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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
During the breathing assessment, auscultate at ____
lung apices | axilla
26
If you see a sucking chest wound
seal with occlusive dressing (tape + plastic)
27
Controlling hemorrhage
TXA Tranexamic acid Blood transfusion Emergency thoracotomy→ Patients without central pulses
28
Step down treatment for shock: | means start at top and keep going until they're not in shock anymore
1 L crystalloid NS or LR 1-2 units O Neg PRBC ``` Start MTP (Massive Transfusion Protocol) Rapid infuser→ 1000ml/minute ```
29
The Massive Transfusion protocol transfusion of _______ at a specific ratio:
******* 1:1:1 ratio PRBC: FFP: Platelets ********
30
When evaluating disability (neuro), do imaging if....
Motor deficit or Spinal cord sensory leve
31
***Lethal triad*** of coagulopathy/shock
Hypothermia Coagulopathy Acidosis
32
An intubated patient can have a max GCS of __ which is written __
GCS 10’T’ | they can't get the 5 verbal points, so they aren't included
33
GCS ___ gets intubated
GCS <8
34
Treat the lethal triad of coagulopathy/shock
Hypothermia→ Remove wet clothing and warm pt Coagulopathy→ permissive hypotension and give blood products Acidosis→ stop the bleeding, treat shock
35
Visualize the patients entire body and don't miss these common regions:
Scalp, axillary folds, perineum, abdominal folds
36
Hypothermia means temp < ___, treat with _____
Hypothermia <35 C Warm blankets Warms IV fluids and blood External warming devices Warm room
37
***Nexus C Spine Rule ***
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
FAST exam
``` Focused Assessment with Sonography for Trauma Looks for bleeding in potential spaces: Between kidneys and liver/spleen Around heart Bladder ```
39
Adult Head Injury CT pathway
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
Who meets inclusion criteria for the Adult Head Injury CT pathway
``` 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
PECARN=Pediatric Head CT Rule: <2 years
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
PECARN=Pediatric Head CT Rule: > 2 years
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
PECARN=Pediatric Head CT Rule: everyone gets a CT if
Severe mechanism→ MVAs, hit by car without helmet, fall > 3 feet, blunt trauma to head (weight?)
44
Get an AMPLLE history in your secondary survery:
Allergies Medicines PMH, Last meal, LMP, Events that lead to this trauma Antiplatelet or anticoagulation “Blood thinners?” Female → pregnant?
45
During the secondary survey physical, the ______ exam can be unreliable
Abdominal exam
46
During the secondary survey physical, the ______ exam should done serially as it changes over time
Neurologic exam
47
Chance fracture
thoracolumbar fracture from excessive flexion, can be due to seat belt in MVA (seat belt sign)
48
Most frequently injured organ in penetrating trauma, 2nd most frequently injured in blunt abdominal trauma
Liver Massive blood loss Most blunt injuries can be managed non-op
49
Most frequent organ injured in blunt trauma in adults
Spleen
50
Most important organ to save in kids
Spleen
51
Shoulder seat belts can cause
Blunt carotid injury, strangle injury
52
In case of spleen injury
Consider Vaccination | • Pneumovax, H. flu, +/- Meningococcus
53
Besides the FAST exam, abdominal evaluation can include
Contrast Abdomen/Pelvis CT
54
How many people does it take to roll a patient?
Minimum 3
55
Who gets a rectal exam, and why?
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
If you suspect a pelvic fracture, ______ and ____. They have a super high mortality rate if left open (1-3 L blood loss)
Bind pelvis Check for blood at meatus (urethral injury)
57
Brachial Indexes: Lower extremity injury
ANKLE-BRACHIAL INDEX ABI >0.9= Normal ABI <0.9= ABNormal
58
Brachial Indexes: upper extremity injury
BRACHIAL-BRACHIAL INDEX (injured) / (uninjured) BBI >0.9= Normal
59
Hard signs of extremity penetrating injury that go to the OR ASAP
``` 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
Contraindication to NG tube
mid face fracture
61
Contraindication to foley catheter
blood at meatus suggests urethral injury | Pelvic fracture
62
Soft signs of extremity penetrating injury that get a CT angiogram only if ABI
Small non expanding hematoma Venous oozing History of Pulsatile Bleeding Unexplained Neuro deficit- sensory or motor
63
Imaging for a patient with no signs of extremity penetrating trauma
Xray
64
Imaging for urethral trauma
Retrograde urethrogram
65
Definitive care to stop traumatic arterial spleen bleeding
Coil embolization
66
If you have an unknown history of a tetanus vaccine, or got less than 3 doses
DTap, Tdap, Td for all wounds TIG if not a clean, minor wound
67
If you've received more than 3 doses of tetanus vaccine
no vaccines or TIG indicated unless: Clean minor wound and > 10 years since last vaccine Other wound and > 5 years since last vaccine
68
Broselow Pediatric Emergency tape
Use to measure height of pt→ tells you medication dosages for the average weight child of that height
69
How do you do CPR on a pregnant women?
left lateral decubitus position with backboard elevated 30 degrees→ moves fetus off of spine
70
How do you do a Perimortem cesarean section?
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
This med, which tons of geriatric ppl are on, seriously increases risk of mortality following trauma
Warfarin (coumadin)
72
Number one cause of death among Americans younger than 50
Drug overdose
73
Outpatient pain control
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
Inpatient pain control
possible surgery: NSAIDS→ caution Augment opiates with non-opioids

Unit 3 Emerg/Surg (5 decks)

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