Emergency Medicine Flashcards

Question

What is a massive haemothorax?

Answer 1

Over 1.5L blood Reduced air sounds, hyperresonant Obtain IV access prior to decompression 1.5L blood or > 200ml/hr = consider urgent thoracotomy

Answer 2

Wound to chest wall communicating with pleural cavity More than 2/3rd aperture is trachea Air moves down pressure gradient into pleural space Wound seals in expiration

Answer 3

2 or more ribs broken in 2 or more places Floating section of ribs Moves paradoxically during respiration Ventilatory failure

Answer 4

Beck’s triad Hypotension Diminished heart sounds Distended neck veins

Answer 5

Penetrating Trauma to the cardiac box

Answer 6

``` Simple pneumothorax Aortic injuries Diaphragmatic injuries Fractured ribs Lung contusion Cardiac contusion ```

Answer 7

Respiratory rate (tachypnoea)

Answer 8

``` Sweaty Anxious agitation contusion Pallor Tachycardia Long CRT Hypotension (late sign) ```

Answer 9

Blood on the floor and 4 more ``` External haemorrhage Chest Abdomen Pelvis Extremities ```

Answer 10

Peritonism Radiological evidence of free air GI haemorrhage Persistent/ resistant haemodynamic instability

Answer 11

Femur Humerus Tibia

Answer 12

Allowance of hypotension due to not being shocked because of distribution problem or others you are shocked because you have lost blood Treat leak rather than adding more fluid Crystalloid does not carry oxygen Crystalloid induced hyperchloraemic acidosis Blood isn’t only red cells

Answer 13

Systolic BP <90 (caveats) HR >130 Low GCS

Answer 14

1 unit RBC 1 unit fresh frozen plasma 1 unit platelets

Answer 15

``` Catastrophic haemorrhage control Pelvic binder Splint long bone fractures Permissive hypotension Tranexamic acid 1g 10 min then 1g infusion over 24hours Emergent damage control surgery Limit crystalloid ```

Answer 16

AVPU Pupillary size and response Motor score of GCS most predictive outcome Sensory level if available

Answer 17

Hypotensive episodes | Hypoxic episodes

Answer 18

CPP = MAP - ICP Trade off Systolic >100 ideal Aim for normal everything else

Answer 19

Hypertension Bradycardia Irregular breathing pattern Raised ICP = raised BP = baroreceptor stimulation = bradycardia Pre coning

Answer 20

Look for obvious limb threatening injuries Ensure patient is being kept warm Consider few bedside tests Don’t forget pain

Answer 21

Hypercoaguable state

Answer 22

``` Respiratory muscle weakness Kyphosis thoracic spine Chest wall rigidity Impaired central response to hypoxia Reduced alveolar gas exchange surface area ``` = Less physiological reserve

Answer 23

Total body water declines with age Peripheral vasculature becomes rigid and non compliant Myocardium replaced by fat and collagen Autonomic and baroreceptor dysfunction Atrial pacemaker atrophy

Answer 24

New urinary symptoms or fever with loin tenderness or; haematuria or;

Answer 25

Presence of nitrites and leukocytes without symptoms. They don't have a UTI. >65 years incidence increased

Answer 26

Focussed assessment with sonography in trauma No more info than CT Low negative predictive value Important role in triage when managing multiple SIPs simultaneously

Answer 27

AP chest Pelvis C-spine series (out of fashion but still valuable and often used) Extremity imaging can wait!

Answer 28

Pelvis is a ring - tortional forces will break in 2 or more places Classification: 1-6 Which direction was the force transmitted in e.g. AP force = open book fracture, vertical shear (fall from height- landing on leg) SIJ pubic rami and ischial rami fractures High risk uncontrollable bleeding

Answer 29

AP Lateral Odontoid peg view

Answer 30

C1 fracture Open mouth view Displacement can be very bad

Answer 31

Fractures axis which may involve odontoid peg, vertebral body or posterior elements. Anterior displacement of the body and peg of C2 in to cord.

Answer 32

Axial loading (dive in shallow pool)