Emergency medicine Flashcards

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1
Q

Glasgow coma scale scoring

A

4 eye opening response: spontaneous (4), opens to command (3), opens to pain (2), none (1)

5 verbal response: oriented (5), confused speech (4), inapprop words (3), incomprehens (2), none (1)

6 motor response: follows commands (6), localizes pain (5), withdraws to pain (4), flex* (3), extens* (2), none (1)

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2
Q

1* survey in a trauma

A

ABCDE: airway, breething, circulation, disability, exposure
A (O2, speak, obstruct*)
B (auscult, pneumothorax, hemothor)
C (pulse, activ bleed, IV access, fluid/bld, tamponade)
D (GCS (if <8 then intubate); motor/sensory)
E (inspect, cover to avoid hypothermia)

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3
Q

2* survey in a trauma

A

Full head-to-toe exam after 1* survey

If hemod unstable or blunt trauma: FAST scan
Hemoperitoneum, hemopericardium: imm surg/centesis
Foley cath: after r/o urethral injury + monitor fluids
CXR; head CT; C-spine CT
Labs; intoxicat*/overdose

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4
Q

Cervical penetrating trauma

A
Violate the platysma
1- Intubate
2- Immed surg explorat* if shock/hge
Surg consult if stable
Angiography of Ao/carotid/...
CT scan w/ or w/o contrast; Doppler US; contrast esophagogram; esophagoscopy; bronchoscopy
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5
Q

Thoracic penetrating trauma

A

Immed intubat* if unstable
Assess + ttt life-threat injuries
Tens* PT, open PT, hemoT, flail contus, card tamponade, Ao disrupt, diaphragm tear, esoph injury

Open thoracotomy (if immed card arrest)
If stable then rapidly unstable: air embolism
New diastolic murmur: Ao dissect*

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6
Q

Abdominal penetrating trauma

A

Gunshot below 4th ICspace: immed laparotomy
Stab wounds + unstable or periton signs: immed laparo
If stable: CT + close follow up
If no dg on CT: peritoneal lavage

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7
Q

Musculoskeletal penetrating trauma

A
Neurovascular assess !!!
Pulse, motor, sensory
Vasc injury: arteriography + surg
Nerv injury: surg
Contaminated wound: 1- Early irrigat* + debridement; 2-AB + tetanus prophylaxis
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8
Q

Blunt and deceleration trauma of the head

A
  • ↑ICP: ttt w/ head elevat*, hyperventil, IV mannitol; surg decompr
  • Coup-contrecoup: bld at both sites
  • Diffuse axonal injury: CT (blurr punctate hge in G-W junct*
  • Epidural hematoma (middle mening art; !!!herniat*; emergent craniotomy)
  • Subdural hematoma (bridging veins; cross line; acute-subacute-chronic)
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9
Q

Blunt and deceleration trauma of the chest

A
  • Tracheobronchial disrupt* (resp distress, hemoptysis, subcut emphysema)
  • Pneumothorax, pneumomediastinum
  • Myocardial contus* (new BBB, dysrhythmia, ↑enz, …)
  • Pulm contus* (hypoxia, patchy alv opacities)
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10
Q

Aortic disruption

A

Rapid decelerat* (complete=fatal; contained hematoma; lacerat* at prox)
Arm HTN; hoarseness (recurr lar N)

CXR (wide mediast; no Ao knob; pleural cap; trachea/esoph deviat*); US (tamponade); CT if stable
ttt: ABC + emergent surg

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11
Q

Flail chest

A

≥3 adjacent ribs fractured at 2 points
Paradoxical inward mvt at inspirat*; crepitus
CXR

ttt: O2, narcotic analg; resp support (intub, mechan ventilat); surg fixat
Compl: resp compromise

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12
Q

Blunt and deceleration trauma of the abdomen/pelvis

A

Spleen #1 injured; liver; hollow viscus
Sympt of bld loss, peritonitis; lower rib fx
Duodenum (compress* inj by spine); retroperit air (AXR, CT); Pancreatic inj, bowel hematoma
Diaphragmatic rupture (Kehr sign; elevated hemidiaph)
Kidneys (contus, lacerat, fx)
If stable, dg all with FAST scan, CT scan, abdo exam
If unstable: immed explo laparotomy

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13
Q

Pelvic fractures

A

High-speed trauma
Unstable pelvis; X-ray/CT if HD stable
HypoTN/shock: exsanguin hge so extern binder
Early resuscitat* (transfus, …); emerg fixat + embolizat*
If stable: surg eval + internal fixat*

!!! Urethral inj (bld at meatus, scrotum; high-riding or nonpalpable prostate); retrogr urethrogram before Foley

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