Pestana: trauma Flashcards
what can be done to secure airway is there is a foreign body present?
cricothyroidectomy
is CVP raised or lowered with hypovolemic shock, cardiogenic shock, pericardial tamponade, and tension pneumothorax, vasomotor shock?
CVP raised: cardiogenic shock, pericardial tamponade, pneumothorax
CVP lowered: hypovolemic shock, vasomotor shock
preferred route of fluid rescuitation in trauma setting is…
2 peripheral IV lines, 16 gauge
management of pericardial tamponade
pericardiaocentesis,
pericardial window
thoractomy
signs of a fracture affecting the base of the skull
raccoon eyes
rhinorrhea
otorrhea
ecchymosis behind ears
expectant management (fear of cervical spine injury)
signs of acute epidural hematoma
unconsciosness, lucid interval then back into coma
fixed dilated pupil
contralateral hemiparesis with decerebrate posture
acute subdural hematoma management
ICP monitoring elevate head hyperventilate avoid fluid overload, give mannitol, furosemide hypothermia- to reduce o2 demand
chronic subdural hematomas seen in
very old people or severe alcoholics
can you get hypovolemic shock from intracranial bleeding?
no, not enough space
penetrating wound to the neck requires what management if patient has deteriorating vital signs or tracheal/esophageal injury?
exploratory surgery
which imaging is best to assess status of cervical spine in emergency setting?
CT for bones, but MRI for spinal cord injuries
anterior cord syndrome effects
loss of motor (CST) and pain/temp (STT) bilaterally
central cord syndrome effects
paralysis and burning pain in upper extremities
central cord syndrome cause
elderly- forced hypertension of neck (rear ends)
rib fracture treatment
local nerve block and epidural catheter
rib fracture can be deadly in elderly because…
pain –> hypoventilate –> atelectasis –> pneumonia
what is a flap that sucks air with inspiration and closes during expiration
sucking chest wound- can lead to deadly pneumothorax!
flail chest
multiple rib fractures allow segment of chest wall to cave in during inspiration and bulge out during expiration (pardoxic breathing)
–> pulmonary contusion
pulmonary contusion on CXR
white out of lungs
what should you suspect when sudden death occurs in a chest trauma patient who is intubated and on a respirator
or when subclavian vein opened to air/CVP lines that become disconnected
air embolism
management and prevention of air embolism
manage: cardiac massage
prevent: trendelenburg position when great veins at base of neck are entered
what is this? long bone fracture –> fever, tachycardia, petechiae, low platelets –> resp distress with bilateral patchy infiltrates on CXR
fat embolism
whats diagnostic if fat embolism reaches brain?
star field pattern on MRI
manage gunshot wounds to abdomen
exploratory laparotomy to repair injuries (not to remove bullets)
which imaging is preferred to diagnose intraabdominal bleeding
CT
what imaging for intraabdominal bleeding if patient is hemodynamically unstable?
FAST sonogram- confirms belly is full of blood
most common source of significant intraabdominal bleeding in blunt abdominal trauma
ruptured spleen
treating intraoperative development of coagulopathy
platelet packs and fresh frozen plasma
managing abdominal compartment syndrome, when tissue is too swollen to close
temporary cover- absorbable mesh (that can be grafted over) or nonabsorbable plastic to be removed later
do scrotal hematomas need intervention?
nope
unless testicle ruptured- do sonogram
what will happen if penis fracture is untreated surgically?
impotence! from arteriovenous shunts
what is main issue in penetrating injury of extremities?
vascular injury
what imaging is done if penetrating injury to extremity near major vessel?
doppler or CT angio
order of management when you hurt nerve, bone, and artery
- bone
- artery
- nerve
prevent compartment syndrome in crushing injuries
fasciotomy
fluids, diuretics, alkanize urine
chemical burn management
irrigation!!
whats worse: alkaline burns or acid?
alkaline (drano)
diagnostics for respiratory burns (inhalation injuries)
fiberoptic bronchoscopy
blood gases–determine whether resp support needed
most important management of extensive thermal burns
fluid replacement- lactated ringers
what topical agent should you use for burn care
silver sulfadizine
when is tetanus ppx needed?
penetrating wounds, burns, bites
is rabies ppx needed for dog bites?
domesticated: no, just observe if dog gets rabies.
wild: then get ppx
snake bite envenomation signs
severe local pain
swelling
discoloration
within 30 min
management of snake bite with venom
type and cross blood
coag studies
liver and renal function
CROFAB antivenin
brightly colored coral snakes bite management and tip for recognizing coral snake
dont wait for signs, just neutralize with antivenin
red on yellow, kill a fellow (red and yellow rings touch eachother, without black separating
black widow spider feature
black with red hourglass on their belly
black widow spider bite signs
N/V, muscle cramps
antidote to black widow spider bites
calcium gluconate
muscle relaxants can help
brown recluse spider bite sign
day after: skin ulcer with necrotic center and surrounding halo of erythema
treatment of brown recluse spider bite
dapsone
surgical excision, or grafting may be needed
bacteriologically, the dirtiest bite comes from
humans!
