the normal time for recovery. Need to rest and minimise stress. Symptoms include:
- irritability
- headache
- fatigue
- anxiety/depression
- dizziness

23
Q

What is chronic traumatic encephalopathy?

A

Repeared concussions leading to cognitive declien and eventual dementia and agression

Common in boxers and rugby players

24
Q

What are the two subtypes of traumatic brain injury?

A

Primary: immediate damage due to force e.g focal (contusion/haematoma) or diffuse (diffuse axonal injury)
Secondary: due to hypoxia from processes like cerebral oedema, ischaemia, infection, tonsillar or tentorial herniation

25
Q

What is a diffuse axonal injury?

A

Occurs as a result of mechanical shearing following deceleration, causing disruption and tearing of axons

Poor prognosis, usually unconsciousness

26
Q

What observations do you need to be cautious of in a head injury?

A

Cushing’s Reflex
Heart rate
Blood pressure

27
Q

When a patient has had a head injury, what are some important questions to ask them?

A
  • Mechanism of injury?
  • LOC?
  • Seizures?
  • Vomiting?
  • Amnesia?
  • Blood/fluid from nose or ears
  • Headache
  • Any anticoagulation
28
Q

What is the criteria for a head CT in head injuries and at what time frame?

A
29
Q

On examination what is important to look at in head injuries?

A
  • GCS
  • Pupils
  • Neurological exam
  • Fractures of skull
  • Signs of basal skull fracture (ears, eyes, nose)
30
Q

What is whiplash and how does it present?

A

Neck sprain caused by a sudden movement of the head forwards, backwards or sideways

Usually gradual onset pain and stiffness, not present immediately after injury
Tender paravertebrally > midline

31
Q

How is whiplash managed?

A
  • Advise will get worse before better
  • Rest for 48h then gradual return to activities
  • NSAIDs and paracetamol
  • Local heat
32
Q

What scenarios do you need to immobilise a C-spine and ensure you have a CT neck before examining?

A
  • Significant mechanism of injury
  • Head injury with neck pain
  • Collapsed with suspected c-spine injury
33
Q

What is the controversy around c-spine immobilisation?

A

Increases risk of aspiration and increases difficulty of airway management

34
Q

What do the following pupil reflexes mean in a head injury?

A
35
Q

If there is raised ICP in an extradural haematoma, what can you do before surgery?

A
  • Give IV mannitol/furosemide
  • Maintain BP sys no less than 100
  • Head elevation
36
Q

Why does CT head become less sensitive over time to diagnose intracranial bleeds?

A

The blood haemolyses!!
If still suspect SAH do lumbar puncture

37
Q

How can you tell the difference between a traumatic tap and xanthochromia?

A

Traumatic tap will dilute over the three vials you take but xanthachromia will not. Also traumatic tap will have normal opening pressure but xanthochromia may be raised