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Phase 3b > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

What is the definition of major trauma

A

Serious and often multiple injuries where there is a strong possibility of death or disability

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2
Q

What is the injury severity score? What is it used for?

A

An anatomic severity scale based on the abbreviated injury scale and deceloped specifically to score multiple traumatic injuries

Used for research purposes

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3
Q

What is trauma important?

A

4th leading cause of death in the western world
Leading course of death in first 4 decades
Economically important population

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4
Q

What are the golden hour and the platinum ten minutes?

A

An hour to get pt to hospital

Life saving interventions should occur in first ten minutes

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5
Q

What is the epidemiology of trauma pt’s?

A

75% male

mean age 39.6 years

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6
Q

Top 3 mechanism of injury pre changing face of major trauma?

A

RTC
Fall from height
Assault
Industrial/agricultural

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7
Q

What is the main mechanism of injury in major trauma now?

A

Falls in the elderly (37%)

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8
Q

How do you approach the critically ill patient?

A

A to E assessment

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9
Q

How do you approach the trauma patient?

A

Primary survey:

Control catastrophic haemorrhage
Airway with C-spine protection
Breathing with ventilation
Circulation with haemorrhage control
Disability: Neuro status
Exposure / environment
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10
Q

What is the concept of initial assessment?

A

Preparation
Triage
Primary survey - adjuncts and resus
Does pt need transferring? CT? ?theatre ?another hosp
Secondary survey - definitive care / monitoring and re-evaluation

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11
Q

Name some mechanisms of injury?

A

Assault
Fall from height
Self harm
Burns and blast injury

Blunt
Sharp
Blast

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12
Q

What commonly occurs in RTC?

A

Cervical spine injury
Blunt thoracic and cardiac injuries
Hollow viscus perf / solid organ injury
Pelvic / acetabular / femur injuries

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13
Q

What happens in motorcycle RTC?

A

Anything

Pelvic injuries!

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14
Q

What injuries occur in assault and falls?

A 
Assault = Often head injuries either direct from falling, stamping on abdo/chest
Falls = anything injured if >2m
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15
Q

What are the four ways injury occurs in blast?

A

Primary - Blast wave disrupts gas filled structures
Secondary - Impact airborne debris
Tertiary - Transmission of body
Quaternary - All other forces

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16
Q

What are the priorities in trauma?

A

Stop bleeding
Prevent hypoxia
Prevent acidaemia
Avoid traumatic cardiac arrest or treat correctly

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17
Q

What is the mnemonic used in trauma to convey info?

A 
ATMIST
Age
Time of injury
Mechanism
Injuries found
Signs
Treatments thus far
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18
Q

What are junctional vessels?

A

Femoral
Axillary
Neck

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19
Q

What are the absolute indications for intubation?

A

Inability to maintain and protect airway regardless of conscious level
Inability to maintain adequate O2 with less invasive manoeuvres
Inability to maintain normocapnia with less invasive manoeuvres
Deteriorating GCS <2 on motor
Significant facial injuries
Seizures

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20
Q

How do you manage burns?

A

Hypoxaemia hypercapnia
Deep facial burns
Full thickness neck burns

Consider early intubation as airway can swell

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21
Q

Relative indications for intubation?

A

Haneorrhagic shock and evolving metabolic acidosis
Agitated patient
Multiple injuries
Transfer

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22
Q

How do you manage the C-spine?

A

Neutral position

Flexion worse than extension but both can displace fractures and cause spinal injuries

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23
Q

Primary survey life threatening chest injuries?

A

ATOM FC

Airway obstruction
Tension pneumothorax
Open pneumothorax
Massive haemothorax
Flail chest
Cardiac tamponade
24
Q

What are the signs of tension pneumothorax?

A 
Hypoxia
Tachycardia
Hypotension
Agitation ‘air hungry’
Diminished breath sounds
Hyperresonance
Distended neck veins
Deviated trachea - mostly PM finding
25
Q

What is a massive haemothorax?

A

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

26
Q

What is an open pneumothorax?

A

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

27
Q

What is a flail chest?

A

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

28
Q

What are the signs of cardiac tamponade?

A

Beck’s triad

Hypotension
Diminished heart sounds
Distended neck veins

29
Q

When do you assume there is damage to the heart?

A

Penetrating Trauma to the cardiac box

30
Q

What are some secondary survey injuries?

A 
Simple pneumothorax
Aortic injuries
Diaphragmatic injuries
Fractured ribs
Lung contusion
Cardiac contusion
31
Q

What is the most reliable indicator of shock (particularly hypovolaemic)?

A

Respiratory rate (tachypnoea)

32
Q

What are signs of a bleeding patient?

A 
Sweaty
Anxious agitation contusion
Pallor
Tachycardia
Long CRT
Hypotension (late sign)
33
Q

4 sites that bleeding can be life threatening?

A

Blood on the floor and 4 more

External haemorrhage
Chest
Abdomen
Pelvis
Extremities
34
Q

Indications for emergency laparotomy?

A

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

35
Q

What are clinically important long bones?

A

Femur
Humerus
Tibia

36
Q

What is permissive hypotension?

A

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

37
Q

What are the indications for fluid administration in trauma?

A

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

38
Q

Ratio of blood product replacement?

A

1 unit RBC
1 unit fresh frozen plasma
1 unit platelets

39
Q

How do you stop bleeding in trauma?

A 
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
40
Q

Assessment of neurology in primary survey?

A

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

41
Q

What are 2 predictors of outcome in head injury?

A

Hypotensive episodes

Hypoxic episodes

42
Q

How do you manage BP in head injury?

A

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

43
Q

What is Cushing’s reflex? Triad?

A

Hypertension
Bradycardia
Irregular breathing pattern

Raised ICP = raised BP = baroreceptor stimulation = bradycardia

Pre coning

44
Q

What is included in E assessment?

A

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

45
Q

Why is hypothermia bad in trauma?

A

Hypercoaguable state

46
Q

What respiratory differences exist in geriatrics?

A 
Respiratory muscle weakness
Kyphosis thoracic spine
Chest wall rigidity
Impaired central response to hypoxia
Reduced alveolar gas exchange surface area

= Less physiological reserve

47
Q

What cardiac differences exist in elderly patients?

A

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

48
Q

What are the signs / symptoms of UTI in the elderly?

A

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

49
Q

What is sterile bactiuria?

A

Presence of nitrites and leukocytes without symptoms. They don’t have a UTI.

> 65 years incidence increased

50
Q

What is a FAST scan?

A

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

51
Q

What is a trauma series?

A

AP chest
Pelvis
C-spine series

(out of fashion but still valuable and often used)
Extremity imaging can wait!

52
Q

What is an unstable pelvic fracture?

A

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

53
Q

What are 3 standard c-spine views?

A

AP
Lateral
Odontoid peg view

54
Q

What is a jefferson #?

A

C1 fracture
Open mouth view
Displacement can be very bad

55
Q

What is a hangman fracture?

A

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

56
Q

what is a burst fracture?

A

Axial loading (dive in shallow pool)

Phase 3b (2 decks)

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