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Fiser Absite > Chapter 15 - Trauma > Flashcards

Chapter 15 - Trauma Flashcards

1
Q

What is the first peak of trauma death? causes

A

0-30 minutes.

  • Heart/aorta
  • brain/brainstem/spinal cord
  • cannot save these patients
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1
Q

What is the second peak of trauma death? causes

A

30 minutes- 4 hours.

  • # 1 head injury
  • # 2 hemorrhage
  • Golden hour, rapid assessment
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2
Q

What is the 3rd peak of trauma death?

A

days to weaks

  • multisystem organ failure
  • sepsis
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3
Q

What percentage of trauma is blunt?

A

80%

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3
Q

What is the most commonly injured organ in blunt trauma?

A

Liver (some say spleen)

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4
Q

What is the formula for kinetic energy?

A

1/2 MV^2

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4
Q

What is the LD50 fall height?

A

4 stories

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5
Q

At what point of blood loss is blood pressure effected?

A

30%

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5
Q

What is the most commonly injured organ in penetrating trauma?

A

Small bowel (some say liver)

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6
Q

What is the most common cause of long term death with trauma?

A

Sepsis

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6
Q

What is the most common cause of upper airway obstruction and how is it alleviated?

A

Tongue, jaw thrust (ohhhh yeaaaa)

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7
Q

What injuries to seat belts cause?

A
  • small bowel perfs
  • lumbar spine fxs
  • Sternal fxs
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7
Q

What site is best for cutdown access?

A

Saphenous vein

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8
Q

When is a DPL positive?

A

> 10cc blood
100k RBC’s
-food particles, bile, bacteria
500cc WBC

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8
Q

If a pelvic fx is present, where must DPL be performed?

A

Supraumbilical

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9
Q

What does a DPL miss?

A

Retroperitoneal hematoma

Contained hematomas

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9
Q

Where does a FAST look for blood?

A
  • perihepatic fossa
  • Pelvis
  • Pericardium
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10
Q

What are flaws with FAST?

A
  • Operator Dependent (fuckin Belsky)
  • Obesity
  • May not detect fluid <50-80
  • Misses retroperitoneal bleed and hollow viscous injury
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10
Q

CT after blunt trauma needed for what?

A
  • Abdominal Pain
  • Need for General Anasthesia
  • closed head injury
  • intoxicants
  • paraplegia
  • distracting injury
  • Hematuria
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11
Q

What does a CT scan of blunt trauma miss?

A
  • hollow viscous injury

- retroperitoneal bleed

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11
Q

These patients need a laparotomy after blunt trauma:

A
  • Peritonitis
  • evisceration
  • (+) DPL
  • clinical deterioration
  • uncrontrolled hemorrhage
  • free air
  • diaphragm injury
  • intraperitoneal bladder injury
  • specific renal, pancreas, biliary tract injury
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12
Q

When does abdominal compartment syndrome happen?

A
  • massive fluid resuscitation
  • trauma
  • abdominal surgery
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12
Q

Bladder pressures of what indicate abdominal compartment syndrome?

A

> 25-30

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13
Q

What is the final common pathway for decreased cardiac output in abdominal compartment syndrome?

A

ICV compression

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13
Q

What causes decreased urine output in abdominal compartment syndrome?

A

Compressed renal vein

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14
Q

What is tx for abdominal compartment syndrome?

A

decompressive laparotomy

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14
Q

When do you use a pneumatic antishock garment?

A
  • SBP <50 without thoracic injury

- release one compartment at a time after reaching ED

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15
Q

When do catecholamines peak after trauma?

A

24-48 hours

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15
Q

Along with catecholamines, what rises after trauma?

A

-ADH
-ACTH
-Glucagon
Fight or flight response

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16
Q

What blood type is a universal donor? Why? Rh can and cannot go to who?

A
  • O, does not contain A or B antigens
  • Males can get Rh positive
  • prepubescent and child bearing age females must get Rh negative
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16
Q

Type specific, non-screened, non-crossmatched blood can be given safely with what side effects?

A

effects from antibodies to minor antigens

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17
Q

Glasgow coma score Motor

A 
6 follows commands
5 localizes pain
4 withdraws from pain
3 flexion with pain 
2 extension with pain
1 no response
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17
Q

Glasgow coma score verbal

A 
5 oriented
4 confused
3 inappropriate words
2 incomprehensible sounds
1 no response
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18
Q

Glasgow coma score eye opening

A

4 spontaneous
3 to command
2 to pain
1 no response

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18
Q

GCS that gets head CT, Intubation, ICP monitor

A

<= 8 ICP monitor

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19
Q

Epidural Hematoma caused by damage to what? What does head CT show? What is patient presentation? When do you operate?

A
  • Arterial bleed from middle meningeal A
  • CT shows lens shape lenticular deformity
  • initial LOC, lucid interval, sudden deterioration
  • Operate for significant degeneration or mass effect shift >5mm
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19
Q

Subdural Hematoma caused by damage to what? Head CT shows? when do you operate?

A
  • venous plexus tearing between dura and arachnoid
  • CT shows crescent deformity
  • operate for significant mass defect
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20
Q

Intracerebral hematomas usually where? When do they need operation?

A
  • Usually frontal or temporal

- operate for significant mass effect

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20
Q

Cerebral contusions can be one of these 2 types

A

coup or contracoup

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21
Q

When do traumatic intraventricular hemorrhages need treatment?

A

ventriculostomy if causing hydrocephalus

21
Q

When imaging is best for DAI?

A

MRI better than CT

22
Q

how do you calculate cerebral perfusion pressure?

A

MAP minus ICP

22
Q

What are signs of elevated ICP?

A
  • decreased ventricular size
  • loss of sulci
  • loss of cisterns
23
Q

When are ICP monitors needed?

A
  • GCS </= 8

- suspected increased ICP and inability to follow clinical exam

23
Q

What is a normal ICP?

A

-10, >20 needs tx

24
Q

What do you want the CPP to be?

A

> 60

24
Q

What is supportive therapy for increased ICP?

A
  • sedation and paralysis
  • raise head of bed
  • relative hyperventilation
  • Na 140-150
  • Serum Osm 295-310
  • Manitol
  • Barbituate coma
  • ventriculostomy with CSF drainage
  • Phenytoin
25
Q

When does ICP peak after injury?

A

48-72 hours

25
Q

What does dilated pupil show?

A

Temporal pressure on SAME side (CNIII compression)

26
Q

Raccoon eyes indicates what?

A

anterior fossa fx

26
Q

Battle’s sign shows what?

A

middle fossa fx

  • acute need exploration
  • delayed secondary to edema
27
Q

Temporal skull fx can injure what cranial nerves?

A

VII and VIII

27
Q

What is the most common site of facial nerve injury?

A

geniculate ganglion

28
Q

when do skull fx need treatment?

A

8-10 mm or > depression

  • contaminated
  • persistent CSF leak
28
Q

What is a Jefferson cervical fx?

A
  • C1 burst
  • caused by axial loading
  • tx rigid collar
29
Q

What is a hangman’s fx?

A

-C2
distraction and extension
-traction and halo

29
Q

What are the 3 types of C2 odontoid fx?

A

I above base, stable
II at base, unstable- need fusion or halo
III extend to vertebral body-need fusion/halo

30
Q

What can facet fractures or disocations cause? how do they happen?

A

cord injury

associated with hyperextension and rotation with ligamentous disruption

30
Q

What is the anterior column or thoracolumbar spine?

A

anterior longitudinal ligament and 1/2 of vertebral body

31
Q

What is the middle column of thoracolumbar spine?

A

Posterior 1/2 of vertebral body and posterior longitudinal ligament

31
Q

What is the posterior column of the thoracolumbar spine?

A

facet joints, lamina, spinous processes, interspinous ligament

32
Q

How many columns of thoracolumbar spine must be disrupted for fx to be considered unstable?

A

> 1

32
Q

What are wedge fractures? stable or unstable?

A

anterior column only; stable

33
Q

What are burst fractures? stable or unstable?

A

> 1 column and usually require fusion

33
Q

What structures are at risk after upright fall?

A

calcaneus
lumbar
wrist/forearm fractures

34
Q

What are the indications for emergent surgical spine decompression?

A
  • fx not reducible with distraction
  • acute anterior spinal syndrome
  • open fractures
  • soft tissue or bony compression of the cord
  • progressive neurological dysfunction
34
Q

What skull fracture is most common cause of facial nerve injury?

A

temporal bone FX

35
Q

What is type I Le Fort fx? tx?

A
  • maxillary fx straight across ( - )

- tx with reduction, stabilization, intramaxillary fixation, +/- circumzygomatic and orbital rim suspension wires

35
Q

What is type II Le Fort fx? tx?

A
  • Lateral to nasal bone, underneath eyes, diagonal toward maxilla ( / \ )
  • tx with reduction, stabilization, intramaxillary fixation, +/- circumzygomatic and orbital rim suspension wires
36
Q

What percentage of nasoethmoidal bone fx have CSF leak?

A

70%

36
Q

What is a type III Le Fort Fx? tx?

A

Lateral orbital walls ( - - )

-suspension wiring to stable frontal bone; may need external fixation

37
Q

What are the 2 types of Nosebleeds? Tx?

A
  • Anterior - Packing

- Posterior - balloon tamponade first, may need embolization of internal maxillary a or ethmoidal a

37
Q

What is the #1 indicator of mandibular injury?

A

malocclusion

38
Q

What is a tripod fx? what do you do?

A

zygomatic bone fx. May need ORIF for cosmesis

38
Q

what are patients with maxillofacial fx at a high risk for?

A

cervical spine injury

39
Q

Asymptomatic blunt neck trauma gets what?

A

Neck CT

39
Q

Neck Zone I? penetrating injury gets what?

A

Clavicle to Cricoid

  • angiography
  • bronchoscopy
  • rigid esophagoscopy
  • barium swallow
  • may need pericardial window/sternotomy
40
Q

Neck Zone II? penetrating injury gets what?

A

Cricoid to angle of the mandible

-Exploration in the OR

40
Q

Neck Zone III? Penetrating injury gets what?

A

Angle of mandible to base of skull

  • Angio
  • Laryngoscopy
  • may need jaw subluxation/digastric SCM release/mastoid sinus resection to reach vascular injuries
41
Q

What is the best method to evaluate esophageal injury?

A

rigid esophagoscopy and esophogram (95% of injuries found)

41
Q

Contained esophageal injuries treated how?

A

observation

42
Q

Non-contained injuries to esophagus treated how?

A

small, <24h old, stable- primary closure

-otherwise, spit fistula and drain leak with chest tube

42
Q

What percentage of esophageal and hypoesophageal injuries leak?

A

20%. always drain

43
Q

How do you approach esophageal injuries?

A
  • Neck- left side
  • upper 2/3- right thoracotomy
  • lower 1/3- left thoracotomy
43
Q

What are the sx of laryngeal fx?

A

crepitus, stridor, respiratory compromise

44
Q

Tx for thyroid injuries?

A

control bleeding, drain

44
Q

Tx recurrent laryngeal nerve injury?

A

repair or reimplant in cricoarytenoid muscle

45
Q

What do fucking shot gun injuries to the neck need other than a pine box?

A

angiogram, neck CT, esophagus/tracheal evaluation.

45
Q

Tx for vertebral artery injury?

A

ligate or embolize without sequelae

46
Q

Common carotid bleeds?

A

can tx with ligation - 20% will stroke

46
Q

When to placed, indications for thoracotomy?

A

> 1500 initially
250cc/h for 3 h
2500cc for 24h
instability

47
Q

If all blood from hemothorax not drained in _____hours, risk this

A

48 hours; fibrothorax, pulmonary entrapment, infected hemothorax

47
Q

unresolved hemothorax after 2 tubes?

A

thorascopic or open drainage

48
Q

How large does a sucking chest wound need to be to be significant?

A

> 2/3 diameter of trachea

-cover wound with dressing that has tape on 2 sides

48
Q

Tracheobronchial injury can be diagnosed by what?

A

worse oxygenation after chest tube placement

49
Q

What side are bronchial injuries more common?

A

right

49
Q

What kind of intubation may be needed for bronchial injuries?

A

mainstem to unaffected side

50
Q

When would you do right thoracotomy for tracheobronchial injury?

A

right mainstem, tracheal, proximal left mainstem

-avoid aorta

50
Q

When would you do left thoracotomy for tracheobronchial injury?

A

-distal left mainstem injuries

Fiser Absite (49 decks)

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