ISE Trauma 6 (Pearls)

Question 1

remarks on hypotension in spinal injury patients

Answer 1

presume blood loss as the cause of hypotensino in spinal injury patients until proven otherwise

Question 2

remarks on pulmonary trauma

Answer 2

Presume penetrating chest injuries to the cardiac box (area bounded by the sternal notch, xyphoid process, and nipples) to involve the HEART or GREAT VESSELS until proven otherwise

Question 3

remarks on cardiac trauma

Answer 3

a more reproducible sign of cardiac tamponade is a narrowing of the pulse pressure, which along with elevation of the central venous pressure, is cardiac tamponade until proven otherwise

Question 4

remarks on genitourinary trauma

Answer 4

on DRE, if the prostate is “missing” or riding high or feels boddy, assume disruption of the membranous urethra until proven otherwise

Question 5

remarks on osteoporotic fractures

Answer 5

thoracic and lumbar spines fractures account for almost half of all osteoporotic fractures
most common at thoracolumbar junction (T12-L1) and midthoracic areas (T7-T8)

Anterior wedge compression fractres are the most common
CT scan is the first line imaging modality for adult patients [in trauma]

Question 6

remarks on pelvic fractures

Answer 6

pubic ramus fractures are the most common injuries,
and lateral compressino is the most common mechanism

CT of the pelvis should be ordered in stable patients with pelvic tenderness after an injury if plain radiographs are negative

Question 7

single most common injury diagnosis that leads to hospitalization in the elderly

Answer 7

hip fractures
-25% mortality of elderly patients within a year of injury
-femoral neck (intracapsular) and intertrochanteric fractures are about equally common
subtrochanteric fractures comprising the remaining 5-10%

Question 8

remarks on upper extremity injuries in the elderly

Answer 8

distal radius fractures (Colles’ fractures) are the most common fractures in women up to age 75, with a lifetime risk of about 15%

Question 9

remarks on causes of fetal death

Answer 9

1. maternal death
2. placental abruption

Question 10

remarks on placental abruption

Answer 10

the most sensitive clinical finding for placental abruption after trauma is uterine irritability, which is defined as more than 3 uterine contractions per hour

Question 11

remarks on severe TBI

Answer 11

GCS 3-8
mortality approaches 40%, with most deaths occuring in the first 48 hours.
fewer than 10% of patients with severe TBI experience good recovery

Question 12

most common thoracic fracture

Answer 12

simple wedge (compression) fracture

Question 13

zones of the neck

Answer 13

zone III - above angle of mandible

zone I - below cricoid cartilage, and above sternal notch

Question 14

most commonly injured neck zone

Answer 14

zone II

Question 15

remarks on strangulation

Answer 15

In all forms of strangulation, death is ultimately due to cerebral anoxia and ischemia; obstruction of cerebral venous return rather than acute airway compromise is postulated to be the most common pathophysiologic mechanism of death

Question 16

remarks on pneumothorax

Answer 16

Although chest radiography remains the most common diagnostic tool for detecting pneumothorax in the ED, it will miss bet 17% and 80% of pneumothoraces for upright and supine chest radiographs, respectively

POCUS is more sensitive that a supine radiograph and is rapid and accurate for detecting pneumothorax

Pneumothorax after a stab wound may be delayed for up to 6 hours

Question 17

remarks on aspiration

Answer 17

consolidation is most common in the right middle and lower lung fields

Question 18

most common bony injuries in chest trauma

Answer 18

rib fractures

Question 19

most common causes of death in young athletes

Answer 19

1. hypertrophic obstructive cardiomyopathy
2. commotio cordis, “disturbance of the heart”
   -result of blunt trauma to the chest wall

Question 20

most common artery involved in injury to coronary vessels

Answer 20

left anterior descending artery

Question 21

remarks on rescucitation of a pregnant patient

Answer 21

Although there are two patients, priority is given to themother as maternal resuscitation is the best fetal resuscitaiton

Fetal survival is dependent on early and aggressive maternal resuscitaiton

Never withhold critical maternal interventions or diagnostic procedures out of concern for potential adverse fetal consequences

Question 22

remarks on pulmonary contusion

Answer 22

areas of lung opacificagtion on chest imaging within 6 hours of blunt trauma are usually considered diagnostic of pulmonary contusion

Question 23

treatment of tension pneumothorax

Answer 23

Perform immediate needle decompressiion, usually in the 4th ICS at the AAL, followed by chest tube insertion

Question 24

flail chest

Answer 24

segmental fractures of 3 or more adjacent ribs anterior or laterally often result in an unstable chest wall physiology known as flail chest

paradoxical inward movement of the involved chest wall segment during spontaneous inspriation and outward movement during expiration

the primary cause of hypoxemia is contusion to the underlying lung

fracture of 8 or more ribs—> indication for early ventilatory support

surgical fixation in those requiring mechanical ventilation when thoracotomy is undertaken to manage other injuries