Emergency - Trauma

Question 1

Primary Survey

-Life threats

Answer 1

Airway - obstruction (odema, blood, foreign body, anyphylaxis)
Breathing - Tension pneumothorax, open pneumothroax, flail chest, massive haemothorax
Circulation - hemorrhagic shock, tamponade, tension pneumothorax
Neuro - penetrating cranial injury, intracranial hameorhage, diffuse axonal injury, high spinal cord injury

Question 2

Primary survey

Answer 2

look at my previous exam notes

Question 3

Management of life-threatening conditions

-Neuro

Answer 3

Airway - Intubate, spinal immobilization

Breathing
tension pneumo - needle decompression
Open - occlusive dressing 
flail chest - supportive (intubate, ventilate)
Massive hemothorax - tube thoracostomy 

Circulation

• Haemorhagic shock - stop bleeding, IV fluids/blood
• Tamponade - pericardocentesis
• tension pneumo - needle decompression

Neuro
Subdural/epidural- surgical evacuation
Subarachnoid/parenchymal or Diffuse axonal injury - manage ICP, supportive care

Question 4

Signs of tension pneumo

Answer 4

• hypoxia
• absent breath sound on one side
• low BP
• tracheal deviation
• elevated JVP

-requires needle decompression then chest tube

Question 5

History and exam for Injury of extremity and complications

Answer 5

History
-mechanism, energy, non-extremity injury, current pain, parasthesia, weakness/pain on moving

Exam

• Vascular, nuero, motor
• Laceration, defmroiting, swelling, contusion
• Palpate
• pulse
• warm/cold
• cap refil
• sensory/motor function (specific nerves)

complications

• compartment syndrome
• Neurovascular injury
• Thromboembolism
• arterial occlusion

Question 6

Category for brain injury and getting head CT

Answer 6

GCS <12
Neurological deficit
Post traumatic seizure
anticoagulated
>65 w LOC, amnesia, confusion

Question 7

Basilar skull fracture characteristics

Answer 7

• blood in ear canal
• hemotympanum
• rhinoorhoea
• otorrhea
• battels sign, raccoon sign
• cranial nerve defect
• facial paralysis
• decreased auditory acuity
• dizziness
• tinnitus
• nystagmus

Question 8

Sensitivity vs specificity

Answer 8

SNOUT

Question 9

GCS

Answer 9

look up

Question 10

subdural vs epidural - layer and shape on CT head

Answer 10

Epidural

• Lemon
• Between dura and skull
• middle meningeal artery
• causes increase ICP
• Immediate LOC, lucid interval, then deteriorate
• does not cross suture line
• surgical evacuation

Subdural

• venous, between dura and arachnoid
• can be acute or chronic
• banana
• crosses suture line
• normally old or on anticoagulants
• surgical evacuation of big

Question 11

Subarachnoid

Intraparencymal haemorrhage

Answer 11

• between pia mata and arachnoid mater
• most common cause in anuerysm rupture or trauma

Intraparenchymal haemorrhage - collection of blood in brain tissue secondary to large trauma

Question 12

Signs of ICP

Answer 12

look up

• headache
• nausea
• vomiting
• increased BP
• AMS change
• confusion
• Papilloedema

Question 13

Mechanisms to reduce ICP (short term, must fix cause)

Answer 13

• elevate head
• mannitol, hypertonic saline
• Hyperventilation
• ventriculostomy (measure)