Emergency medicine Flashcards
Glasgow coma scale scoring
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)
1* survey in a trauma
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)
2* survey in a trauma
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
Cervical penetrating trauma
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
Thoracic penetrating trauma
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*
Abdominal penetrating trauma
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
Musculoskeletal penetrating trauma
Neurovascular assess !!! Pulse, motor, sensory Vasc injury: arteriography + surg Nerv injury: surg Contaminated wound: 1- Early irrigat* + debridement; 2-AB + tetanus prophylaxis
Blunt and deceleration trauma of the head
- ↑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)
Blunt and deceleration trauma of the chest
- Tracheobronchial disrupt* (resp distress, hemoptysis, subcut emphysema)
- Pneumothorax, pneumomediastinum
- Myocardial contus* (new BBB, dysrhythmia, ↑enz, …)
- Pulm contus* (hypoxia, patchy alv opacities)
Aortic disruption
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
Flail chest
≥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
Blunt and deceleration trauma of the abdomen/pelvis
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
Pelvic fractures
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
