Ch.3 Trauma

Question 1

Classes of Hemorrhagic Shock

Answer 1

I. 0-750cc; no changes VS
II. 750-1.5L; narrow pulse pressure, tachy >100
III. 1.5L-2L; tachy >120, systolic hypotension
IV. >2L; ; tachy >140, confusion!

Question 2

Complications of massive transfusion

Answer 2

Electrolytes: hypo/hyperK, hypoCa (2/2 citrate)
Metabolic alkalosis (citrate)
Hypothermia
Dilutional Coagulopathy
Thrombocytopenia
ARDS

Question 3

Head Injury Classification by GCS

Answer 3

Varies, usually Severe <8 …

Question 4

Which head injury crosses midline but NOT suture lines?

Answer 4

epidural

Question 5

GCS

Answer 5

..

Question 6

Classic amount shift in SDH requiring NSGY

Answer 6

5mm

Question 7

Basilar skull fx signs

Answer 7

Battle Sign
Raccoon Eyes
CSF otorrhea/rhinorrhea
Hemotympanum
CN VII-VIII injuries (facial palsy, nystagmus, vertigo, hearing change)

Question 8

Ways to tell if rhinorrhea/otorrhea is CSF

Answer 8

• Ring/halo sign on sheet (blood stain encircled by clear/yellow ring)
• test for high glucose and transferrin

Question 9

Signs of uncal herniation

Answer 9

ipsilateral CNIII palsy (down and out)

Question 10

ICP and CPP, MAP goals for TBI

Answer 10

CPP>70, ICP 90 (some say 110)

Question 11

Do steroids help brain edema?

Answer 11

No CRASH trial showed increased mortality

Question 12

Most common fx facial bones

Answer 12

1. Nose

2. Mandible

Question 13

Hard signs in neck injury

Answer 13

Expanding hematoma
Decreased/absent pulse
Bruit/thrill
Cerebral ischemia
Artery obstruction

Question 14

Which neck zone has high morbidity/mortality?

Answer 14

Zone I (inferior margin cricoid to clavicle)

Question 15

Neck zone most commonly injured?

Answer 15

Zone II

Question 16

Neck zone with best prognosis?

Answer 16

Zone II (Most accessible)

Question 17

Should you explore neck wounds if they penetrate platysma?

Answer 17

Never

Question 18

Unstable spine fractures

Answer 18

Jefferson Bit Off A Hangman’s Thumb

1. Jefferson (C1 burst); b/l lateral mass
2. Bilateral facet dislocation
3. Odontoid (II, III)
4. Any fx-dislocation
5. Hangman’s (C2)
6. Teardrop-usually anterioinfer. C2; both flexion/hyperext mechs are unstable

Question 19

NEXUS

Answer 19

NSAID

• neuro deficit
• spinal tenderness (midline)
• AMS
• intoxication
• distracting injury

Question 20

CXR signs aortic injury

Answer 20

diameter >8cm at level arch
abnormal shadow descending aorta
Left apical cap
downward displacement L bronchus
Right tracheal deviation
blurring arch
abnormal contour arch
left HTX

Question 21

BP goals in aortic injury

Answer 21

Keep systolic <120, target HR 60-80; can use labetolol

Question 22

Beck’s triad

Answer 22

muffled heart sounds, JVD, hypotension