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Emergency Med > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

Nexus National Emergency X-ray utilization Study

A 
No Post. midline C-Spine Tenderness
No evidence of intoxication
Alert Mental Status
No focal Neuro deficits
No painful distracting injuries
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2
Q

If a patient is obtunded what can be assumed?

A

Assume a cervical spine injury until proven otherwise

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3
Q

Preferred study for Cervical Spine injury

A

CT Scan

Should not delay Urgent operative procedures

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4
Q

The following warrant immediate intervention

A

Tension pneumothorax needle D
36 French Chest tube for hemo-pneuo thorax
Occlusive dressing to sucking chest wound

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5
Q

Asymmetric or absent breath sounds in the intubated patient, what is the treatment

A

Partially withdraw ET tube from R main stem entubation

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6
Q

If no breath sounds and massive hemothorax or vascular injury suspected, what indicates a thoracotomy or video assisted thoracic surgery?

A

Chest tube output of > 1,000ml or >200ml/hr of blood

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7
Q

Class I Blood Loss

A

up to 750 ml

15%

<100 BPM

BP = Normal Pulse = Normal or increased

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8
Q

Class II Blood loss

A

750-1,500 ml

15-30%

Pulse 100-120

BP= Normal Pulse = Decreased

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9
Q

Class III Blood Loss

A

1,500-2,000 ml

30-40%

Pulse = 120-140

BP = Decreased Pulse Pressure = Decreased

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10
Q

Class IV Blood Loss

A

> 2,000 ml

> 40%

> 140

BP= Decreased Pulse Pressure= Decreased

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11
Q

Can Mask Early hemodynamic indicators of shock

A

B-Blockers

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12
Q

The following transfusion treatment showed decreased mortality when using

A

FFP: PRBCs 1:1 10 units

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13
Q

A patient with a GCS < 15 and appropriate MOI of head trauma has what?

A

Significant Head injury until proven otherwise

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14
Q

Monitor serum glucose for euglycemia and avoid _______ in head injury patients

A

Prophylactic hyperventilation/ Hyperventilation

of 25mmHg or less

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15
Q

Abdominal Tenderness or distention on palpation with hypotension indicates what?

A

Exploratory Laparotomy (Immediate OR transport)

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16
Q

Strongest recommendation for ED thoracotomy is?

A

Patients w/ penetrating trauma with witnessed signs of life during transport & at least Electrical activity upon arrival

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17
Q

Secondary survey consists of what?

A

Head to toe exam for injuries

Do not start until basic functions are corrected

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18
Q

If Meatal blood is present or prostate is displaced, suggesting urethral injury, what should be done prior to inserting a foley?

A

Perform a Retrograde Urethrography

If vaginal= Bimanual exam

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19
Q

Most frequently missed conditions in secondary survey?

A

Orthopedic Conditions

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20
Q

Patients who are not rapidly transported to the OR CT after initial assessment, what can be performed?

A

Standard Radiography imaging of C-spine, Chest and pelvis

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21
Q

FAST examination is an effective screening tool for ?

A

Intraperitoneal bleeding, Pericardial tamponade, and pneumo/Hemothorax

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22
Q

Obtunded patients get what imaging?

A

Entire spine if MOI warrants it

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23
Q

Routine labs for trauma include

A

Blood Type and screen, HgB, Urine Dipstick for blood, and ethanol level; Glucose for AMS; >55 =ECG and Cardiac markers

(HCG for child bearing age Females)

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24
Q

When transferring a patient what must be completed?

A

A rapid but thorough primary and secondary survey prior to transferring.

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25
Q

Which Injuries may not be readily apparent on initial CT?

What is required?

A

Pancreas, Bowel and head trauma

Repeated imaging and neurologic & LOC assessments

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26
Q

Most common herniation. Displaced Inferiorly through medial edge of tentorium

Leads to compression of CNIII Parasympathetic fibers

An ipsilateral fixed and dilated pupil due to unopposed sympathetic tone.

Results in contralateral motor paralysis

A

Uncal Herniation

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27
Q

Less common, occurs w/ midline lesions.

Lesions of the frontal or occipital lobes, or vertex

Bilateral pin point pupils, Bilateral Babinski’s, and increased muscle tone. (Decorticate Posturing)

A

Central Transtentorial Herniation

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28
Q

Pinpoint pupils, flaccid paralysis, and sudden death.

Cerebellum portions herniates through foramen magnum.

Upwards transtentorial herniation leads to conjugate downward gaze w/ absent vertical eye movements

A

Cerebellotonsilar Herniation

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29
Q

GCS classified as Severe

A

GCS score 3-8

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30
Q

GCS classified as Moderate

A

GCS score of 9-13

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31
Q

GCS classified as Mild

A

GCS score of 14-15

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32
Q

Prior to intubating a patient what needs to be recorded?

A

Best score of GCS

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33
Q

Single fixed dilated pupil indicates what?

A

Intracranial hematoma- Uncal Herniation

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34
Q

Bilateral Fixed dilated pupils indicates what?

A

Increased ICP with poor brain perfusion, Bilat uncal herniation, Atropine drug effect or severe hypoxia

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35
Q

Bilateral pinpoint pupils indicates what?

A

Opiate exposure or Central Pontine lesion

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36
Q

Presentation of upper extremity flexion and lower extremity extension is what posturing?

Where is the intracranial injury?

A

Decorticate

Above the level of the midbrain

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37
Q

presentation of arm extension and internal rotation with wrist and finger flexion, and extension of lower extremities is what posturing?

Where is the intracranial injury?

A

Decerebrate

More Caudal to midbrain injury

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38
Q

Most important prehospital interventions for head trauma are?

A

Airway and BP management

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39
Q

Optimal Airway and BP management in head trauma

A

Capnometry PCO2@ 35-45

S BP> 90mmHg and Hypoxemia > 60
<90mmHg & PAO2 < 60 = mortality 150%

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40
Q

May decrease Baseline ICP and prevent transient rises in ICP elevation

A

Sedation and Analgesia

41
Q

Appropriate early management of which conditions will have better outcomes ?

A

Hypotension, hypoxemia, Hypercarbia, and Hyperglycemia

42
Q

Intubation agent may cause a lower ICP and may be neuro protective

A

Etomidate 0.3mg/kg IV

43
Q

Intubation agent that has a rapid onset and anti-seizure properties. May cause hypotension if not adequately resuscitated

A

Propofol 1-3 mg/kg

44
Q

Intubation agent that is short acting that may cause extensive muscle injury. Avoid in Burns

A

Succinylcholine 1-1.5 mg/kg

45
Q

Intubation agent that is short acting and is safe in hyperkalemia

A

rocuronium (0.6-1.0 mg/kg

46
Q

Maintain Sys BP and MAP at

A

> 90mmHg and MAP= 80mm Hg

47
Q

hyperglycemia is associated with worse outcome. what is an adequate glycemic control?

A

100-180 mg/dL

48
Q

Treatments that may lower ICP and improve cerebral blood flow

A

Elevate head 30 degrees

Mannitol &/or hypertonic saline 3% NaCl (250 ml over 30 min.)

49
Q

If GCS < or = 8, this treatment can be used to monitor ICP and serve as extraventricular drain

What is the ICP monitoring criteria

A

Intracranial Bolt

> 40 y/o
Uni/Bilat motor posturing
Sys Bp < 90mmHg

50
Q

An ICP of ______ mmHg increases morbidity and mortality. Monitor will be placed by neurosurgery

A

> 20mmHg

51
Q

Scalp Laceration can be treated with what, if direct pressure is not effective?

A

Locally infiltrate with Lidocaine and Epinephrine and clamp or ligate bleeding vessels

Galeal Lacerations tx with appropriate examination

52
Q

Categorized linear fracture with an overlying laceration

A

Open fracture

53
Q

Open or depressed skull fractures should be treated with

A

Vancomycin 1 Gm and Ceftriaxone 2 G

54
Q

Decreased hearing or deafness and 7th nerve palsy.

Fluid collected that is sent for analysis. Found only in CSF

A

Basilar Skull Fx Beta Transferrin

55
Q

Results from the disruptionof parenchyma and present with blood in the CSF

Present with Photophobia, headache, meningeal signs

MC CT abnormality

A

Subarachnoid Hemorrhage

56
Q

have a three fold higher mortality and can be missed on early CT scans

A

Subarachnoid hemorrhage

Repeat CT after 6-8 hrs

57
Q

Blunt trauma to temporal r temporoparietal area w associated skull fx

Middle meningeal arterial disruption

Significant blunt trauma with loss of consciousness or altered sensorium, followed by lucid period

Biconvex football shaped

A

Epidural Hematoma

58
Q

The high-pressure arterial bleeding can lead to herniation within hours

A

Epidural Hematoma

59
Q

Sudden acceleration-Deceleration of brain.

subsequent tearing Bridging Dural veins.

Tend to collect more slowly, than epidural because of venous nature. Crescent shaped lesion

A

Subdural Hematoma

60
Q

Are more susceptible in elderly and alcoholics: < 2 y/o

Acute ______
Chronic _______

A

Subdural hematoma

W/I 14 days
After 2 weeks

61
Q

Caused by sudden deceleration shearing forces.

Disruption of axonal fibers in the white matter and brainstem

MVC and Shaken Baby Syndrome

A

Diffuse axonal Injury

62
Q

Most frequently damaged abdominal organ

A

Liver

63
Q

Most frequently damaged abdominal organ from sports accidents

A

Spleen

64
Q

Most common mechanism for blunt abdominal trauma

A

MVC

65
Q

Considered a penetrated abdominal cavity injury until proven otherwise

A

Lower chest, pelvis, flank, or back

66
Q

Mimic intra-abdominal injury

A

Rectus abdominis hematomas

67
Q

hemoperitoneum is quickly detected with a single view up to 90% of patients at?

A

Morrison’s pouch

68
Q

The fast cannot evaluate the______ the ______ imaging is more ideal for this area

A

retroperitoneum: CT

69
Q

Non invasive gold standard imaging study

A

CT with contrast

70
Q

Gold standard therapy for significant intra-abdominal injury

A

Laparotomy

71
Q

60 minutes of resuscitative endovascular balloon occlusion is tolerated

A

REBOA endovascular Balloon of Aorta

72
Q

Anatomically unique designed for rotation of spine, held by the transverse ligament

A

C1 Atlas & C2 Odontoid

73
Q

Most commonly injured region of the spine

A

Cervical C5-C7 and C2 level

(C1-C7) most flexible–> most injured

74
Q

2nd MC injured region of spine

A

Thoracolumbar transition zone

75
Q

Rigid segment and enhanced reinforcement with rib articulation. Spinal canal also narrower–> complete transection

A

T1-T10

76
Q

Can produce bowel or bladder dysfunction

A

Sacral Fractures that involve central canal

77
Q

Spine injury is considered unstable when?

A

At least 2 columns of a particular region are involved

assume any spine fx is unstable until spine surgeon confirms it is stable

78
Q

Defined as the absence of sensory and motor function below the level of injury

A

Complete Neurologic Lesion

79
Q

Defined as sensory and motor or both functions are partially present below the neurologic level of injury

A

Incomplete Neurologic Lesion

80
Q

Patients in spinal shock lose all reflex activities below the area of injury, lesions cannot be deemed truly complete until

A

Spinal shock has resolved

81
Q

Damage results in ipsilateral findings muscle weakness, spasticity, increased tendon reflexes, and babinski’s sign

Descending motor pathway originates from the cortex and 90% cross to the opposite side of origin at medulla through the _________

A

corticospinal tract

82
Q

Loss of pain and temperature sensory on the contralateral half of body

Cross the midline immediately and ascend to thalamus via the________

A

spinothalamic Tract

83
Q

Vibration, position loss in ipsilateral half

light touch not lost unless damage to both________&______ and cross at the medulla

A

Dorsal columns and spinothalamic tracts

84
Q

Damage to_______Can cause immediate respiratory arrest

A

C-3

85
Q

Any patient with damage to______ or above should have their airway secured by ET tube

A

C5

86
Q

_______ denotes an incomplete spinal cord level injury even if patient has complete motor sensory motor loss

A

Anogenital Reflex

87
Q

Cremasteric reflex: stoking the medial thigh with a blunt instrument causes what?

A

The scrotum to rise= spinal cord integrity exists

88
Q

Loss of motor function ad pain temperature sensation do distal lesion.

Only vibration, position and tactile sensation preserved

A

Anterior Cord

89
Q

Decreased strength, decreased pain and temperature sensation: more in upper than lower extremities

A

Central cord

90
Q

Ipsilateral loss of motor function, proprioception, and vibratory sensation

loss of pain and contralateral and temperature sensation

A

Brown sequard syndrome (Penetrating MC)

91
Q

Not a true spinal cord syndrome:

Bowel and Bladder dysfunction, saddle anesthesia, variable loss of lower extremity reflexes

A

Cauda Equina

92
Q

present with warm skin, peripherally vasodilated and hypotensive bradycardia.

A

Neurogenic shock

HyTN Presumed to be other than Neuro R/O

93
Q

Standard Radiographic ID of cervical injury includes

A

Lateral (90% ID)

Ant-Posterior

Odontoid

(Swimmers view for C spine junction)

94
Q

Persistent neck pain/ midline tenderness, extremity paresthesia, or neurologic findings despite normal CT or radiographs indicate what?

A

Ligamentous injury

95
Q

SOC for Ligament injuries

A

MRI

Reliable patients with persistent CT and normal CT= DC with firm foam collar and F/U in 3-5 days

96
Q

The two type of fractures amenable to outpatient therapy

A

Wedge or Anterior compression fractures

<40% loss of height
>50% loss of height= unstable

97
Q

Fractures may result in retropulsed fragments that can impinge the spinal canal

A

Burst fractures

98
Q

SOmetimes misdiagnosed as wedge compression fractures

occurs via flexion distraction mechanism- involves significant distraction of the middle and posterior ligamentous structure

A

Chance Fracture

99
Q

Coccygeal fractures assessment do not include

A

Imaging

Emergency Med (2 decks)

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