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MM Test 4 > B6.072 The Basics of Trauma > Flashcards

B6.072 The Basics of Trauma Flashcards

1
Q

mechanisms of blunt trauma injury

A 
falls
MVC
assault
pedestrian struck
MCC
bicycle wreck
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2
Q

mechanisms of penetrating injury

A

stab wounds
GSW
SGW
impalement

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3
Q

special situations that cause traumatic injuries

A 
explosions
burns
crush injuries
drowning
hypothermia/exposure
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4
Q

rule #1 of trauma

A

don’t panic

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5
Q

pre-requisites of initial trauma assessment

A

wide angled view (don’t get distracted by gory injury)
pattern recognition skills
ability to triage and set priorities
organized structure

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6
Q

overview of primary survey

A 
A- secure airway
B- ensure breathing
C- is it shock?
D- deficit/deformity
E- where are all the injuries
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7
Q

overview of secondary survey

A 
more detailed history
look them over head to toe
reassess
FAST
adjuncts
imaging studies
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8
Q

A is for airway

A

clear and establish a good airway
-consider intubation for coma, shock, obvious airway compromise, some thoracic injuries
maintain C-spine stabilization

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9
Q

B is for breathing

A 
chest excursion and breath sounds
-flail chest (paradoxical movement)
pneumothorax
-open
-tension
massive hemothorax
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10
Q

treatment of pneumothorax

A

needle decompression followed by chest tube

chest tube drains blood from the lungs

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11
Q

C is for circulation

A 
perfusion (mental status, skin, pulse)
control bleeding with pressure
pericardial tamponade
establish 2 large bore IVs
resuscitate with blood early, especially for hemorrhagic shock
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12
Q

most common cause of shock in trauma patients

A

hemorrhagic

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13
Q

Becks triad

A

JVD
muffled heart sounds
hypotension

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14
Q

massive blood loss

A

loss of a blood volume within 24 h or acute 50% reduction of total blood volume within minutes of injury

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15
Q

massive transfusion

A

> 10 units PRBC or equivalent patient’s blood volume in 6-24 h

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16
Q

what class of hemorrhagic shock presents with hypotension

A 
class 3
class 1 and 2 have normal BP, so need to be on the lookout early
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17
Q

triad of hemorrhagic shock

A

hypothermia
acidosis
coagulopathy

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18
Q

treatment of hemorrhagic shock

A

balanced resuscitation

1: 1:1
blood: FFP: platelets

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19
Q

D is for disability

A

neuro status

  • glasgow coma scale
  • spinal cord injury (neuro shock)
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20
Q

D is for deformity

A

obvious broken bones

-open vs closed (tetanus status, antibiotics, more urgent OR)

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21
Q

Glasgow coma scale scores

A

minor brain injury: 13-15

moderate: 9-12
severe: 3-8

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22
Q

neurogenic shock

A

due to high spinal cord injury which leads to interruption of sympathetic vasomotor input

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23
Q

physical findings in neurogenic shock

A

hypotension
bradycardia
warm extremities

24
Q

treatment of neuro shock

A

volume resuscitation followed by vasopressors if not resolved with volume

25
Q

E is for exposure

A 
remove clothes
temperature (warm blankets and fluid)
log roll
-maintain spine precautions
-palpate for spinal deformities
-rectal exam to check tone, blood, prostate
26
Q

what do you do if a patient decompensates at any point during the primary / secondary survey?

A

respond and restart survey at ABCDE again

27
Q

important components of patient history

A

tetanus

AMPLE (allergy, meds, PMH, last meal, environment)

28
Q

common imaging in secondary survey

A

CXR
pelvis Xray
FAST
CT

29
Q

blood sampling /monitoring in secondary survey

A

type and cross

ABG

30
Q

what is the FAST exam

A 
quick ultrasound to scan for blood in the abdomen
4 view:
1. hepatorenal pouch
2. perisplenic space
3. pelvis
4. pericardial
black = fluid
31
Q

pros of FAST exam

A 
fast
portable
bedside
non-invasive
may be repeated
32
Q

cons of FAST exam

A

not specific for injury
no evaluation of retroperitoneum
will miss bowel injuries

33
Q

what is the next step in management if your FAST is positive and the pt is hypotensive

A

go to the OR

34
Q

management of fractures in trauma scenarios

A

stabilize
relocate dislocated joints
reassess pulses

35
Q

what is an effect of long bone/pelvic fractures

A

increased blood loss

36
Q

what is a step you can take in the management of a bad pelvic fracture

A

bring patient to IR for embolization

37
Q

what are some difficulties with abdominal trauma

A

high morbidity and mortality if unrecognized (massive hemorrhage, sepsis)
internal injury difficult to assess in the field
often confounding factors present

38
Q

epidemiology of abdominal trauma

A

7-15% of all trauma deaths
penetrating injuries account for <10%
blunt injuries are the most difficult to diagnose and have a 10-30% mortality
75% of blunt abdominal trauma is due to MVCs

39
Q

abdominal vs thoracic injuries

A

abdominal: found on secondary survey and higher % require surgery
thoracic: found on primary survey and lower % require surgery

40
Q

define the abdomen on the anterior

A 
between nipples (diaphragm) and pubic symphysis
between axillary lines
41
Q

define the abdomen on the posterior

A

between scapular tips to crest of iliac wings

42
Q

solid organs in the peritoneal cavity

A

liver
spleen
risk of hemorrhage > hypotension

43
Q

hollow organs in the peritoneal cavity

A

stomach
intestines
colon
risk of contamination > peritonitis

44
Q

components of retroperitoneal cavity

A

solid organs (kidneys, pancreas)
large blood vessels (aorta and vena cava)
potential space for massive hemorrhage

45
Q

results of deceleration forces

A

differential movement of fixed and non-fixed structures

tearing occurs leading to bleeding and contamination

46
Q

organs most commonly injured in blunt trauma

A

solid organs (spleen, liver kidney

47
Q

blunt diaphragm injury

A

can be due to increased abdominal pressure or lacerations from rib fractures

48
Q

blunt small bowel injuries

A

“seat belt injury”

can be due to crushing, deceleration, or increased pressure

49
Q

2 types of blunt bladder injury

A
  1. intraperitoneal rupture with full bladder (need surgery)

2. extraperitoneal rupture with pelvic fracture (heal with foley decompression)

50
Q

assessment of abdominal trauma

A

look: distension, bruising, seat belt sign
feel: tenderness, guarding, rebound, soft vs rigid

51
Q

peritoneal signs

A

= acute abdomen

  • guarding
  • rebound tenderness
  • percussion guarding
52
Q

what is the response to discovery of an acute abdomen

A

laparotomy

53
Q

what are some factors that could make a physical exam unreliable within trauma

A

if it is normal
associated (distracting) injuries
head injury
intoxication

54
Q

pitfalls in physical exam in trauma patients

A
  • blood is not initially irritating to the peritoneum
  • altered sensorium decreased physical exam
  • small bowel injury may not show signs of peritonitis for many hours
55
Q

treatment of small bowel perf

A

debridement and primary repair

56
Q

treatment of transverse colon perf

A

transverse colectomy

MM Test 4 (20 decks)

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