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General Trauma Flashcards

1
Q

Define the grades of hypothermia

A
  • Mild = 32-35
  • Moderate = 28-32
  • Severe = <28
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2
Q

What are the CPR adjustments in hypothermia

A
  • Defibrillation is ineffective until warm
  • Use IV Bretylium
  • Death cannot be confirmed until patient is warm
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3
Q

Define heat stroke

A

Pyrexia >41 degrees associated with anhidrosis and neurological dysfunction

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4
Q

Outline the monitored variables (HR, CVP, CO, SV, SVR) in hypovolaemia

A
  • HR = up
  • CVP = down
  • CO = down
  • SV = down
  • SVR = up
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5
Q

Outline the monitored variables (HR, CVP, CO, SV, SVR) in cardiogenic shock

A
  • HR = up
  • CVP = up
  • CO = down
  • SV = down
  • SVR = up
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6
Q

Outline the monitored variables (HR, CVP, CO, SV, SVR) in septic shock

A
  • HR = up
  • CVP = down
  • CO = up
  • SV = down
  • SVR = down
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7
Q

Outline the monitored variables (HR, CVP, CO, SV, SVR) in tamponade

A
  • HR = up
  • CVP = very up
  • CO = down
  • SV = down
  • SVR = up
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8
Q

Outline the monitored variables (HR, CVP, CO, SV, SVR) in neurogenic shock

A
  • HR = down
  • CO = down
  • SVR = down
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9
Q

What is normal CO

A

6L/min

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10
Q

Describe class 1 hypovolaemic shock

A
  • 0-750ml loss (0-15%)
  • Pulse <100
  • BP unchanged
  • Pulse pressure unchanged
  • Urine output >30
  • RR 14-20
  • Restless
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11
Q

Describe class 2 hypovolaemic shock

A
  • 750-1500ml loss (15-30%)
  • Pulse 100-120
  • BP unchanged
  • Pulse pressure decreased
  • Urine output 20-30
  • RR 20-30
  • Anxious
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12
Q

Describe class 3 hypovolaemic shock

A
  • 1500-2000ml loss (30-40%)
  • Pulse 120-140
  • BP decreased
  • Pulse pressure decreased
  • Urine output 5-15
  • RR 30-40
  • Anxious/confused
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13
Q

Describe class 4 hypovolaemic shock

A
  • > 2000ml loss (>40%)
  • Pulse >140
  • BP decreased
  • Pulse pressure decreased
  • Anuric
  • RR >40
  • Confused/lethargic
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14
Q

What conditions can falsely raise CVP

A
  • Tension pneumothorax
  • Pericardial effusion
  • Air embolus
  • MI
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15
Q

Define ‘massive transfusion’

A

Replacement of a patient’s total blood volume in <24 hours OR administration of over half the patient’s blood volume per hour

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16
Q

What ratio of blood products should be transfused in haemostatic resuscitation

A
  • 1:1:1

- Packed cells: platelets: FFP

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17
Q

Normal urine outputs per hour for infant, child and adult

A
  • Infant = 2ml/kg/hr
  • Child = 1ml/kg/hr
  • Adult = 0.5ml/kg/hr
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18
Q

What hormones are increased in the stress response

A
  • Growth hormone
  • Cortisol
  • Renin
  • ACTH
  • Aldosterone
  • Prolactin
  • ADH
  • Glucagon
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19
Q

What hormones are decreased in the stress response

A
  • Insulin
  • Testosterone
  • Oestrogen
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20
Q

What hormones remain unchanged in the stress response

A
  • TSH
  • LH
  • FSH
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21
Q

Result of neurogenic shock on preload

A

Reduces as loss of vasomotor tone causes pooling in the capacitance vessels

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22
Q

List the 6 immediate life-threatening chest injuries (ATOMIC)

A
  • Airway obstruction
  • Tension pneumothorax
  • Open (sucking) pneumothorax
  • Massive haemothorax
  • Intercostal disruption (flail chest)
  • Cardiac tamponade
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23
Q

What is the AMPLE history

A
  • Allergies
  • Medication
  • Past medical history
  • Last meal
  • Events of the injury
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24
Q

What autonomic symptoms are seen in diffuse axonal injury

A
  • Fever
  • HTN
  • Sweating
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25
Q

Most common vessel to cause extradural haematoma

A

Middle meningeal artery

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26
Q

Why are children and young adults more susceptible to extradural haematoma

A

The dura becomes more adherent to the skull with age

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27
Q

What causes pupillary dilatation in extradural haematoma

A

Herniation of the uncus of the temporal lobe across the tentorial edge compresses the 3rd nerve

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28
Q

Describe the appearance of extradural haematoma on CT

A
  • Bi-convex (lemon)

- Limited by the dural attachments of the suture lines

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29
Q

Rupture of what vessels causes acute subdural haematoma

A

Bridging veins

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30
Q

Describe the classical presentation of extradural haematoma

A

Initial concussion followed by lucid interval

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31
Q

Describe the presentation of acute subdural haematoma

A

Rapid deterioration

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32
Q

Define the Monroe-Kelly Doctrine

A

Cranium is a rigid box, therefore total volume must remain constant if ICP is not to change

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33
Q

To what volume can the body compensate ICP for changes in intracranial volume

A

100ml

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34
Q

Outline the Cushing’s response

A
  • Respiratory rate falls (herniation of brainstem)
  • Heart rate decreases
  • SBP rises
  • Pulse pressure rises
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35
Q

How is cerebral perfusion pressure calculated

A

MAP - ICP

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36
Q

What can break the cycle of exponentially rising ICP when autoregulation fails

A
  • Ventilate to normocapnia 4.5kPa
  • IV fluid to normovolaemia
  • Mannitol bolus
  • Thiopental infusion
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37
Q

Why does hyponatraemia develop in head injuries

A

SIADH

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38
Q

What is the minimal cerebral perfusion pressure in adults

A

70mmHg

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39
Q

List the causes of bilaterally constricted pupils

A
  • Opiates
  • Pontine lesions
  • Metabolic encephalopathy
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40
Q

Criteria for immediate CT head within 1 hour

A
  • GCS <13 on admission
  • GCS <15 after 2 hours
  • Suspected open/depressed skull fracture
  • Suspected skull base fracture
  • Focal neurology
  • Vomiting >1 episode
  • Post traumatic seizure
  • Coagulopathy (or receiving an anticoagulant)
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41
Q

How often should a patient undergo observations following head injury

A

Half-hourly until GCS 15

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42
Q

What type of facial fracture does movement of the maxillary teeth suggest

A

Le Fort 1

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43
Q

What type of facial fracture does movement of the nasal bridge suggest

A

Le Fort 2 or 4

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44
Q

What must be excluded in septal fracture or dislocation

A

Septal haematoma

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45
Q

When do naso-ethmoidal fractures need to be referred to neurosurgery

A

If dural tear occurs at the cribriform plate

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46
Q

List the signs of longitudinal temporal bone fractures

A
  • Swollen external auditory canal
  • Tear of tympanic membrane
  • Bleeding from the ear
  • CSF otorrhoea
  • Facial nerve palsy
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47
Q

List the signs of transverse temporal bone fractures

A
  • Haemotympanum
  • 50% have facial nerve palsy
  • Sensorineural hearing loss
  • Vertigo
  • Nystagmus
  • CN 9, 10, 11 palsies
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48
Q

How should temporal bone fractures be managed

A
  • Hearing test
  • EMG if facial nerve palsy
  • Surgical decompression +/- facial nerve grafting
49
Q

How may a TMJ dislocation be reduced

A

Downward and forward traction

50
Q

Describe a Le Fort 1 fracture

A

Horizontal - Severs the tooth-bearing portion of the maxilla from the upper maxilla

51
Q

Describe a Le Fort 2 fracture

A

Pyramidal - extends from nasal bridge (at or below nasofrontal suture) through the superior medial wall of the maxilla, inferolaterally through the lacrimal bones and inferior orbital floor

52
Q

Describe a Le Fort 3 fracture

A

Transverse A.K.A. Craniofacial dissociation - involve zygomatic bone. Begin at nasofrontal and frontomaxillary sinus and extend posteriorly along the medial wall of the orbit, through the nasolacrimal groove and ethmoid air cells, continues through lateral orbital wall and zygomatic arch

53
Q

Define flail chest

A

Two rib fractures in the same rib of two consecutive ribs

54
Q

What is the effect on tidal volume in flail chest

A

Reduces due to paradoxical chest wall movement

55
Q

How are tension pneumothoraces immediately decompressed

A

14G needle in 2nd intercostal space MCL

56
Q

Define massive haemothorax

A

1500ml or more blood drained from the chest cavity on insertion of a chest drain

57
Q

Describe the site of chest drain insertion

A

Mid-axillary line, 5th ICS

58
Q

When is thoracotomy indicated in haemothorax

A

If immediate loss >2000ml or continuing losses of 200ml/hr

59
Q

When should great vessel damage be suspected in haemothorax

A

If there are signs of penetrating injury medial to the nipples/scapula

60
Q

List the CXR signs of mediastinal injury

A
  • Subcutaneous emphysema
  • Haemothoraces
  • Pleural cap
  • Widened mediastinum
  • Free air in the mediastinum
61
Q

What incision may be required to control pericardial tamponade or uncontrolled bleeding following blunt chest trauma

A

Left anterolateral thoracotomy

62
Q

What size chest drain should be used in traumatic pneumothorax

63
Q

What sensory deficit arises in Le Fort 2 fractures

A

Infraorbital paraesthesia

64
Q

How should traumatic pneumothoraces be managed

A

Insert chest drain for all

65
Q

Describe Beck’s Triad

A
  1. Raised JVP
  2. Muffled heart sounds
  3. Low BP
66
Q

Describe Kussmaul’s sign

A

Raised JVP on inspiration (seen in cardiac tamponade)

67
Q

How should traumatic cardiac tamponade be managed

A

Pericardiocentesis

68
Q

Which Le Fort fracture is associated with CSF rhinorrhoea

69
Q

How can CSF rhinorrhoea be confirmed

A

Beta-2 transferrin assay

70
Q

Site of rupture in aortic disruption

A

Just distal to Ligamentum arteriosum

71
Q

Which side is diaphragmatic rupture more likely to occur on

A

Left (right side is protected by the liver)

72
Q

What percentage of blunt abdominal trauma require laparotomy

73
Q

What four areas does a FAST scan assess

A
  1. Perihepatic and hepatorenal space
  2. Perisplenic
  3. Pelvic
  4. Pericardium
74
Q

Contraindications to diagnostic peritoneal lavage

A
  • Absolute decision for laparotomy already made

- Relative = previous abdominal surgery, obesity, pregnancy, coagulopathy, advanced cirrhosis

75
Q

Indications for diagnostic peritoneal lavage

A
  • Multiply injured patient with equivocal abdominal exam
  • Suspicion of injury with difficult examination
  • Refractory hypotension with no other sites of haemorrhage
76
Q

List the indications for laparotomy following trauma

A
  • Unexplained shock
  • Peritonism
  • Evisceration - bowel or omentum
  • Radiological evidence of intraperitoneal gas
  • Radiological evidence of ruptured diaphragm
  • Gunshot wounds
  • +ve DPL or CT
77
Q

Define Kehr’s sign

A

Shoulder tip pain secondary to blood in the peritoneal cavity - left sided Kehr’s is classic of ruptured spleen

78
Q

Outline the classification system used for splenic injury

A 
1 = capsular tear 
2 = tear and parenchymal injury 
3 = tear up to the hilum 
4 = complete fracture
79
Q

When is splenic resection indicated post-trauma

A
  • Hilar injuries
  • Major haemorrhage.
  • Major associated injuries
80
Q

What structures are at risk during splenectomy

A

Tail of the pancreas

81
Q

What infections may complicate splenectomy

A
  • Strep pneumoniae
  • Haemophilus influenzae
  • Neisseria meningitidis
82
Q

How should those with grades 1-3 splenic injury be managed

A

Observation in HDU

83
Q

Outline the management of liver trauma

A
  • Conservative if capsule intact
  • Suture laceration
  • Partial hepatectomy
  • Packing
84
Q

Outline how pancreatic trauma is classified

A
  • Major = proximal gland damage involving the head with duct disruption
  • Intermediate = distal gland damage with duct disruption
  • Minor = contusion or laceration that does not include damage to the main ducts
85
Q

What x-ray signs suggest renal damage following trauma

A
  • Loss of psoas shadow
  • Enlarged kidney
  • Fracture of overlying ribs/transverse processes
  • Scoliosis from muscle spasm
86
Q

Imaging of choice in suspected renal injury

A

CT with contrast

87
Q

Outline the classification system used for renal trauma

A 
1 = contusion, subscapular haematoma but intact renal capsule 
2 = minor laceration of the cortex not involving the medulla or collecting system 
3 = major laceration extending through the cortex and medulla but not involving the collecting system 
4 = a major laceration extending into the collecting system 
5 = completely shattered kidney or renal pedicle avulsion
88
Q

List the absolute indications for renal exploration

A
  • Persistent hypotension despite resus
  • Expanding haematoma
  • Disruption of the renal pelvis with leakage of urine
89
Q

Most common cause of ureteric trauma

A

Iatrogenic in gynaecological surgery

90
Q

Investigation of choice in suspected ureteric trauma

A

IV urogram

91
Q

How is ureteric damage managed if immediately recognised

A
  • Ligation of ureter
  • Direct-end-to-end repair
  • Bladder mobilised up to ureter
92
Q

How is ureteric damage managed if delayed recognition

A
  • Retrograde stent via bladder
  • Nephrostomy to relieve obstruction
  • Subsequent repair at 6 weeks
93
Q

Where do tears of the bladder typically occur

94
Q

How is bladder trauma assessed

A

Retrograde cystoscopy

95
Q

When is retrograde urethrogram indicated

A

If there is any doubt regarding urethral trauma

96
Q

How is urethral trauma classified

A
  • Anterior = affects the penile and bulbar parts of the urethra
  • Posterior = usually affects the membranous urethra
97
Q

How does urethral trauma present

A
  • Blood at urethral meatus
  • Inability to void
  • Palpably full bladder
  • (Butterfly bruising of perineum in anterior injury)
98
Q

Describe the 3 layers of a peripheral nerve

A
  1. Endoneurium = connective tissue around individual axons
  2. Perineurium = dense connective tissue surrounding fascicle
  3. Epineurium = outermost layer of connective tissue
99
Q

C5 motor test

A

Elbow flexion

100
Q

C6 motor test

A

Wrist extension

101
Q

C7 motor test

A

Elbow extension

102
Q

C8 motor test

A

Flexes fingers

103
Q

T1 motor test

A

Spreads fingers

104
Q

L2 motor test

A

Flexes hip

105
Q

L3 motor test

A

Extends knee

106
Q

L4 motor test

A

Dorsiflexes foot

107
Q

L5 motor test

A

Wiggles toes

108
Q

S1 motor test

A

Plantarflexes toes

109
Q

Corticospinal tract function

A

Fine limb control

110
Q

Spinothalamic tract function

A

Light touch, temperature, pain, pressure

111
Q

Spinoretucular tract function

A

Pain sensation from tissue injury

112
Q

Spinocerebellar tract function

A

Proprioceptive feedback from muscles

113
Q

Gracile fasciculus (Dorsal column) function

A

Gross touch, visceral pain, vibration

114
Q

Consequence of dorsal column lesion

A
  • Loss of vibration and proprioception

- Tabes dorsalis, SACD

115
Q

Consequence of spinothalamic tract lesion

A

Loss of pain, sensation and temperature

116
Q

Consequence of Brown-Sequard syndrome

A
  • Hemisection of the spinal cord
  • Ipsilateral paralysis
  • Ipsilateral loss of proprioception and fine discrimination
  • Contralateral loss of pain and temperature
117
Q

Describe a Jefferson fracture

A
  • Blow-out fracture of C1

- Best viewed on open-mouth view

118
Q

Outline the 3 types of odontoid fractures

A
  • Type 1 = above the base
  • Type 2 = across the base
  • Type 3 = fracture extends into vertebral body

Trauma (3 decks)

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