Pestana

Question 1

3 causes of shock in trauma setting

Answer 1

1) hemmorrahgic (most common) (low CVP)
2) pericardial tamponade (high CVP, no resp dist)
3) tension pneumothorax (high CVP with resp dist)

Question 2

Hemmorhagic shock: First step (urban vs all ovthers)

Answer 2

Urban: surgical intevention to stop bleeding

All others: volume resuscitation (2L LR the packed red cells)

Question 3

Imaging is pericardial tamponade suspected?

Answer 3

US

Question 4

Fluids for cardiogenic shock?

Answer 4

NO! lethal. Treat with circulatory support. Recognize via high CVP.

Question 5

Vasomotor shock treatment?

Answer 5

Pressors

Question 6

Skull base fractures - how to recognize and what to avoid?

Answer 6

Raccoon eyes, rhinorrha, otorrhea, ecchymosis behind ears

AVOID NASAL ENDOTRACHEAL INTUBATION

Question 7

Hematoma with lucid interval?
Trauma where?
CT shows shape?

Answer 7

Epidural
Side of head
Biconvex, lens-shaped

Question 8

Subdural hematoma - CT finding?
Treatment goal?
Methods?

Answer 8

Crescent shaped hematoma
Preventing damage from ICP
Elevate head, hyperventilate to CO2 35, mannitol or furosemide, hypothermia or sedation to reduce O2 demand

Question 9

Brown-Sequard (hemi section) - sx on injury and non-injury side?

Answer 9

Injury side: paralysis and loss of proprioception distal to injury
Non-injury side: loss of pain perception distal to injury

Question 10

Anterior cord syndrome - typical scenario?

Lost and preserved?

Answer 10

Burst vertebral body fractures
Lost: motor, pain sensation and TEMPERATURE SENSATION b/l distal to injury
Preserved: vibration and position sense

Question 11

Central cord syndrome - typical scenario?

Sign?

Answer 11

Elderly, rear-ended (forced hyperextension)

Paralysis and burning pain in UE, preserved function LE

Question 12

Hemothorax diagnostic imaging?
Surgery required?
Treatment?

Answer 12

CXR
Not often (unless intercostal artery is source of bleeding not lung)
Evacuate blood to prevent empyema

Question 13

Suckling chest wounds - what is it? What do you do?

Answer 13

Flap that sucks air in but does closes during expiration

Occlusive dressing that lets air out but not in

Question 14

Deteriorating blood gases and “white out” of lungs on CXR right after chest trauma - 48 hours later?
Treat?

Answer 14

Pulm contusion

Fluid restrict and diuretics

Question 15

Suspect what with sternal fractures?

And check with?

Answer 15

Myocardial contusion

EKG

Question 16

Bowel in LEFT chest (PE and CXR) - suspect what and check how?

Answer 16

Rupture of diaphragm

Eval with laparoscopy

Question 17

When to suspect traumatic aortic rupture?

How to check?

Answer 17

If severe deceleration injury
First rib, scapula, sternum breaks
Check with spiral CT, with IV dye (ie. CAT angio)

Question 18

Air embolism - when suspected and management?

Answer 18

Subclavian open to air (line placement, disconnected etc.)

Cardiac massage, patient left side down

Question 19

Pt with multiple trauma, long bone fractures, with petechial rashes in axillae and eneck, fever, tachy, low PL - what is it???
Treat?

Answer 19

Fat embolism

Resp support

Question 20

3 places where blood can go if hypovolemic shock?

Answer 20

abdomen, thighs, pelvis

Question 21

Clue you can do CT?

Answer 21

“hemodynamically stable”

Question 22

How to assess if there is intraabdominal bleeding in hemodynamically unstable?
Next step if positive?

Answer 22

diagnostic peritoneal lavage or US (FAST)

Go to ex lap

Question 23

Most common cause of SIGNIFICANT intraabdominal bleeding?

Answer 23

Ruptured spleen
(insignifciant but more common: liver)
TRY to REPAIR rather than remove

Question 24

Bacteria esp susceptible to if asplenic?

Answer 24

H-flu B, pneumococcus, meningococcus