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EM Exam #2 Retake > Lecture 10: Trauma + IPV/abuse > Flashcards

Lecture 10: Trauma + IPV/abuse Flashcards

1
Q

What is the 4 step approach to a trauma patient?

A
  1. Primary survey
  2. Resuscitation
  3. Secondary survey
  4. Definitive care
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2
Q

What falls under the primary survey?

A
  • Airway
  • Breathing
  • Circulation
  • Disability (neuro status)
  • Exposure/environment
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3
Q

If a patient can respond to you appropriately, what can we assume is intact?

A
  • Airway
  • Breathing
  • Neuro status
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4
Q

When should we assume C-spine is needed?

A
  • Blunt trauma
  • ALOC
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5
Q

What is the predominant cause of death post injury?

A

Hemorrhage

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6
Q

What does a pale/ashen gray extremity suggest?

A

Hypovolemia

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7
Q

What does a rapid thready pulse suggest in trauma?

A

Hypovolemia

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8
Q

How do we manage an external hemorrhage?

A
  1. Direct manual pressure
  2. Tourniquet with caution
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9
Q

How do we manage an internal hemorrhage?

A

Splint application or consult surgery

Chest, abdomen, retroperitoneum, pelvis, long bones

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10
Q

How long can a tourniquet be on before theres a risk of limb loss?

A

3 hours

Write down the time it was applied.

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11
Q

What do you want to rule out for neuro disability quickly?

A
  • Alcohol
  • Hypoglycemia
  • Narcotics
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12
Q

When is the general rule of thumb for intubation for an unconscious patient with no gag reflex?

A

Less than 8, intubate

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13
Q

What are the 4 areas checked in a FAST exam?

A
  • Cardiac-subxiphoid
  • RUQ-hepatorenal
  • LUQ-splenorenal
  • Suprapubic views

Focused assessment with sonography in trauma

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14
Q

What must be done prior to secondary survey? (3)

A
  • Primary Survey
  • Resuscitation
  • Normalized vitals
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15
Q

Where does an epidural hematoma tend to occur and what artery is usually disrupted?

A
  • Temporal/temporoparietal area
  • MMA (middle meningeal artery)
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16
Q

What is the classic hx with an epidural hematoma?

A
  • Hx of blunt head trauma with LOC or ALOC
  • Lucid period, then another ALOC
  • Associated skull fx
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17
Q

What is the highest risk epidural hematoma hx?

A

Traumatic blow over the lateral aspect of the head

Baseball or pool stick injury

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18
Q

How does an epidural hematoma tend to appear on CT?

A
  • Biconvex, football shaped (lens shaped)
  • Temporally (usually)
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19
Q

What is the initial tx/SBP goals for an epidural hematoma?

A
  • Maintain SBP > 100 for 50-69
  • Maintain SBP > 110 for 15-49 or 70+

Maintaining CPP and oxygenation is prioritiy.

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20
Q

What is the general mechanism for a subdural hematoma?

A

Acceleration-deceleration of brain parenchyma

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21
Q

What veins are typically injured in subdural hematomas?

A

Bridging dural veins

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22
Q

What are the two biggest RFs for subdural hematomas?

A
  • Elderly
  • Chronic alcoholics

Brain atrophy

Also children < 2

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23
Q

When is a subdural hematoma considered chronic?

A

Within 14d of injury

After 2 weeks, its chronic.

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24
Q

How does a subdural hematoma appear on CT?

A

Hyperdense (white), crescent shaped lesions crossing suture lines

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25
Q

What physical signs can suggest C-spine trauma? (4)

A
  • Seat belt marks
  • C-spine tenderness
  • Subcutaneous emphysema
  • Tracheal deviation
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26
Q

What are the 3 zones of soft tissue injury for your neck?

A
  • Zone 1 = clavicles to cricoid = further eval
  • Zone 2 = cricoid to angle of the mandible = surgery
  • Zone 3 = angle of the mandible to base of skull = further eval

Second zone is the Surgery zone

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27
Q

What kind of trauma increases risk for needing a surgical cricothyrotomy?

A

Neck trauma

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28
Q

What is the proximate cause of death in most penetrating neck injuries?

A

Exsanguination

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29
Q

What are the two general causes of penetrating neck injuries?

A
  • GSWs
  • Stab wounds
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30
Q

Hard & Soft Signs

A
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31
Q

What characterizes anterior cord syndrome?

A

Loss of motor function, pain, & temperature distal to lesion.

32
Q

What functions are preserved in anterior cord syndrome?

A

Vibration, position, and tactile sensation

33
Q

What is the classic history of central cord syndrome?

A

Elderly with preexisting cervical spondylosis gets a hyperextension injury

34
Q

What is affected in central cord syndrome?

A
  • Decreased strength
  • Decreased pain & temperature
  • Usually more in the upper extremities

Bilateral symptoms.

Upper ext are more medial

35
Q

What is the classic history of Brown seqard syndrome?

A

Hemisection of cord due to penetrating injury

36
Q

What are the symptoms seen in Brown-seqard syndrome?

A
  • IPSILATERAL loss of motor function, propioception, & vibratory sensation. (MVP)
  • CONTRALATERAL loss of pain and temperature. (OPT)

Must-know!

Brown Is my MVP hes a CPT
BROWN

B: Back pain (initially)
R: Reduced proprioception and vibration sense (on the same side as the lesion)
O: Opposite loss of pain and temperature sensation (on the contralateral side)
W: Weakness and paralysis (on the same side as the lesion)
N: Neurogenic bladder or bowel dysfunction
37
Q

Cauda Equina Mnemonic

A
  • Saddle anesthesia
  • Pain (lower)
  • Incontinence
  • Numbness (groin/legs)
  • Emergency (needs surgery)

SPINE

38
Q

What nerve root does CES occur below?

A

L1

39
Q

Summary of Cord Syndromes

A

Memorize this image!

40
Q

Generally, what is a small pneumothorax?

A
  • < 1 cm wide
  • confined to upper third of chest
41
Q

What are the S/S of a tension pneumothorax?

A
  • Tachypneic
  • Tachycardic
  • Tracheal deviation
  • No breath sounds
42
Q

Where and how is a tension pneumothorax treated?

A

Needle decompression in the 4th AICS in midclavicular? above rib.

Then put a chest tube

43
Q

When is laparotomy indicated?

A

ANY blunt abd trauma with diffuse peritonitis or unstable hemodynamics

44
Q

What kind of abdominal injury generally does not appear on physical exam?

A

Hemorrhage due to mesenteric injury

Hollow viscus injury

45
Q

What does mobility of the pelvis with anterior to posterior pressure with heels of hands on ASIS suggest?

A

Pelvic ring disruption

You only get one shot to test it!! Otherwise bleeding will occur

46
Q

What lab is used to check for rhabdo?

A

CK (5x ULN)

Check if anyone was found down for unknown time

47
Q

What urine is suspicious for rhabdo?

A

Dark, tea-colored urine

Or coke colored urine

48
Q

What is the classic triad of rhabdo?

A
  1. Muscle pain
  2. Weakness
  3. Dark urine
49
Q

What 5 things do you check in compartment syndrome?

A
  • Pain
  • Paresthesias
  • Pallor
  • Pulselessness
  • Paralysis

the 5 P’s

Pain is pain out of proportion

50
Q

Where is the MC location for compartment syndrome?

A

Calf

51
Q

Where are non-accidental bruises found on pediatrics?

A
  • Torso (abd)
  • Neck
  • Ears
  • Cheeks
  • Buttocks
  • Back (if clustered, large, and symmetrical)
52
Q

What kind of burns are suspicious for abuse?

A
  • Stocking-glove distribution
  • Clear demarcations
53
Q

What kind of rib fx are suspicious for child abuse?

A
  • Any rib fx unless severe trauma is present
  • Posterior rib fx is most suspicious
54
Q

What is a shear injury?

A

Metaphyseal fx caused by yanking or shaking

Highly sus for child abuse

Spiral fx are also very sus

55
Q

Top RFs for IPV/abuse

A
  • Female
  • Ages 18-24
  • Low socioeconomic
  • Separated relationship
  • Rental housing
56
Q

Use of what in male patients can increase detection of trauma?

A

Anoscopy

57
Q

What are some characteristic injuries of IPV?

A
  • Fingernail scratches
  • Bite marks
  • Cigarette burns
  • Rope burns
  • Forearm bruising
  • Nightstick fx (defensive posture)
  • Abdominal injuries in pregnant
58
Q

When must evidence collection for sexual assault occur by?

A

Within 72 hours

Need informed consent prior to using a rape kit

59
Q

If the timeframe for evidence collection has passed or the victim declines, what else do you do in regards to sexual assault evaluation?

A
  • H&P
  • Prophylaxis from pregnancy and STIs
  • Urine sample if suspicious of drug-induced rape

> 72 hours

60
Q

What kind of determination is sexual assault?

A

A legal determination

It is not a Dx

61
Q

Who gets screened for IPV?

A

Essentially any female presenting to the ED

62
Q

What are your options for emergency contraception in the ED?

A
  • Single dose levonorgestrel (OTC)
  • Ulipristal acetate (Rx)
  • Ovral 2 pills BID once
63
Q

What is the STD prophylaxis regimen in the ED for sexual assault?

A
  • Rocephin 250 mg IM or Cefixime 400 mg PO
  • Metronidazole 2g PO
  • Azithromycin 1g PO or Doxy 100mg PO BID x 7 days

1 from each category

Doxy is the only 7 day one
Rocephin = gonorrhea
Macrolides = chlamydia
Metro = Trichomonas + vaginosis

64
Q

Besides the 3 STDs treated prophylactically, what STD can be treated when it appears and how?

A

Syphilis via Pen G IM or erythromycin 500 mg PO Q6H for 15 days

Single dose vs 15 days…

65
Q

What is the consensus on hepatitis prophylaxis and HIV?

A
  • Only give hep vaccine if not previously vaccinated.
  • HIV prophylaxis is generally only indicated for high risk pts
66
Q

When is a person most at risk for IPV during their relationship?

A

When they try to break up

67
Q

What is the primary presentation of a child neglected in early infancy?

A

FTT

Wide eyed, hypertonic LE, difficult to console, excessive wt gain?

68
Q

What is a psychosocial dwarf?

A
  • Child over the age of 2
  • Short stature
  • Bizarre and voracious appetites
  • Hyperactive with unintelligible or delayed speech
69
Q

What findings suggest physical abuse in a child?

A
  • Inconsistent history
  • Bruises over multiple areas
  • Bite injuries > 3 cm
  • Mouth lacs due to force-feeding
  • Burns of whole hands/feet
  • its so long just see below
70
Q

Describe Munchausen by proxy

A
  • Medical child abuse
  • Parent fabricates illness in child to get attention from providers.
  • They can give drugs to induce conditions
  • They typically WANT diagnostic tests and are happy abt positive tests.
71
Q

What might suggest a child has been abused sexually?

A
  • Overly compliant with painful procedures
  • Overly protective of abusing parent
  • Overly affectionate of medical staff
72
Q

Under what age would a serious injury immediately raise suspicion of abuse?

A

5

73
Q

When is speculum exam needed in a child?

A

Only if perforating vaginal trauma is suspected

74
Q

How do you test for STDs in children?

A

Cultures

Rapid antigen tests are not reliable.

75
Q

What are the 2 MC types of elder abuse?

A
  1. Caregiver neglect
  2. Financial abuse

Reportable in all 50 states.

EM Exam #2 Retake (7 decks)

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