NRSRGRY - TRM Flashcards
Leading cause of death in children and young adults
trauma
True about scalp injury
a. Bleed profusely
b. For simple injury close with secondary intention
c. both
d. neither
A
Fracture covered with intact skin
Skull fracture
fracture associated with disrupted overlying skin
Open/compound fracture
breaks in the bone that transverse the full thickness of the skull from the outer to inner table. They are usually fairly straight with no bone displacement.
linear fracture
A bone fracture in which the lines of break radiate from a point, usually from the site of an injury.
stellate
a fracture in which the bone has broken into several pieces.
Comminuted fracture
Ecchymosis behind the ear as a sign of basal skull fracture is called
battle’s sign
Periorbital ecchymosis as a sign of basilar skull fracture is called
raccoon’s eyes
Immediate injury to neurons from transmission of the force of impact
Primary injury
Subsequent neuronal damage due to the sequelae of trauma
Secondary injury
What comprises initial assessment of closed head injuries
ABCD(E) Airway Breathing Circulation Disability Exposure
medical management of closed head injuries to decrease incidence of early post
Phenytoing 17 mg/kg loading dose
Phenytoin 300-400 mg/kg/day
Peptic ulcer as a result of brain injury
Cushing’s ulcer
Mild traumatic Brain injury GCS level
13-15
Severe traumatic Brain injury GCS level
3-8
Moderate TBI GCS level
9-12
At least what GCS to intubate?
8 below
temporary neuronal dysfunction following nonpenetrating head trauma
Concussion
bruise of the brain occurs when the force from trauma is sufficient to cause breakdown of small blood vessels and extravasation of blood into the brain
contusion
damage to axons throughout the brain due to rotational acceleration and then deceleration
diffuse axonal injury
Shape of epidural hematoma on imaging
lenticular (biconvex)
Shape of subarachnoid hemorrhage on imaging
Crescent
Definition of brain death
absence of signs of brain stem function or motor response to deep central pain in the absence of systemic medical conditions that could impair brain function
What are the criteria to declare brain death?
a. 3 clinical exams 12 hours apart
b. 2 clinical exams 12 hours apart
c. 1 clinical exam and a confirmatory test
d. 2 confirmatory tests
e. A and B
f. B or C
g. B, C or D
F
What are the clinical exams that could be performed to evaluate for brain death?
Nonreactive pupils No corneal blink reflex No oculocephalic reflex No oculovestibular reflex Loss of drive to breath ( apnea test) No response to deep central pain
Positive doll’s eyes
eyes move in the opposite direction of the head movements, and it is therefore sometimes called doll’s eyes
Positive vestibulo-ocular reflex
Ice cold or warm water or air is irrigated into the external auditory canal, usually using a syringe. head turn to the contralateral side. The eyes then turn toward the ipsilateral ear, with horizontal nystagmus to the contralateral ear.
Type of neurologic spinal injury with residual motor or sensory function below the level of the lesion
Incomplete spinal injury
Spinal injury that persist for >24 hours, no function below the level of injury and probability of return to function is low
Complete spinal injury
True about initial assessment and management of spine injury EXCEPT
a. must be considered in select patients
b. a patient with no sx, referable to neurologic injury, no neck or back pain and a known mechanism of injury unlikely to cause spine injury is at minimal risk for significant injury to the spine
c. trauma patient should be kept on flat board with pad s and strap for immobilization
d. hard cervical collar is kept in place
A. in all px
injury to the entire cord with total loss of motor and sensory function below the level of the lesion
cord transection
injury to half the cord resulting in loss of motor control and proprioception ipsilaterally and loss of nociceptor and thermoception contralaterally
Brown Sequard sydrome
Injury to inferior gray mater of the cord in the cervical spine with UE worse than LE
central cord syndrome
Bilateral paralysis and loss of nocicpetion and thermoception
Anterior cor syndrome
What plain films provide rapid survey of bony spine
Anteroposterior
Open mouth
Lateral plain films
Definitive management for spinal cord injury
Spinal dose steroids
Orthotic devices
Surgery
