ATLS Flashcards
Describe the Lethal Trauma Triad
Hypothermia; occurs from exposure and cold fluid resuscitation, results in impaired enzyme function including blood clotting.
Acidosis; may reflect respiratory dysfunction resulting in inadequate oxygenation but most commonly occurs due to Tissue Hypoperfusion (metabolic acidosis) due to Hypovolaemia. Lactate > 2.5 precludes all but life-saving surgery.
Coaguloathy; indicates consumption of coagulation factors and the hyperstimulation of the inflammatory and coagulation systems, may be exacerbated by transfusion of red cels without additional blood products.
Clinical signs of Fat Embolism
Gurd and Wilson’s Diagnostic Criteria
Major Signs;
- Respiratory Symptoms, signs and radiographic changes
- Cerebral Signs unrelated to head injury or another condition
- Petechial Rash
Minor signs;
- HR > 110
- Pyrexia
- Retinal Changes of Fat or Petechiae
- Renal Impairment
- Acute Fall in Hb
- Sudden Thrombocytopenia
- High ESR
- Fat Macroglobulinaemia
Spinal Fractures within Polytrauma
Cervical - 55%
Thoracic - 15%
Thoracolumbar Junction - 15%
Lumbosacral area - 15%
10% of patients with c-spine fractures have a second noncontigious vertebral column fracture
Approximately 5% patients with brain injury have a spinal injury too.
5% of patients with spinal injury experience a worsening of neurological symptoms after arrival in ED. This is typically due to Spinal Ischaemia, worsening Spinal Cord Oedema but can also be due to excessive movement of the spine.
Describe the difference between Neurogenic and Spinal Shock
Neurogenic shock results from loss of vasomotor tone sympathetic dennervation to the heart. It occurs though injury to the Spinal Cord at T6 or above. The loss of Vasomotor tone results in a Distributive shock and loss of sympathetic tone results in Bradycardia or at least an inability to mount a reflex tachycardia to the Hypotension that occurs due to vasodilation and pooling of blood. There is typically no response to fluid resuscitation though haemorrhagic shock is the most common cause of shock in trauma and can occur in conjunction with neurogenic shock.
Spinal shock refers to the falccidity and loss of reflexes that occurs immediately after spinal cord injury, after a period of time spasticity ensues.
How is Spinal Cord Injury level defined?
How is Complete vs Incomplete defined.
The last (most caudal) level which has normal sensory and motor function. Motor is assessed by the lowest key muscle which has power 3/5 or above.
The zone of partial preservation is the area below the level where some function is retained. This constitutes an Incomplete injury. In terms of function below the level - sensation, voluntary anal contraction or voluntary muscle contraction all count whereas sacral reflexes such as bulbocavernosus reflex and anal wink do not count. If below the neurological level there is no function whatsoever then is a complete injury.
Frequently the bony level of injury and neurological level of injury are not the same. It is important to assess both left and right for level.
What is Central Cord Syndrome?
Central cord syndrome is characterised by disproportionately greater loss of motor function in the upper limbs with varying degrees of sensory loss.
MoI; hyper-extension injury and can occur with or without cervical spine fracture or dislocation.
More common in patients with underlying cervical canal stenosis e.g. elderly people, and may occur just from a fall from height and landing on their face.
Prognosis: better than other incomplete injuries
What is Anterior Cord Syndrome?
Injury to motor and sensory pathways in the anterior cord so corticospinal (motor) and spinothalamic (heat, pain) whereas the dorsal column (proprioception and vibration) is preserved.
MoI; cord ischaemia
Poor prognosis
What is Brown-Sequard Syndrome?
Hemi-section of the spinal cord. Ipsilateral Motor Loss (Corticospinal) and Proprioception/Vibration (Dorsal Column) along with Contralateral Pain and Temperature Loss (Spinothalamic)
MoI; penetrating trauma
Prognosis generally get some recovery of function
What is the most common type of C1 Fracture?
The most common fracture of Atlas (C1) is a Burst fracture - Jefferson Fracture.
MoI; axial loading by something landing on head or the patient landing on their head in a neutral position.
Posterior and anterior elements fracture and the lateral masses are pushed laterally. It is not usually associated with a spinal cord injury.
What is the most common type of C2 Fracture?
The most common fracture of Axis (C2) are Odontoid (peg) fractures.
Type 1: tip of the odontoid.
Type 2: base of the ondontoid (most common)
Type 3: through base and extend obliquely into body of the axis.
What is a Hangman’s Fracture?
Hangman’s fracture is a C2 Posterior Elements fracture (pars-interarticularis)
MoI; extension type
What is the most common site of Cervical Spine fracture and why?
C5-C6 is where the greatest movement of the c-spine occurs so is most vulnerable. C5 is most commonly fractured and C5 onto C6 is the most common subluxation.
What are Chance Fractures?
Chance fractures are transverse fractures through the vertebral body. They occur due to flexion about an axis anterior to the vertebral column e.g. the Abdomen, as such they are often associated with intra-abdominal injuries.
What injuries should prompt consideration of Blunt Carotid and Vertebral Artery Injury?
Spinal fractures C1-C3, fractures involving the transverse foramina, cervical spine subluxation.
