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Rosens > 32. Multi Trauma > Flashcards

32. Multi Trauma Flashcards

1
Q

OA common injury sites - 3

A

extremity
craniofacial
closed head

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2
Q

What determines the amount of tissue damaged in a gunshot wound?

A

kinetic E of bullet - determined by bullet w, v

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3
Q

In what 4 ways do gunshot wounds cause trauma to surrounding tissue?

A

direct laceration
crush injury
shock waves
cavitation (displacement of tissue forward and radially)

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4
Q

MVC: associated injuries in - head on collision

A

facial
LE
aortic

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5
Q

MVC: associated injuries in - rear end coll

A

hyperext injury of cspine
c spine #
central cord syndr

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6
Q

MVC: associated injuries in - lateral/t-bone collision

A

thoracic injury
abdo injury - spleen, liver
pelvic
clavicle, humerus, rib #

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7
Q

MVC: associated injuries in - rollover

A

cursh injury
compression # of spine

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8
Q

MVC: associated injuries in - ejection

A

spinal

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9
Q

MVC: associated injuries in - windshield damage

A

closed head injury
FACIAL #
Skull #
cervical spine #

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10
Q

MVC: associated injuries in - steering wheel damage

A

thoracic injuries
sternal and rib #
- flail chest
cardiac contusion
aortic injuries
htx, ptx

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11
Q

MVC: associated injuries in - dashboard involvement/damage

A

pelvic/acetabular injury
dislocated hip

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12
Q

Restraint/seat belt use: associated injuries in - lap belt only in a three point restraint

A

chance #
abdo injury
head and facial injury and fracture

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13
Q

Restraint/seat belt use: associated injuries in -proper 3pt restraint

A

sternal and rib #
pulmonary contusion

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14
Q

Restraint/seat belt use: associated injuries in -shoulder belt only

A

c spine injuries and #
concern for possible “submarine” out

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15
Q

Air bag deployment: associated injuries in ?-

A

UE soft tissue injury and #
LE injury and #

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16
Q

Ped vs automobile injuries at low braking automobile

A

tibia and fibular #
knee injuries

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17
Q

Ped vs automobile injuries at high speed

A

waddel’s triad: tibia adn fibula or femur #
truncal injuries
craniofacial injuries

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18
Q

Bicycle injuries, automobile related mc injuries:

A

closed head
handblebar: spleen/liver lac, additional intraabdo
consider penetrating

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19
Q

Bicycle injuries, non-automobile related mc injuries:

A

extremity injuries
handlebar injuries

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20
Q

Falls - LD50?

A

36-60ft

(fatal to 50%)

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21
Q

Vertical impact injuries

A

calcaneal and LE #
pelvic #
closed head injury
c-spine #
renal and renal vascular injuries

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22
Q

Horzontal fall impact injuries

A

craniofacial #
hand and wrist #
abdo and thoracic visceral injuries
aortic injury

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23
Q

When to use a torniquet for circulation?

A

++ bleeding

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24
Q

Goal of the secondary survey

A

(1) obtain pertinent historical data about the patient and injury; and (2) identify and manage all significant injuries by performing a systematic, complete examination. An AMPLE (allergies, medications, past medical history, last meal, envi- ronments and events) history should be obtained

25
Q

Blunt trauma goal of management, focusing on localizing injury to what possibl 4 things?

A

(1) obvious external hemorrhage; (2) long bone fractures; (3) pelvic fractures; or (4) internal hemorrhage.

26
Q

What does Rosen’s state is a sufficient airway protection?

A

gcs >/=9
suficient resp effort
no active emesis
no significant oropharyngeal bleeding

27
Q

What consideration is helpful before intubation?

A

gcs

28
Q

If no respiratory distress, breathing wise, what to consider for empiric tx

A

bg
narcan
tx and ID non traumatic hypocia/hypoventil

29
Q

No bilateral breath sounds, what to consider?

A

tension ptx
open ptx
massive htx

30
Q

Bilateral breath sounds present, what breathing issues to consider?

A

flail chest
cardiac injury
pulmonary contusion

31
Q

Main two distinctions of shock in rosen’s

A

hemorrhagic
or other

32
Q

Physical exam for hemorrhage finding?

A

external
thoracic
abdo
pelvis
long bone

33
Q

Rosen’s basics for hemorrhagic resuscitation

A
  • Adequate IV access
  • Minimum—two bore IVs
  • Balanced resuscitation
  • 1-2 L warmed isotonic fluids
  • Packed red blood cells, platelets, plasma–> 2:1:1 vs 1:1:1 ratio
  • Prevent hypothermia
  • Consider tranexamic acid 1 g IV bolus over
    10 minutes, followed by 1 g IV infused over 8 hours
34
Q

Treatment of long bone fracture hemorrhage site vs pelvic #

A

long bone - reduce, splint
pelvic #: reduce pelvic vol, wrap pelvis, angio embolize

35
Q

PE pieces for A, B, C

A

A - Protecting airway? * Insufficient resp effort
* GCS ≤ 8
* Vomiting or bleeding

B -
* Equal breath sounds
* Use of accessory muscles * Tachypnea
* Oxygen saturations
* Cyanosis

C
* Tachycardia
* Hypotension
* Decreased capillary refill * Cool/mottled extremities

36
Q

Intubation considerations for blunt trauma

A
  • Maintain in-line immobilization
  • Assess for laryngeal/ tracheal injury
  • Anticipate blood/ emesis in airway
37
Q

Intubation considerations for penetrating trauma

A

Watch for expanding hematoma
* Anticipate significant bleeding
* Impaired video/ fiberoptic techniques

38
Q

Special airway considerations in blunt trauma

A

Severe
maxillofacial
injuries
* Cervical spine
immobilization
* Consider
awake intubation for cervical spine injuries

39
Q

Special airway considerations in penetrating trauma

A
  • Vascular injury
  • Significant bleeding
  • Airway displacement or obstruction
40
Q

Special considerations of blunt trauma - breathing

A
  • Chest contusions
  • Flail segment
  • Bowel sounds
    in chest
41
Q

Penetrating trauma - special considerations for B

A
  • Chest injury * Significant
    bleeding
  • Sucking chest
    wound
42
Q

Circulation - special considerations of blunt vs penetrating trauma

A
  • Positive FAST * Unstable
    pelvis
  • Long bone
    fracture * Signs of
    retroperitoneal bleeding

Obvious vascular injury
* External hemorrhage

43
Q

Secondary survey - aspects of general assessment and critical dx

A

Level of consciousness
Glasgow Coma Scale (GCS) score
Specific complaints

gcs </=8
focal mo deficit

44
Q

Secondary survey - aspects of head assessment and critical dx vs emergent

A

pupils - sh/size/reactivity
contusions
lacs
evidence of skull #

hernation syndrome vs emergent: globe rupture, open skull #, csf leak

45
Q

Secondary survey - aspects of face assessment and critical dx vs emergent

A

contusion, lac, midface instability, malocclusion

airway obs due to bleed

facail #, mandible #

46
Q

Secondary survey - aspects of neck assessment and critical dx vs emergent

A

penetr injury, lacs
trach deviatiion
JVD
subcut emphysema
hematoma
midl cervical tenderness

carotid injury, pericardial tamponade, trach/largyneal #, vascular injury, cervical #, dislocation

47
Q

Secondary survey - aspects of chest assessment and critical dx vs emergent

A

resp effort, excursion
contusins
lacs
focal tenderness, crepitus
subcut emphysema
heart tones muffled
breath sounds (symmetric)

impending resp failure, flail chest, cardiac tamponade, tension ptx
vs
cardiopulmonary, intrathoracic injury, rib #, ptx, htx

48
Q

Secondary survey - aspects of abdo/flank assessment and critical dx vs emergent

A

contusions, penetr injury, lacs
stability, symphseal tenderness
blood (urethral meatus, vag bleed, hematuria)
rectal exam

pelvic hemorrhage, unstable pelvic #, colorectal injury/bleed

urogenital injury vs urethral injury

49
Q

Secondary survey - aspects of neurogenic assessment and critical dx vs emergent

A

midline bony spinal tenderness
mental status
paresthesias
sensory level
mo function, including sphincter tone

spinal #, disloc, epidural hematoma, subdural hematoma, spinal #/dislocation

cerebral contusion, shear injury, sci, contusion, n root injury

50
Q

Secondary survey - aspects of extremities assessment and critical dx vs emergent

A

contusin, lac, deformity, focal tenderness, pulses, cap refill, eval of compartments

compartment syndr, vascular injury, nv injury, arterial injury, arterial injury, hemorrhagic shock, arterial injury, compartment syndrome

rhabdo, #

51
Q

List trauma labs

A

Electrolyte levels, liver function studies, interna- tional normalized ratio (INR), urinalysis, blood typing and screening (or cross-matching, depending on severity of injury), lactate levels, and base deficit
bhg if women

52
Q

Criteria for obtaining thoracic imaging:
7

A

(1) age above 60 years, (2) rapid deceleration mechanism, (3) chest pain, (4) drug or alcohol intoxication, (5) abnormal alertness and mental status, 6) distracting painful injury
7) tenderness to chest wall palpation

53
Q

American College of Surgeons RQ for presence of a surgeon at major resuscitation

A

A surgeon should be present in the emergency department on trauma patient arrival or within 15 min if any of the following major criteria are found:

  • Confirmed hypotension (systolic blood pressure <90 mm Hg)
  • Gunshot wounds to the neck, chest, abdomen, or proximal extremities
  • Intubated patients transferred from the scene
  • Respiratory compromise requiring an emergent airway
  • Penetrating gunshot wound to the neck, chest, abdomen, or pelvis
  • Glasgow Coma Scale score <8 attributed to trauma
  • At the discretion of the emergency clinician
54
Q

Rosen’s vitals reasons to transfer to trauma 1 center

A

gcs </=13
spbp <90
RR <10 or >29

55
Q

Rosen’s injuries recommended transfer to trauma 1 center - list 7

A
  • All penetrating injuries to head, neck, torso and extremities proximal to elbow or knee
  • Chest wall instability or deformity (eg, flail chest)
  • Two or more proximal long bone fractures
  • Crushed, degloved, mangled, or pulseless extremity
  • Amputation proximal to wrist or ankle
  • Pelvic fractures
  • Open or depressed skull fracture
  • Paralysis
56
Q

Falls , high risk auto crash, auto vs ped vs motorcycle crash reasons to transfer to trauma 1 centre

A
  • Falls
    – Adults: >20 feet (one story is equal to 10 feet)
    – Children: >10 feet or two or three times the height of the child
  • High-risk auto crash
    – Intrusion,**including roof: >12 inches occupant site; >18 inches any site – Ejection (partial or complete) from automobile
    – Death in same passenger compartment
    – Vehicle telemetry data consistent with a high risk of injury
  • Auto vs. pedestrian/bicyclist thrown, run over, or with significant (>20 mph) impact * Motorcycle crash > 20 mph
57
Q

Special population reasons to transfer to level 1 trauma centre

A
  • Older adults
    – Risk of injury/death increases after age 55 years
    – SBP < 110 might represent shock after age 65 years
    – Low-impact mechanisms (eg, ground level falls) might result in severe injury
  • Children
    – Should be triaged preferentially to pediatric-capable trauma centers
  • Anticoagulants and bleeding disorders
    – Patients with head injury are at high risk for rapid deterioration
  • Burns
    – Without other trauma mechanism: triage to burn facility – With trauma mechanism: triage to trauma center
  • Pregnancy > 20 weeks * EMS provider judgment
58
Q

East guidelines for a thoracotomy

A

pulseless with signs of life after penetr thoracic injury - includes pupillary response, spont vent, presence carotid pulse, measurable or palpable BP, extremity movement, cardiac electrical activity

pulseless w /o SOL after penetrating thoracic injury
pulseless w /o or WITH SOL after penetrating extra-thoracic injury
pulseless WITH SOL after blunt injury

NOT for pulseless without SOL after blunt injury

59
Q

West guidelines for a thoracotomy

A

blunt - <10 min prehospital CPR
penetr trauma:
- <15 min prehosp CPR
- <5 min prehosp CPR in pt with penetr trauma to neck/extremity

other: + profound refr shock

Rosens (63 decks)

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