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Unit 3 Emerg/Surg > L15: Trauma Eval > Flashcards

L15: Trauma Eval Flashcards

1
Q

Distribution of trauma mortality

A

Immediate→ death at the seen. Fatal disruption of great vessels, heart, lungs, or major body cavity.

Early→ Death 1-4 hours following injury. Result of CV or pulmonary collapse.

Late→ Death days to weeks after injury (less common). Due to sepsis and multiple organ failure

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2
Q

Most common cause of preventable mortality

A

Hemorrhage

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3
Q

Most common cause of trauma deaths:

A

1/2: CNS injuries

1/3: Exsanguination

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4
Q

Trauma centers

A

Level 1→ Highest level of care, Leaders in research, clinical care and education

Level 2→ Provides definitive care in wide range of complex traumatic patients

Level 3→ Provides initial stabilization and treatment. May care for uncomplicated trauma patients

Level 4/5 → Provides initial stabilization and transfers all trauma patients for definitive care

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5
Q

SALT Mass Casualty Triage algorithm: who to assess (Step 1: Global sorting)

A

1st: still or obvious life threat
2nd: waves/purposeful movement
3rd: walking

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6
Q

Try these life saving interventions in a triage situation

A

Control major hemorrhage
Open and position airway (if child give 2 rescue breaths)
Chest decompression

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7
Q

PPE + ABCDE

A 
Personal protective Equipment
Airway
Breathing
Circulation
Disability
Exposure
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8
Q

Maintain airway patency by

A

Suction of Secretions
Chin Lift/Jaw thrust
Airway adjuncts→ Nasopharyngeal Airway, Laryngeal Mask Airway, Oropharyngeal Airway→ aspiration still possible

Definitive Airway→ Endotracheal airway is protective*

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9
Q

Airway support

A

Oxygen
NRBM (100%)
Bag Valve Mask
Definitive Airway

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10
Q

Inline cervical stabilitization

A

Surgical cirocthyroidotomy after attempting ET intubation

Incision through cricothyroid membrane; insert small tube→ Later convert to orotracheal tube or tracheostomy

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11
Q

Pts with increased mortality

A

Older

Lower GCS

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12
Q

Definitive airways include

A

Endotracheal Intubation→ Inline cervical stabilization

Surgical Cricothyroidotomy

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13
Q

Who gets C-collars?

A

All blunt trauma patients

Cervical collar→ Remove anterior portion for intubation

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14
Q

If you don’t have a C collar, you can do:

A

Manual in-line stabilization
Head in neutral position
Grasped at mastoid process

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15
Q

Immediate threats to life (breathing)

A

Tension pneumothorax
Massive hemothorax
Cardiac tamponade

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16
Q

Unstable patients (breathing) get

A

CXR

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17
Q

Presumptively treat:

A

Signs of pneumothorax

Unstable trauma patient

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18
Q

Interventions for Signs of pneumothorax

A

Hypotension, dyspnea, ipsilateral decreased breath sounds
Needle decompression→ 5th intercostal space, Anterior to mid
axillary line
Kids→ 2nd intercostal space, midclavicular line
Tube thoracostomy→ Immediately following needle decompression

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19
Q

Interventions for Unstable trauma patient (presumptively treat)

A

Anticipate hemothorax and pneumothorax

Tube thoracostomy→ 5th intercostal space, midaxillary line

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20
Q

When checking circulation, palpate _____

A

Central pulses: carotid or femoral

exact BP not needed

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21
Q

Permissive hypotension is

A

SBP 80-100

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22
Q

Circulation interventions

A

Intravenous catheters→ 16 gauge (or larger)

Blood type and crossmatch

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23
Q

How to control an arterial hemorrhage

A

Manual pressure, proximal compression (tourniquet or manual BP cuff), and elevation
Hemostatic agent

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24
Q

How to control a venous hemorrhage

A

Direct pressure

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25
Q

During the breathing assessment, auscultate at ____

A

lung apices

axilla

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26
Q

If you see a sucking chest wound

A

seal with occlusive dressing (tape + plastic)

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27
Q

Controlling hemorrhage

A

TXA Tranexamic acid
Blood transfusion
Emergency thoracotomy→ Patients without central pulses

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28
Q

Step down treatment for shock:

means start at top and keep going until they’re not in shock anymore

A

1 L crystalloid NS or LR

1-2 units O Neg PRBC

Start MTP (Massive Transfusion Protocol)
Rapid infuser→ 1000ml/minute
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29
Q

The Massive Transfusion protocol transfusion of _______ at a specific ratio:

A

1:1:1 ratio
PRBC: FFP: Platelets
**

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30
Q

When evaluating disability (neuro), do imaging if….

A

Motor deficit or Spinal cord sensory leve

31
Q

Lethal triad of coagulopathy/shock

A

Hypothermia
Coagulopathy
Acidosis

32
Q

An intubated patient can have a max GCS of __ which is written __

A

GCS 10’T’

they can’t get the 5 verbal points, so they aren’t included

33
Q

GCS ___ gets intubated

A

GCS <8

34
Q

Treat the lethal triad of coagulopathy/shock

A

Hypothermia→ Remove wet clothing and warm pt

Coagulopathy→ permissive hypotension and give blood products

Acidosis→ stop the bleeding, treat shock

35
Q

Visualize the patients entire body and don’t miss these common regions:

A

Scalp, axillary folds, perineum, abdominal folds

36
Q

Hypothermia means temp < ___, treat with _____

A

Hypothermia <35 C

Warm blankets
Warms IV fluids and blood
External warming devices
Warm room

37
Q

**Nexus C Spine Rule **

A

Radiography is Unnecessary if patient satisfies ALL of the following low risk criteria:

No midline cervical tenderness
No focal neuro deficits
Normal alertness
No intoxication
No painful distracting injury
38
Q

FAST exam

A 
Focused Assessment with Sonography for Trauma
Looks for bleeding in potential spaces: 
Between kidneys and liver/spleen
Around heart
Bladder
39
Q

Adult Head Injury CT pathway

A

CT if one of the following:
V, HA, FND, basilar skull fracture
Coagulopathy: warfarin, NOAs, LMWH, liver disease, inherited disorder
Thrombocytopenia
Dangerous MOI→ MVA ejection, pedestrian vs car, fall > 3 ft/5 stairs
CT if LOC or post traumatic amnesia and:
>60 years, intoxicated, short term memory deficit, visible trauma above clavicles, seizures

40
Q

Who meets inclusion criteria for the Adult Head Injury CT pathway

A 
Age 18-64, GCS-15, injury within last 24 hours
Non a multi-system trauma patient
Not penetrating head injury
No brain tumor or VP shunt
Not pregnant
Not taking antiplatelet drugs

Assess these ppl for Head CT idk what to do if they don’t meet the criteria tho

41
Q

PECARN=Pediatric Head CT Rule: <2 years

A

CT→ AMS, GCS <15, palpable skull fracture

Observation vs CT→ LOC > 5 sec, non-frontal hematoma, not acting normally, severe mechanism

Discharge→ if meets none of above criteria

42
Q

PECARN=Pediatric Head CT Rule: > 2 years

A

CT→ AMS, GCS <15, signs of basilar skull fracture

Observation vs CT→ history of LOC or vomiting, severe HA, severe mechanism

Discharge→ if meets none of above criteria

43
Q

PECARN=Pediatric Head CT Rule: everyone gets a CT if

A

Severe mechanism→ MVAs, hit by car without helmet, fall > 3 feet, blunt trauma to head (weight?)

44
Q

Get an AMPLLE history in your secondary survery:

A

Allergies Medicines PMH, Last meal, LMP, Events that lead to this trauma

Antiplatelet or anticoagulation “Blood thinners?”

Female → pregnant?

45
Q

During the secondary survey physical, the ______ exam can be unreliable

A

Abdominal exam

46
Q

During the secondary survey physical, the ______ exam should done serially as it changes over time

A

Neurologic exam

47
Q

Chance fracture

A

thoracolumbar fracture from excessive flexion, can be due to seat belt in MVA (seat belt sign)

48
Q

Most frequently injured organ in penetrating trauma, 2nd most frequently injured in blunt abdominal trauma

A

Liver

Massive blood loss

Most blunt injuries can be managed non-op

49
Q

Most frequent organ injured in blunt trauma in adults

A

Spleen

50
Q

Most important organ to save in kids

A

Spleen

51
Q

Shoulder seat belts can cause

A

Blunt carotid injury, strangle injury

52
Q

In case of spleen injury

A

Consider Vaccination

• Pneumovax, H. flu, +/- Meningococcus

53
Q

Besides the FAST exam, abdominal evaluation can include

A

Contrast Abdomen/Pelvis CT

54
Q

How many people does it take to roll a patient?

A

Minimum 3

55
Q

Who gets a rectal exam, and why?

A
  1. Spinal cord injury (to assess for sacral sparing)
  2. Pelvic fracture (to assess for open fracture)
  3. Penetrating abdominal trauma (to assess for gross blood)
56
Q

If you suspect a pelvic fracture, ______ and ____. They have a super high mortality rate if left open (1-3 L blood loss)

A

Bind pelvis

Check for blood at meatus (urethral injury)

57
Q

Brachial Indexes: Lower extremity injury

A

ANKLE-BRACHIAL INDEX
ABI >0.9= Normal
ABI <0.9= ABNormal

58
Q

Brachial Indexes: upper extremity injury

A

BRACHIAL-BRACHIAL INDEX
(injured) / (uninjured)
BBI >0.9= Normal

59
Q

Hard signs of extremity penetrating injury that go to the OR ASAP

A 
Active or Pulsatile Bleeding
Expanding Hematoma
Pulseless limb
Shock – attributed to vascular injury(no other injury to explain shock)
Compartment Syndrome (6 P’s)
Bruit thrills- Rare
60
Q

Contraindication to NG tube

A

mid face fracture

61
Q

Contraindication to foley catheter

A

blood at meatus suggests urethral injury

Pelvic fracture

62
Q

Soft signs of extremity penetrating injury that get a CT angiogram only if ABI

A

Small non expanding hematoma
Venous oozing
History of Pulsatile Bleeding
Unexplained Neuro deficit- sensory or motor

63
Q

Imaging for a patient with no signs of extremity penetrating trauma

A

Xray

64
Q

Imaging for urethral trauma

A

Retrograde urethrogram

65
Q

Definitive care to stop traumatic arterial spleen bleeding

A

Coil embolization

66
Q

If you have an unknown history of a tetanus vaccine, or got less than 3 doses

A

DTap, Tdap, Td for all wounds

TIG if not a clean, minor wound

67
Q

If you’ve received more than 3 doses of tetanus vaccine

A

no vaccines or TIG indicated unless:

Clean minor wound and > 10 years since last vaccine

Other wound and > 5 years since last vaccine

68
Q

Broselow Pediatric Emergency tape

A

Use to measure height of pt→ tells you medication dosages for the average weight child of that height

69
Q

How do you do CPR on a pregnant women?

A

left lateral decubitus position with backboard elevated 30 degrees→ moves fetus off of spine

70
Q

How do you do a Perimortem cesarean section?

A

Within 5 minutes of maternal arrest→ best prognosis for infant survival
Goal: remove fetus & continue resuscitation of mother & fetus
Continue maternal CPR during procedure
Vertical midline abdominal incision from 4-5 cm below xiphoid process to pubic symphysis→ incise through fascia and muscles into peritoneum

71
Q

This med, which tons of geriatric ppl are on, seriously increases risk of mortality following trauma

A

Warfarin (coumadin)

72
Q

Number one cause of death among Americans younger than 50

A

Drug overdose

73
Q

Outpatient pain control

A

Keep opioid naive patients opioid naive
3 day max prescription (throw away)

Discuss benefits and harms with patient
Set expectations: goal is not zero pain

74
Q

Inpatient pain control

A

possible surgery:

NSAIDS→ caution

Augment opiates with non-opioids

Unit 3 Emerg/Surg (5 decks)

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