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ED/Surgery > Crawford - Trauma > Flashcards

Crawford - Trauma Flashcards

1
Q

Definition of trauma

A

Physical damage to living tissue caused by extrinsic forces, often violence, accident, etc.

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2
Q

Describe timing and causes of death in triphasic disease.

A

1st phase – Seconds to minutes; deaths due to major or severe injuries
2nd phase – Minutes to hours; deaths due to treatable but life-threatening injuries
3rd phase – Days to weeks; deaths due to multiple organ system failure or infection

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3
Q

80% of trauma deaths occur when?

A

first hour after injury

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4
Q

“Lethal triad” seen in ER

A

hypothermia -> coagulopathy -> acidosis -> hypothermia…

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5
Q

What is the primary survey?

A

ABCDE

Quickly assess vital functions and intervene

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6
Q

What is secondary survey?

A

“Head to toe, treat as you go”
H&P exam
Every square cen/meter
“A finger or tube in every orifice”

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7
Q

Initial XR in ER trauma

A

Cross table C-spine, pCXR, Pelvis

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8
Q

When is FAST (Focused Abd Sonogram for Trauma) used? What is specifically examined?

A

Unstable patient in ED
Rapid U/S looking for blood or fluids around heart or in abdomen
4 views: perihepatic space, perisplenic space, pericardium, bladder/pelvis

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9
Q

Downsides of FAST exam?

A

High false negative
Operator dependent
Only picks up fluid over 500mL
Poor for use in obese

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10
Q

When to intubate according to GCS?

A

“less than 8, intubate”

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11
Q

Signs of basilar skull fracture

A

Battle’s sign
Hemotympanum
Raccoon’s eyes

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12
Q

Cerebral perfusion pressure = _______ - ________

A

mean arterial pressure - ICP

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13
Q

In an epidural hematoma, keep cerebral perfusion pressure above _______. How?

A

65-70 mmHg

with pressors (vasopressin, norepi, epi, dopamine)

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14
Q

What is Cushing’s Reflex?

A

HTN and bradycardia = BAD!!!

may occur in response to epidural bleed and elevated ICP

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15
Q

How is elevated ICP treated?

A
  1. Seda/on and pain management
  2. Hypertonic saline 3% - limits 3OM spacing in brain
  3. Mannitol – diure/c to remove intracellular fluid (osmo/c) 4. Hyperven/la/on- very temporarily
  4. Chemical paralysis – reduces cerebral oxygen demand
  5. Surgical procedures – craniotomy vs craniectomy
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16
Q

How to r/o ruptured globe in eye trauma?

A

good EOM

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17
Q

EOM entrapment is _________ until proven otherwise.

A

orbital fracture

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18
Q

How to treat retrobulbar hematoma?

A

emergency lateral canthotomy

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19
Q

LeFort fractures

A

facial fractures involving the maxillary bone and surrounding structures

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20
Q

Nexus Rules for clearing C-spine precautions and getting XR

A

No midline tenderness No neurologic deficits
No intoxicants
No distracting injury Normal mental status

If none of the above criteria present, C-Spine cleared and imaging is not required.

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21
Q

Spinal fracture management

A

Immobilization - NOT traction

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22
Q

Chance fracture

A
  • Complete anterior-posterior spinal fracture
  • Unstable fracture
  • High association with mesenteric or bowel injury
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23
Q

What is SCIWORA?

A

Spinal cord injury without obvious radiographic abnormality

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24
Q

young adult with sudden CVA symptoms =

A

Carotid Artery Dissection

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25
Q

Why give anticoagulation in carotid artery dissection?

A

prevent embolic stroke

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26
Q

Typical location of aortic disruption? Why?

A

ligamentum arteriosum due to rapid deceleration

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27
Q

Signs of aortic disruption on PE and XR

A

Difference of +10mmHg between R/L arms should raise suspicion

CXR demonstrates widened mediastinum, apical capping, or tracheal displacement

28
Q

Treatment of aortic disruption

A

Emergent aor/c repair (endovascular) or replacement

29
Q

Treatment of open pneumothorax

A

cover hole on 3 sides

30
Q

Treatment of tension pneumothorax

A

EMERGENCY needle decompression

31
Q

Late signs of tension pneumothorax

A

JVD

Tracheal deviation

32
Q

Location of needle decompression for tension pneumothorax

A

2nd intercostal space at midclavicular line; advance needle OVER rib

33
Q

How to do tube thoracostomy?

A

36 Fr or bigger tube (bigger the better)
Sentinel hole must be within pleural cavity
Output from CT (>1500ml ini/ally, or >200ml/hr) requires surgical exploration

34
Q

Iatrogenic cause of hemothorax

A

intercostal vessel injured during chest tube insertion

35
Q

Sign of diaphragm injury on exam

A

bowel sounds in chest

36
Q

Significance of any 1st rib or scapular fractures

A

require large energy to produce fracture

must look for other injuries even if patient ok

37
Q

What must be causing a continued large air leak with 2 well-placed chest tubes?

A

tracheal or bronchial tree injury

38
Q

Hallmark sign of Pericardial Tamponade

A

Becks triad - hypotension, muffled heart tones, JVD

39
Q

What must you think in association with PEA?

A

Pericardial tamponade

40
Q

Prophylactic immunizations for splenectomy or higher than Grade III laceration

A

Izzies for encapsulated organisms: H. flu, Menigococus, Pneumococcus

41
Q

Abdominal compartment syndrome exam findings

A

Exam reveals a hypotensive pa/ent, increasing ven/lator resistance, diminished urine output, with a
firm abdomen, and significantly elevated bladder pressures >30mmHg

42
Q

Treatment of abdominal compartment syndrome

A

laparotomy (open abd) even if in ED or ICU - can’t wait!!!

43
Q

All open fractures require what treatment?

A

antibiotics

44
Q

What should always be eval’d on a fall from height injury?

A

entire spine and bilateral calcanei

45
Q

Treatment of pelvic fractures

A

“close the book”, Sam-Sling, sheet, external fixation, surgical repair

46
Q

What urethral injuries require RUG before advancing a catheter?

A

Blood at the meatus, high-riding prostate, or perineal ecchymosis

47
Q

Fat embolism syndrome characterized by what symptoms?

A

petechial rash, confusion, hypoxia, bilateral pulm infiltrates, microfat in urine

48
Q

If vascular injury suspected, then what should be checked?

A

Ankle/Brachial index

ABI less than 0.90 needs further eval

49
Q

What is occluded in compartment syndrome?

A

arterial blood flow to contained space

50
Q

Pain out of proportion to exam with absent pulse and pallor of extremity =

A

compartment syndrome

51
Q

How is compartment syndrome treated?

A

Fasciotomy

52
Q

Best method of hemorrhage control? other options?

A

Direct pressure and elevation

others: Tourniquet, Cautery, Suture

53
Q

Where can you lose enough blood to bleed to death?

A

“CARTS” = Chest, Abdomen, Retroperitoneum, Thigh, Street (at the scene)

54
Q

Rule ratio for massive blood transfusion

A

1:1:1:1 Rule (try to make whole blood) - plasma, platelets, RBCs

55
Q

______ is narrowest part of pediatric airway, whereas ______ is narrowest part in adults.

A

cricoid

vocal cords

56
Q

Rule for trauma in a pregnant patient

A

Treat the mother = save the fetus

57
Q

Important positioning of pregnant patient

A

prop on right side or roll backboard to keep uterus off the vena cava

58
Q

First degree vs second vs third

A

1st: only epidermis affected
2nd: epidermis and dermis; BLISTERS
3rd: dermis destroyed including dermal appendages; no pain or blanching

59
Q

Rule of 9’s when estimating percentage of body burned

A 
Head = 9
Each arm = 9
Front of each leg = 9
Front of torso = 18
Back of torso = 18
60
Q

Leading complication in burns, causing high morbidity

A

infection -> systemic sepsis

61
Q

Fluid resuscitation treatment in burns

A

Parkland formula:
% BA x kg x 4mL/hr = total fluid needed in next 24 hrs

1/2 in first 8 hrs and 1/2 in next 16 hrs

NS or LR

62
Q

How to measure adequate circulation and hemodynamic stability in burn patient? What is normal?

A

urine output with Foley catheter

at least 0.5 mL/kg/hr in adult
at least 1 mL/kg/hr in child

63
Q

When is escharotomy indicated?

A

in circumferential burns of extremities or anterior trunk where there is risk for compartment syndrome

64
Q

Most common topical burn ointment

A

Sulfadiazine (Silvadene)

65
Q

How to treat minor burn?

A

Bacitracin and gauze

ED/Surgery (16 decks)

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