EMERGENCY - Trauma Flashcards
What is polytrauma?
Polytrauma is when a patient has sustained multiple injuries across different body systems
What is primary polytrauma?
Primary polytrauma refer to injuries that occur at the time of the initial traumatic event
What is secondary polytrauma?
Secondary polytrauma refers to injuries that develop after the initial trauma as a result of various factors
Which three categories of trauma is death most commonly associated with?
Thoracic trauma
Central nervous system (CNS) trauma
Abdominal trauma
What are pulmonary contusions?
Pulmonary contusions are bruising of the lung parenchyma caused by leakage of blood and oedema into the alveoli caused by blunt trauma
How do pulmonary contusions affect gaseous exchange?
Gaseous exchange is impaired as oxygenated air cannot enter the fluid filled alveoli during inhalation resulting in a ventilation-perfusion mismatch and hypoxaemia
What can you use to diagnose pulmonary contusions?
Ultrasound
Radiography
Which two features on ultrasound can be indicative of pulmonary contusions?
B-lines
C-lines
What are B-lines and how can they be indicative of pulmonary contusions?
B-lines are vertical artifacts that appear as echogenic lines that extend from the pleural line into the lung parenchyma on ultrasound. B-lines are indicative of fluid accumulation in the alveoli and are thus indicative of pulmonary contusions
What are C-lines?
C-lines are irregular pleural lines
What is the characteristic sign of pulmonary contusions on a radiograph?
Increased lung opacity/alveolar lung patterns
How do you manage pulmonary contusions?
For patients with pulmonary contusions you usually provide supportive management such as oxygen supplementation or even intubation in severe cases. It is also important to monitor patients with pulmonary contusions as they can progress in severity within the first 24-48 hours
Why is it important to avoid over-zealous fluid therapy in patients with pulmonary contusions?
In patients with pulmonary contusions, over-zealous fluid therapy can increase the risk of fluid overload and cause pulmonary oedema which could further impair gaseous exchange
(T/F) The extent and severity of pulmonary contusions is not always immediately apparent
TRUE. Pulmonary contusions are progressive and will generally worsen over the first 24-48 hours so it is important to reassess patients with thoracic trauma to ensure contusions haven’t developed or worsened
When should pulmonary contusions begin to improve?
Pulmonary contusions should begin to improve within 3 - 10 days
What is a pneumothorax?
A pneumothorax is an accumulation of free gas within the pleural space which puts positive pressure on the lungs resulting in lung collapse
What is an open pneumothorax?
An open pneumothorax is an accumulation of air in the pleural space resulting from a penetrating injury that permits the entry of air into the pleural space
What is a closed pneumothorax?
A closed pneumothorax is an accumulation of air originating from the respiratory system in the pleural space
What is a tension pneumothorax?
A tension pneumothorax is an accumulation of air into the pleural space where the site of air leakage acts as a one way valve resulting in the continuous entrance and entrapment of air into the pleural space
How can a pneumothorax cause cardiovascular collapse?
When a pneumothorax causes lung collapse, this causes an increase in intrathoracic pressure which can impede venous return to the heart (liquid will move from high pressure in the thoracic cavity to low pressure in the periphery), causing a decrease in cardiac output and rapidly progress to cardiovascular collapse. A pnuemothorax can also cause anatomical obstruction of the great vessels or the heart itself resulting in decreased venous return to the heart and decreased cardiac output
What are the four possible
clinical signs of a pneumothorax?
Dull dorsal lung sounds
Hyperesonance on percusion
Barrel-chest appearance (particularly in tension pneumothorax)
Paradoxical breathing
Which two diagnostic tools can be used to diagnose a pneumothorax?
Radiography
Ultrasound
What are the three characteristic signs of a pneumothorax on a radiograph?
- Heart elevated from the sternum
- Retraction of the lung lobes with free gas between the lung and the thoracic wall
- Increased lung opacity
What are the five characteristic signs of a tension pneumothorax on a radiograph?
- Heart always elevated from the sternum
- Retraction of the lung lobes with free gas between the lung and the thoracic wall
- Increased lung opacity
- Flat or concave diaphragm
- Increased size of intercostal spaces
What is one of the characteristic signs of a pneumothorax on ultrasound?
In a normal patient, you should see the pleural line glide slightly on ultrasound as the patient breathes. If the patient has a pneumothorax, this glide sign is lost
What are your main goals when treating a pneumothorax?
When treating a pneumothorax, your main goals are to allow for re-expansion of the lung and reduce intrathoracic pressure to improve venous return and cardiac output
Which two methods can be used to treat a pneumothorax?
Thoracocentesis
Thoracostomy tube placement
What treatment plan should you consider for a patient with an ongoing/unresolved pneumothorax?
Exploratory thoracotomy
What are the three main clinical signs of a diaphragmatic rupture?
Dull ventral lung sounds
Borborygmi on thoracic auscultation
Paradoxical breathing
Which diagnostic tools can you use to diagnose a diaphragmatic rupture?
Radiography
Ultrasound
What are two characteristic features of a diaphragmatic rupture on a radiograph?
Presence of abdominal structures in the thorax
Loss of visualisation of the diaphragm
What are two characteristic features of a diaphragmatic rupture on ultrasound?
Presence of abdominal structures in the thorax
Loss of diaphragmatic line
How do you treat a diaphragmatic rupture?
Surgical intervention
What are the two causes of paradoxical breathing?
Pleural disease
Diaphragmatic disease
How do you manage a patient with fractured rib(s)?
Treat pain associated hypoventilation with systemic analgesics or local analgesic blocks
What is flail chest?
Flail chest is when multiple consecutive ribs are fractured in two or more places. This results in a paradoxical chest motion where the injured section of the chest wall moves in an opposite direction to the uninjured side of the chest wall
What is a primary head trauma/traumatic brain injury (TBI)?
A primary head trauma/traumatic brain injury (TBI) refers to injuries that occur at the time of the initial traumatic event
What is a secondary head trauma/traumatic brain injury (TBI)?
A secondary head trauma/traumatic brain injury (TBI) refers to injuries that develop after the initial trauma as a result of various factors
List two examples of primary head traumas/traumatic brain injuries (TBI)?
Concussion
Brain contusion
What is a concussion?
A concussion is characterised by a brief loss of consiousness and is not associated with an underlying histopathological lesion
What is a brain contusion?
Brain contusions are bruising of the brain parenchyma caused by leakage of blood and oedema into the brain parenchyma
What are coup brain lesions?
Coup brain lesions occur in the brain directly under the site of injury
What are contrecoup brain lesions?
Contrecoup brain lesions occur on the opposite brain hemisphere from the site of injury
What are axial brain lesions?
Axial brain lesions is a descriptive term used to describe brain lesions that are within the brain parenchyma
What are extra-axial brain lesions?
Extra-axial brain lesions is a descriptive term used to describe brain lesions that are external to the brain parenchyma
What are the three main clinical signs of increased intracranial pressure (ICP)?
Deterioration in mentation
Signs of brainstem dysfunction
Development of the cushings reflex
What is the cushing’s reflex?
The cushing’s reflex is a physiological response to increased intracranial pressure characterised by hypertension and bradycardia
What are your three main goals when treating a patient with head trauma/traumatic brain injury (TBI)?
- Ensure adequate oxygenation of the brain
- Avoid and/or correct factors that predispose the patient to secondary brain injury
- Address increased intracranial pressure (ICP)
At what level should you maintain the PaO2 to maintain adequate oxygenation of the brain?
PaO2 more than 80mmHg
Why is it important to treat any factors that can increase intrathoracic pressure in patients that have sufferered a head trauma/traumatic brain injury (TBI)?
Increased intrathoracic pressure can impede venous return to the heart, causing a decrease in cardiac output and thus blood flow to and oxygenation of the brain