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clin med > EM- Trauma > Flashcards

EM- Trauma Flashcards

1
Q

what is the “golden hour”?

A

the period of time following a traumatic injury during which there is the highest likelihood that prompt medical and surgical treatment will prevent death.

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2
Q

what is most important in history for trauma ? low vs high energy wounds?

A

mechanism of injury: penetrating, blunt, blast

  • Low energy GSW and stab wounds cause tissue damage by lacerating and tearing
  • High energy GSW transfer more kinetic energy causing increased damage due to temporary cavitation of the bullet
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3
Q

what is included in the primary survey for trauma?

A

ABCDE (while doing rescusciation)

airway; breathing; circulation; disability; exposure

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4
Q

what is included in ABCDE?

A

Airway management with keeping cervical spine protected: Assess for airway patency
Breathing: Look for chest rise and symmetry
Circulation control of hemorrhage: Tachycardia, vasoconstriction, decreased CO, narrow pulse pressure, decreased blood flow, decreased mean arterial pressure
Disability: brief neurologic exam with intracranial mass lesion recognition
Exposure/Environment: completely undress the patient, but prevent hypothermia

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5
Q

what are the components of the secondary survey?

A

head to toe assessment to see if there is bruising, breaks,etc.

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6
Q

what is included in the “initial steps” following the secondary survey?

A

o IV access and small bolus for hydration
o Keep patient NPO
o Analgesics: start with fentanyl – has no effect on BP and works well for treating bad pain
o Labs: CBC, BMP/CMP, lactate, UA, Troponin
Always rule out cardiac cause
* Then FAST looking for blood in the abdomen

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7
Q

does a negative FAST rule out a hemorrhage?

A

A negative FAST DOES NOT RULE OUT HEMORRHAGE ***

FAST exams cannot see retroperitoneum

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8
Q

continuum: signs of hypovolemia –> hemorrhage

A
  1. Altered level of consciousness
  2. Ashen grey skin color of face and white skin of exsanguinated extremities
  3. Capillary refill greater than 2 seconds; Cool extremities
  4. Rapid, thready pulse; Narrowed pulse pressure
  5. Fall in mean arterial blood pressure; HypoTN
  6. Tachycardia & Tachypnea
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9
Q

absent central pulses signify what?

A

the need for immediate resuscitation to control hemorrhage and response depleted blood volume

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10
Q

what populations rarely exhibit S+S of shock?

A

elderly, pregnant, athletes, certain medications, hypothermia, defib/pacemakers

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11
Q

what 7 things are included in abdominal trauma?

A 
Splenic Injury
Livery Injury
Intestinal injury
GU injury
Vascular Injury
Pelvic Trauma and Fracture
Trauma in Pregnancy
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12
Q

Splenic injury: S+S (includes what two “signs”) ?

A

LUQ, left rib cage, left flank

  • Kehr’s sign- pain in left shoulder that worsens with inspiration and is due to irritation of phrenic nerve
  • abdominal wall contusion/hematoma (seatbelt sign),
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13
Q

imaging for splenic injury?

A

Initial: FAST EXAM
Definitie: CT with contrast

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14
Q

liver injury: S+S (includes what “signs”)

A

pain in RUQ
Peritoneal signs, abdominal tenderness
Seatbelt sign

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15
Q

imaging for liver injury

A

Initial: FAST EXAM:
Positive → ex lap
Negative → repeat later

Definitive: CT with contrast

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16
Q

what usually causes intestinal trauma injury?

A

Blunt injury to intestines commonly due to deceleration injuries causing tearing (just wearing the lap belt in MVA)
Seat-belt signs → possible intestinal injury

17
Q

imaging for intestinal injury?

A

Initial: FAST
CXR helpful (presence of retroperitoneal air as well as foreign bodies
Definitive: CT abd/pelvis

18
Q

indications for laparotomy

A
  1. Blunt abdominal trauma + hypoTN + positive FAST
  2. hypoTN + penetrating abdominal wound
  3. GSW that traverses peritoneal cavity
  4. Evisceration
  5. Bleeding from stomach, rectum, or GU tract
  6. Peritonitis
  7. Free air, retroperitoneal air, rupture of hemidiaphragm
  8. CT findings suggestive of rupture
19
Q

leading cause of death from a pelvic ring fracture?

A

Leading cause of death = hemorrhage

Pelvic fractures can hold up to 3 L of blood in the pelvis

20
Q

imaging for pelvic injury

A

AP pelvis, Judet, inlet, outlet views

21
Q

3 part txt for pelvic injury

A
  1. Hemorrhage control + fluid resuscitation
    need FFP and PRBC (packed red blood cells)
  2. Pelvic binder - hemorrhage control (need to be over the greater trochanters for proper placement)
  3. Definitive treatment = surgery/ORIF
22
Q

pregnancy: cardiac and pulmonary changes?

A

cardiac: increased CO, HR, BP
pulmonary: state of respiratory alkalosis, increased tidal volume

23
Q

what two things do you need to look for with trauma in pregnancy? what should you anticipate?

A

look for abruptio placentae/uterine rupture

-Anticipate rapid O2 desaturation and aggressively treat acidosis

24
Q

why do you aggressively resuscitate pregnant trauma pts?

A

Aggressive resuscitation measures necessary because blood loss is easily underestimated

25
Q

trauma in pregnancy: are mom’s or baby’s vitals more important?

A

Baby will go into stress before mom does- don’t trust mom’s vitals a much as baby’s
- baby in distress will indicate that mom is

26
Q

stab wounds in pregnant pt : upper vs lower abdomen

A

stab wounds in lower abdomen (of pregnant mom) are less likely to cause visceral injuries (b/c organs are moved up higher into the chest)

27
Q

why should you always consider doing a post-mortem C-section?

A

fetus has been reported to survive up to 30 minutes after maternal cardiac arrest.
May improve the possibility of returning spontaneous maternal circulation as part of ongoing resuscitation of the mother

28
Q

blood in the meatus (GU trauma) - warrants what type of imaging?

A

retrograde urethrogram (RUG)

29
Q

Traumatic aortic rupture: what is the common MOA? what do most survivors have?

A

Common with decelerating injuries

Survivors commonly have hematoma formation that is preventing exsanguination (severe loss of blood)

30
Q

imaging for traumatic aortic rupture

A

CT chest

31
Q

txt for traumatic aortic rupture

A

HR and BP control can decrease likelihood of rupture

Short-acting B-blockers or CCB

clin med (88 decks)

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