3) Trauma Flashcards
FAST exam
Focused assessment w/ sonography for trauma
- Morison pouch (hepatorenal)
- splenorenal recess
- pouch of douglas (pelvis)
- pericardium
Raccoon eyes
periorbital ecchymosis (may represent basilar skull fracture)
Battle sign
ecchymosis over the mastoid (may represent basilar skull fracture)
Things that represent urethral injury
blood at urethral meatus
perineal hematoma
scrotal hematoma
Cushing Triad
-hypertension
-bradycardia
-respiratory pattern irregularity
(signs of markedly elevated ICP)
Central Cord Syndrome
Typically due to cervical hyperextension when the ligamentum flavum buckles into the spinal canal and pinches the cord
-weakeness that is greater in the upper extremities than the lower extremities
Brown Sequard Syndrome
Lateral half of the spinal cord is injured at a specific level (penetrating trauma)
- ipsilateral motor paralysis and contralateral sensory loss distal to the injury
- bowel and bladder function is usually maintained
Anterior Cord Syndrome
Anterior aspect of the spinal cord is injured by bone fragment compression, disc hernaition or ischemia resulting from anterior spinal artery compromise
- paralysis and loss of pain and temperature sensation distal to the injury
- posterior columns are unaffected so position, touch, and vibration sense is usually preserved
If cervical spine f(x) is suspected and NEXUS criteria can not be met
AP, lateral and open-mouth odontoid views should be obtained
Views of the cervical spine to help identify ligamentous injury
-flexion and extension views of the cervical spine
What is the most sensitive imaging modality for detecting spinal cord injury, ligamentous injury and hematomas?
MRI
Correct way to describe a fracture
1: open or closed
2: type
3: displacement
4: angulation
5: location
6: other
Wound examination should include
- location
- size
- shape
- margins
- depth
- damage to underlying adjacent tissues
- foreign bodies
- wound contamination
Anesthesia dose in wound repair
- can give single dose of locally infiltrated lidocaine in a quantity up to 5mg/kg not to exceed 300mg
- if epinephrine is included may be administered in larger quantities up to 7mg/kg
Lidocaine anesthesia effects
- develops w/in seconds
- lasts 20-60 min
Bupivicaine/Marcaine anesthesia effects
- onset w/in seconds
- lasts 1hr20min-80hrs
What wounds should receive antibiotic prophylaxis
- dog
- cat
- human
- full thickeness oral lacerations
- wounds contaminated by fresh water
- planat puncture wounds
Rabies
bullet shaped rhabdovirus
- transmitted by bite of infected carnivorous animal or bat (raccoons, bats, skunks, foxes)
- dogs and cats less common
- rodents and rabbits rarely
Instructions after wound closure
- keep wounds clean and ry for 24-48hours until there is enough epithelialization protect from contamination
- after 24-48hpatients may wash their wounds gently w/ mild soap and water
- topical abx ointment may help reduce the risk of infection and improve cosmoses
- wounds at high risk for infection should be reevaluated within 24-48h
- return if erythema, warmth, swelling,drainage, and dehiscence of the wound occur (suggest infection)
First degree burn
superficial involving the epidermis
-erythematous and painful
2nd degree burn
partila thickness
- extending into the dermis
- erythematous w/ classic blistering of the skin
- deeper injuries have mottles or white color changes
- exquisitely tender
3rd degree burn
full thickness
- destruction of epidermis and dermis
- white, leathery and in some cases charred skin
- insensate
4th degree burn
extends into the subcutaneous tissue and may involve adjacent muscle, bones and neuromuscular structures
Which burns need to be hospitalized?
Adults w/ >25% BSA involvement
Children w/ >10% BSA involvement
Treatment of significant oral lacerations
Should be considered contaminated and treated with antibiotic like penicillin
Most common site of site of traumatic aortic tears
in the descending aorta just distal to the take off of the led subclavian artery
Sprain vs Strain
sprain = abnormal joint motion leads to ligament injury strain = injury to the muscle-tendon unit from stretching or overexertion
