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Clin Med IV: Emergency Medicine > Approach to Trauma Patient > Flashcards

Approach to Trauma Patient Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is the number 1 cause of death in age group 1-44

what is the mortality most commonly associated iwth

A

Trauma

head injury, chest injury, major vascular injury

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2
Q

What is Trimodal death distribution

A

Immediate (seconds to min)
Early (minutes to hours)
Late (days to weeks)

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3
Q

What is “golden hour”

A

early (minutes to hours) death distribution
Focus: control bleeding, supportive care, sugical management

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4
Q

What is the primary survey

A

ATLS approach (ABCs)
Airway assessment/protection
Breathing and ventilation
Circulation assessement
Disability assessment (neuro)
Exposure and environment (keep warm while getting them naked)

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5
Q

What is the most common cause of preventable death

A

Hemorrhage

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6
Q

What are the NEXUS C-spine rules

A

Focal deficit?
midline tenderness?
AMS?
Intoxicated?
Distractiong injury?

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7
Q

What areas should you look for significant blood loss

A

chest
abdomen
pelvis
long bone
floor

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8
Q

What is a trauma Neuro assessment

A

Eye opening
best verbal response
best verbal response
best motor response

Head injury
pupils
sensation
posturing
seizures

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9
Q

What is SAMPLE

A

S: signs and symptoms
A: Allergies
M: Medications
P: Past medical history
L: Last oral intake
E: events surrounding trauma

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10
Q

What is included on a secondary assessment

A

typically head to toe assessment
will often include CXR and pelvic XR
E-fast exam

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11
Q

what is the massive transfusion protocol

A

> 10 units of pRBCs in 24 hrs following trauma

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12
Q
A
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13
Q

What are risks of transfusion

A

infection
allergic rxn
immunologic rxn
volume overload
hyperkalemia
iron overload

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14
Q

when should a CT be obtained with head trauma

A

ASAP

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15
Q

what are keys with bleeding head traumas

A

reverse anticoagulation
call neurosurgery
BP management (target SBP <180)
if blown pupil/unresponsive - burr hole

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16
Q

What are signs of elevated ICP

A

Decorticate posturing
Decerebrate posturing

17
Q

What are the H-bombs

A

hypotension
hypoxia
hypo/hypercarbia
hyepr/hypothermia
hypoglycemia

18
Q

What is neurogenic shock

A

distributive shock wiht hypotension, bradycardia, warm/flushed skin, good pulses.
seen with injury above T6

19
Q

What is a complete spinal injury

A

traumatic disruption of the entire cord
- insensatie, areflexic and immobile distal to site of injury

20
Q

What is incomplete spinal cord injury

A

only a section of the cord has been injured
- includes the cord syndrome
- may not only be associated with trauma but also malignancy or other compressive pathology

21
Q

What can you not miss with chest trauma

A

airway obstruction
tension pneumothorax
cardiac tamponade
vascular injury

22
Q

what is the significance of a simple pneumothorax

A

progression to tension pneumothroax
will need decompression

23
Q

what is the significance of aortic dissection

A

exsanguination
disruption of blood flow
need surgical repair

24
Q

what is the significance of diaphragm rupture

A

herniated abdominal contents into chest->
decrease lung volumes

25
Q

what is the significance of myocardial contusion

A

decreased CO
risk of arrhythmia

26
Q

what is the significance of pulmonary contusions

A

increased ventilatory pressures
decreased VQ

27
Q

What is the workup for thoracic trauma

A

ABC, IV/O2/Monitor
E-fast
CXR
ECG
CT scan (consider CTA)
if pt worsens with PPV, reeassess (think pneumo)

28
Q

what is the gold standard imaging for abdomen and pelvic traumas

A

CT scan (if stable) with contrast

29
Q

what is the most common abodmen and pelvic trauma

A

blunt injury

30
Q

what is the E-fast exam

A

Right and left anterior chest: penumothorax
RUQ/LUQ: peritoneal FF, pleaural FF
Subxiophoid/PSL: pericardial effusion
Suprapubic: peritoneal FF

31
Q

What injuries are at HIGH RISK for life-threatening hemorrhage

A

Pelvic fractures

32
Q

What is included in the initial assessment of open pelvic fractures

A

perindeal exam
vaginal exam in females
DRE
bleeding at the urethreal meatus

33
Q

When should thoractomy be considered with a penetrating trauma

A

penetrating wound with arrest

Clin Med IV: Emergency Medicine (18 decks)

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