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MODULE 14 - Patient Support > EMERGENCY - Trauma > Flashcards

EMERGENCY - Trauma Flashcards

1
Q

What is polytrauma?

A

Polytrauma is when a patient has sustained multiple injuries across different body systems

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2
Q

What is primary polytrauma?

A

Primary polytrauma refer to injuries that occur at the time of the initial traumatic event

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3
Q

What is secondary polytrauma?

A

Secondary polytrauma refers to injuries that develop after the initial trauma as a result of various factors

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4
Q

Which three categories of trauma is death most commonly associated with?

A

Thoracic trauma
Central nervous system (CNS) trauma
Abdominal trauma

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5
Q

What are pulmonary contusions?

A

Pulmonary contusions are bruising of the lung parenchyma caused by leakage of blood and oedema into the alveoli caused by blunt trauma

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6
Q

How do pulmonary contusions affect gaseous exchange?

A

Gaseous exchange is impaired as oxygenated air cannot enter the fluid filled alveoli during inhalation resulting in a ventilation-perfusion mismatch and hypoxaemia

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7
Q

What can you use to diagnose pulmonary contusions?

A

Ultrasound
Radiography

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8
Q

Which two features on ultrasound can be indicative of pulmonary contusions?

A

B-lines
C-lines

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9
Q

What is the characteristic sign of pulmonary contusions on a radiograph?

A

Increased lung opacity/alveolar lung patterns

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10
Q

How do you manage pulmonary contusions?

A

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

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11
Q

Why is it important to avoid over-zealous fluid therapy in patients with pulmonary contusions?

A

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

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12
Q

(T/F) The extent and severity of pulmonary contusions is not always immediately apparent

A

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

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13
Q

When should pulmonary contusions begin to improve?

A

Pulmonary contusions should begin to improve within 3 - 10 days

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14
Q

What is a pneumothorax?

A

A pneumothorax is an accumulation of free gas within the pleural space which puts positive pressure on the lungs resulting in lung collapse

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15
Q

What is an open pneumothorax?

A

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

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16
Q

What is a closed pneumothorax?

A

A closed pneumothorax is an accumulation of air originating from the respiratory system in the pleural space

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17
Q

What is a tension pneumothorax?

A

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

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18
Q

How can a pneumothorax cause cardiovascular collapse?

A

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

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19
Q

What are the four possible
clinical signs of a pneumothorax?

A

Dull dorsal lung sounds
Hyperesonance on percusion
Barrel-chest appearance (particularly in tension pneumothorax)
Paradoxical breathing

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20
Q

Which two diagnostic tools can be used to diagnose a pneumothorax?

A

Radiography
Ultrasound

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21
Q

What are the three characteristic signs of a pneumothorax on a radiograph?

A
  • Heart elevated from the sternum
  • Retraction of the lung lobes with free gas between the lung and the thoracic wall
  • Increased lung opacity
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22
Q

What are the five characteristic signs of a tension pneumothorax on a radiograph?

A
  • 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
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23
Q

What is one of the characteristic signs of a pneumothorax on ultrasound?

A

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

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24
Q

What are your main goals when treating a pneumothorax?

A

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

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25
Q

Which two methods can be used to manage and treat a pneumothorax?

A

Thoracocentesis
Thoracostomy tube placement
Intubation and IPPV if indicated

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26
Q

What treatment plan should you consider for a patient with an ongoing/unresolved pneumothorax?

A

Exploratory thoracotomy

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27
Q

What are the three main clinical signs of a diaphragmatic rupture?

A

Dull ventral lung sounds
Borborygmi on thoracic auscultation
Paradoxical breathing

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28
Q

Which diagnostic tools can you use to diagnose a diaphragmatic rupture?

A

Radiography
Ultrasound

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29
Q

What are two characteristic features of a diaphragmatic rupture on a radiograph?

A

Presence of abdominal structures in the thorax
Loss of visualisation of the diaphragm

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30
Q

What are two characteristic features of a diaphragmatic rupture on ultrasound?

A

Presence of abdominal structures in the thorax
Loss of diaphragmatic line

Normal diaphragm on ultrasound
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31
Q

How do you treat a diaphragmatic rupture?

A

Surgical intervention

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32
Q

What are the two causes of paradoxical breathing?

A

Pleural disease
Diaphragmatic disease

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33
Q

How do you manage a patient with fractured rib(s)?

A

Treat pain associated hypoventilation with systemic analgesics or local analgesic blocks

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34
Q

What is flail chest?

A

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

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35
Q

What is a primary head trauma/traumatic brain injury (TBI)?

A

A primary head trauma/traumatic brain injury (TBI) refers to injuries that occur at the time of the initial traumatic event

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36
Q

What is a secondary head trauma/traumatic brain injury (TBI)?

A

A secondary head trauma/traumatic brain injury (TBI) refers to injuries that develop after the initial trauma as a result of various factors

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37
Q

List two examples of primary head traumas/traumatic brain injuries (TBI)?

A

Concussion
Brain contusion

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38
Q

What is a concussion?

A

A concussion is characterised by a brief loss of consiousness and is not associated with an underlying histopathological lesion

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39
Q

What is a brain contusion?

A

Brain contusions are bruising of the brain parenchyma caused by leakage of blood and oedema into the brain parenchyma

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40
Q

What are coup brain lesions?

A

Coup brain lesions occur in the brain directly under the site of injury

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41
Q

What are contrecoup brain lesions?

A

Contrecoup brain lesions occur on the opposite brain hemisphere from the site of injury

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42
Q

What are axial brain lesions?

A

Axial brain lesions is a descriptive term used to describe brain lesions that are within the brain parenchyma

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43
Q

What are extra-axial brain lesions?

A

Extra-axial brain lesions is a descriptive term used to describe brain lesions that are external to the brain parenchyma

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44
Q

What are the main clinical signs of increased intracranial pressure (ICP)?

A

Deterioration in mentation
Signs of brainstem dysfunction
Postural changes
Abnormal respiratory patterns
Development of the cushings reflex

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45
Q

Give an example of a postural change that can occur due to increased intracranial pressure (ICP)

A

Decerebrate rigidity

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46
Q

What is the cushing’s reflex?

A

The cushing’s reflex is a physiological response to increased intracranial pressure characterised by hypertension and bradycardia

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47
Q

What are your three main goals when treating a patient with head trauma/traumatic brain injury (TBI)?

A
  • Ensure adequate oxygenation of the brain
  • Avoid and/or correct factors that predispose the patient to secondary brain injury
  • Address increased intracranial pressure (ICP)
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48
Q

At what level should you maintain the PaO2 to maintain adequate oxygenation of the brain?

A

PaO2 more than 80mmHg

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49
Q

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)?

A

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

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50
Q

What else can you do to ensure normal blood flow to the brain?

A

Elevate the head to 30° to prevent jugular compression as jugular compression can lead to a backup of blood to the brain - worsening the intracranial pressure and affecting cerebral perfusion

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51
Q

Why is it important to prevent hypercapnia in patients at risk of increased intracranial pressure (ICP)?

A

Hypercapnia triggers cerebral vasodilation to increase blood flow to flush out the excess CO2 which can further increase intracranial pressure (ICP)

52
Q

What PCO2 level should you maintain in patients at risk of increased intracranial pressure (ICP)?

A

Maintain the PCO2 levels between 30 - 35mmHg using IPPV

53
Q

What should you do if there is clinical evidence of increased intracranial pressure (ICP)?

A

Hyperosmolar therapy
Reduce the cerebral metabolic rate

54
Q

How can hyperosmolar therapy be used to treat increased intracranial pressure (ICP)?

A

Hyperosmolar therapy involves the administration of intravenous mannitol or hypertonic saline to create an osmotic gradient which moves fluid from the intracranial space into the intravascular space to reduce the intracranial pressure

55
Q

What volume of mannitol should you administer in hyperosmolar therapy?

A

0.5 - 1ml/kg intravenous mannitol over 20 mins

56
Q

What volume of hypertonic saline should you administer in hyperosmolar therapy?

A

2 - 4ml/kg intravenous hypertonic saline over 10 mins

57
Q

What can be done to reduce the cerebral metabolic rate?

A

Anaesthesia
Barbituate therapy
Induce hypothermia

58
Q

What can happen if raised intracranial pressure (ICP) is not identified and treated?

A

Brain herniation

59
Q

What is transtentorial brain herniation?

A

Transtentorial brain herniation is the herniation of the cerebrum caudally

60
Q

What is transforaminal brain herniation?

A

Transforaminal brain herniation is the herniation of the cerebellum through the foramen magnum

61
Q

What is a common skeletal trauma seen in cats following a road traffic accident?

A

Mandibular symphyseal fracture

62
Q

What is important to consider when treating a mandibular symphyseal fracture?

A

It is important to consider the nutritional managment of a patient with a mandibular symphyseal fracture and consider placing an oesophagostomy tube

63
Q

What is the difference between abdominal trauma and acute abdomen?

A

Abdominal trauma is an injury to the abdomen, whereas acute abdomen is a per-acute, rapidly deteriorating condition (often caused by abdominal trauma) that prompts emergency treatment

64
Q

What is a fluid wave test?

A

A fluid wave test is a physical exam technique used to test if there is fluid accumulation in the abdomen. The clinician places their hand on one side of the abdomen and taps the opposite side. If a fluid wave is felt, it indicates the presence of fluid

65
Q

How many millilitres of fluid does their have to be in the abdomen for a positive fluid wave test?

A

At least 40ml/kg of fluid in the abdomen

66
Q

Why is it important to do a series of ultrasounds in a patient that has undergone abdominal trauma?

A

It is important to do a series of ultrasounds to assess for any delayed or progressive fluid accumulation

67
Q

What are the three main classifications of effusions?

A

Transudate
Modified transudate
Exudate

68
Q

What is transudate?

A

Transudate is a fluid with a low protein count and specific gravity with the primary cell types found in this fluid being mononuclear and mesothelial cells

69
Q

What is modified transudate?

A

Modified transudate is a fluid with a moderate protein count and specific gravity with the primary cell types found in this fluid being mononuclear cells, mesothelial cells, neutrophils and erythrocytes

70
Q

What is exudate?

A

Exudate is a fluid with a high protein count and specific gravity with the primary cell types found in this fluid being mononuclear cells, neutrophils and erythrocytes

71
Q

What is a haemoabdomen?

A

A haemoabdomen is the presence of haemorrhagic fluid in the peritoneal cavity

72
Q

What are the five main clinical signs of a haemoabdomen?

A

Shock (specifically haemorrhagic shock)
Collapsed
Arrhythmias
Anaemia
Pulse deficits

73
Q

Which seven diagnostic tools can be used to help diagnose a haemoabdomen?

A

Ultrasound
Radiography
PCV/TS
Haematology
Biochemistry
Coagulation profile
Abdominocentesis

Haemoabdomen on ultrasound
74
Q

Why should you carry out a coagulation profile if you suspect a haemoabdomen?

A

You should carry out a coagulation profile to see if the haemoadbomen may be secondary to a coagulation disorder

75
Q

How can you confirm that the fluid collected from an abdominocentesis is a haemoabdomen?

A

To confirm the fluid collected from the abdominocentesis is a haemoabdomen, you should compare the PCV of the effusion to the patient’s peripheral PCV (take a blood sample). If the effusion PCV is within 10-25% of the peripheral PCV, then it is a haemoabdomen

76
Q

What if your goal when treating a haemoabdomen?

A

When treating a haemoabdomen, your goal is to manage the shock and control the source of the bleeding

77
Q

What can you do to manage shock when treating a haemoabdomen?

A

Goal directed fluid therapy
Hypotensive resuscitation
Whole blood transfusion
Oxygen supplementation

78
Q

Why would you choose hypotension resuscitation over goal directed fluid therapy for shock management in a patient with a haemoabdomen?

A

The animal could be actively bleeding into their abdomen so fully overzealous fluid therapy could result in fluid overload and exacerbate the bleeding. Hypotensive resuscitation uses minimal fluids and blood products to improve the patients condition and deliberately allows the patient’s mean arterial pressure (MAP) to remain lower than normal physiological levels to prevent exacerbating the bleeding

Careful goal directed fluid therapy is generally fine

79
Q

If you don’t have blood products available in your clinic, what other method can you use to transfuse blood into a patient with a haemoabdomen?

A

Autotransfusion - a process where a patient receives their own blood for a transfusion

80
Q

What can be used to control the bleeding in a mild haemoabdomen?

A

A pressure banadage around the abdomen can be used to control the bleeding in a mild haemoabdomen

81
Q

Why is it so important to frequently change a pressure banadage being used to treat a mild haemoabdomen?

A

It is important to frequently change the pressure bandage being used to treat a mild haemoabdomen to prevent pressure necrosis of the abdominal organs

82
Q

Which surgery is often required following stabilisation of the patient to definitively treat a haemoabdomen?

A

Exploratory laparotomy to identify and repair the source of the bleeding

83
Q

What is a uroabdomen?

A

A uroabdomen is the leakage of urine into the peritoneal or retroperitoneal cavities caused by a loss of integrity of the urinary system

84
Q

What is the most common cause of a uroabdomen?

A

Blunt trauma - so every patient with abdominal trauma should be assessed for uroabdomen

85
Q

What is the term used to describe a leakage of urine into the peritoneum?

A

Uroperitoneum

86
Q

The loss of integrity of which three structures can cause a uroperitoneum?

A

Distal ureters
Bladder
Abdominal urethra

87
Q

What is the term used to describe a leakage of urine into the retroperitoneum?

A

Uroretroperitoneum

88
Q

The loss of integrity of which two structures can cause a retrouroperitoneum?

A

Kidneys
Proximal ureters

89
Q

What are the clinical signs of a uroabdomen?

A

There are often non-specific clinical signs. The bladder may or may not be palpable however this does not rule anything out as a uroabdomen can be due to a loss of integrity of any portion of the urinary system

90
Q

Describe how the pathophysiology of a uroabdomen results in several electrolyte imbalances

A

Urine is rich in potassium, urea and creatinine. When urine accumulates in the abdomen, the potassium and urea move from high to low concentration from the abdomen into the bloodstream via the peritoneum, causing hyperkalaemia and azotaemia, the azotaemia can progress to metabolic acidosis. Creatinine is too big of a molecule to pass into the bloodstream so it will remain in the abdomen, creating a driving force which will move water, sodium and chloride out of the intravascular space into the abdomen, causing hyponatraemia and hypochloraemia

91
Q

Describe how the pathophysiology of a uroabdomen affects the kidneys

A

Hyperkalaemia is detected by the kidneys which will increase their glomerular filtration rate (GFR) to process more of the potassium rich plasma and excrete this excess in the form of urine. Hyperkalaemia will also trigger the release of aldosterone which will trigger sodium reabsorption into the bloodstream and potassium excretion into the urine by the kidneys. However, this potassium rich urine that is being produced will just end up back in the abdomen due to the leakage from the urinary system - worsening the uroabdomen

92
Q

How does the pathophysiology of a uroabdomen result in dehydration and hypovolaemia?

A

The increased glomerular filtration rate and aldosterone release both trigger increased urine production which can contribute to dehydration. Furthermore, the persistence of urine (which has high levels of potassium, urea and creatinine) in the abdomen exerts an osmolar drive moving water from the extracellular compartment (intravascular and interstitial) and even from the intracellular compartment. This can lead to dehydration and hypovolemia

93
Q

How does the pathophysiology of a uroabdomen affect the heart?

A

Hyperkalaemia results in bradyarrythmia’s

94
Q

Which four diagnostic tools can be used to help diagnose a uroabdomen?

A

Ultrasound
Positive contrast radiography
Biochemistry
Abdominocentesis

95
Q

How can you confirm that the fluid collected from an abdominocentesis is a uroabdomen?

A

To confirm the fluid collected from the abdominocentesis is a uroabdomen, you should compare the ratios between the effusion creatinine and potassium to the blood creatinine and potassium levels

96
Q

What ratio between effusion creatinine and blood creatinine is indicative of uroabdomen?

A

A ratio of more than 2:1 (effusion creatinine: blood creatinine)

97
Q

What ratio between effusion potassium and blood potassium is indicative of uroabdomen in dogs?

A

A ratio of more than 1.4:1 (effusion potassium: blood potassium) in dogs

98
Q

What ratio between effusion potassium and blood potassium is indicative of uroabdomen in cats?

A

A ratio of more than 1.9:1 (effusion potassium: blood potassium) in cats

99
Q

Why is it important to do a smear of the fluid that you collect from a patient with a uroabdomen?

A

Do a smear of the fluid collected to assess for an infection

100
Q

How do you treat a uroabdomen?

A

A uroabdomen often required surgical intervention but it is important to stabilise the patient before surgery

101
Q

How do you stabilise a patient with a uroabdomen?

A

Goal directed fluid therapy
Urinary catheterisation
Correct the electrolyte balance
Abdominal drainage
Antibiotics if indicated

102
Q

Why is it important to place a urinary catheter and abdominal drain in a patient with a uroabdomen?

A

It is important to place a urinary catheter and abdominal drain in a patient with a uroabdomen because it helps to drain the urine being produced and aids in stabilisation as it prevents worsening hyperkalaemia etc.

103
Q

What is septic peritonitis?

A

Septic peritonitis is a peritonitis as a result of an identifiable source of intraperitoneal infection that is typically bacterial in origin

104
Q

What is a primary septic peritonitis?

A

Septic peritonitis caused by a spontaneous source of infection

105
Q

What is a secondary septic peritonitis?

A

Septic peritonitis caused by a leakage of bacteria into the peritoneum

106
Q

What is a tertiary septic peritonitis?

A

A recurrent septic peritonitis

107
Q

Which diagnostic tools can be used to help diagnose a septic peritonitis?

A

Ultrasound
Radiography
Haematology
Biochemistry
Blood lactate
Abdominocentesis
Cytology

108
Q

How can you confirm that the fluid collected from an abdominocentesis is a septic peritonitis?

A
  • Do a cytology to identify intracellular bacteria and degenerate neutrophils most diagnostic method
  • If the effusion glucose levels are 2.1mmol/L than the peripheral blood this is indicative of septic peritonitis
  • If the effusion lactate levels are 2.5 mmol/L than the peripheral blood this is indicative of septic peritonitis
109
Q

What are your goals when treating septic peritonitis?

A

When treating septic peritonitis, your aim is to manage the septic shock and control the source of infection

110
Q

What can you do to manage the septic shock as a result of septic peritonitis?

A

Administer broad spectrum antibiotics
Goal directed fluid therapy
Vasopressors

111
Q

Why might you need to administer vasopressors to manage septic shock?

A

Sepsis causes vasodilation and hypotension due to the systemic inflammatory response so vasopressors should be administered to trigger vasocontriction to improve the blood pressure

112
Q

Which four methods can be used to control the source of infection when treating septic peritonitis?

A

Administer broad spectrum antibiotics
Exploratory laparotomy
Peritoneal lavage
Abdominal drainage

113
Q

What is bile peritonitis?

A

Bile peritonitis is the leakage of bile into the peritoneal cavity

114
Q

List three possible causes of bile peritonitis

A

Traumatic gall bladder rupture
Post hepatic biliary obstruction
Chemical erosion of the gall bladder

115
Q

What is one of the main clinical signs of bile peritonitis?

A

Icterus

116
Q

Which diagnostic tools can be used to help diagnose a bile peritonitis?

A

Biochemistry
Abdominocentesis
Radiography
Ultrasound

117
Q

How can you confirm that the fluid collected from an abdominocentesis is a bile peritonitis?

A

To confirm the fluid collected from the abdominocentesis is a bile peritonitis, you should compare the ratios between the effusion bilirubin and the blood bilirubin levels

118
Q

What ratio between effusion bilirubin and blood bilirubin levels is indicative of bile peritonitis?

A

A ratio of more than 2:1 (effusion bilirubin: blood bilirubin)

119
Q

How do you treat a bile peritonitis?

A

A bile peritonitis often required surgical intervention but it is important to stabilise the patient before surgery

120
Q

How do you stabilise a patient with a bile peritonitis?

A

Goal directed fluid therapy
Supplement with fresh frozen plasma or vitamin K

121
Q

Why should you supplement a patient with bile peritonitis with fresh frozen plasma or vitamin K?

A

Bile peritonitis can cause coagulopathies

122
Q

Which three surgical methods can be used to treat a bile peritonitis?

A

Exploratory laparotomy
Peritoneal lavage
Abdominal drainage

123
Q

What is traumatic pancreatitis?

A

Traumatic pancreatitis is inflammation of the pancreas which can be caused by direct or indirect trauma

124
Q

What can occur when there is direct trauma to the pancreas?

A

Direct trauma to the pancreas can cause leakage of pancreatic enzymes which can cause autodigestion of the pancreas

125
Q

In which species is traumatic pancreatitis very common?

A

Cats

MODULE 14 - Patient Support (24 decks)

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