Random Misc e.g. Trauma Flashcards
When might you want to do jaw thrust over a head tilt chin lift?
In a patient where cervical spine injury is a concern
Which airway protects against aspiration?
Endotracheal tube
Which airway is CI in base of skull fracture?
Nasopharyngeal airway
Which airway is most common operatively?
Oropharyngeal airway
How can you assess the extent of a burn?
Rule of Nines Head + Neck = 9% Each Arm = 9% Front of chest = 9% Front of abdomen = 9% Back of chest = 9% Back of abdomen = 9% Front of leg = 9% Back of leg = 9%
How can you assess the depth of a burn?
Red and painful = first degree (superficial epidermal)
Pale pink/blistered = second degree (superficial dermal)
White + reduced sensation = second degree (deep dermal)
White/brown/black, no pain = third degree (full thickness)
Who needs referral to secondary care for a burn?
All deep dermal + full thickness (any that are white or reduced sensation)
Any superficial dermal of more than 3%
Any superficial dermal involving hands/face/feet/perineum/genitalia
Any inhalation injury or burn caused by electrical/chemical
How to initially manage a burn?
Superficial epidermal = symptomatic relief and emollients only
Superficial dermal = cleanse wound, leave blister intact
In more severe burns - consider intubation and inserting a Catheter (basically do an A-E)
Who requires IV fluids for burns? How is the amount of fluid calculated?
Child = burns more than 10% Adult = burns more than 15%
Volume of fluid = burn surface area (%) x weight x 4
Half of this fluid should be given in first 8 hours
What are red flag signs of head injury?
Impaired consciousness Fixed + dilated pupils Base of skull fracture FOcal neurological deficit Seizures/Amnesia
What are the indications for a CT head after a head injury?
GCS <13 at time of arrival GCS <15 after 2 hour Any signs of skull fracture Seizure More than one episode of vomiting Focal neurological deficit
How do you assess brainstem death?
Need to check all brainstem reflexes Pupillary light reflex Corneal reflex Pain stimuus Gag reflex Cough reflex
What is a diffuse axonal injury and how can you diagnose it?
Type of traumatic brain injury not seen on CT
Need to do head MRI
How is a tibial shaft fracture managed?
Realign ASAP - ideally in A+E under analgesia
Then above the knee backslab
Repeat XR after manipulation
THen likely need definitive surgical management with intramedullary nailing
What is the main complication of a tibial shaft fracture?
High risk of compartment syndrome
How is a suspected cervical fracture investigated and managed?
In adults = CT scan
In children = MRI scan
C spine immobilisation with a collar
DO NOT DO A HEAD TILT/CHIN LIFT!
How do you manage a suspected pelvic fracture?
Do a full neuromuscular assessment and check anal tone
Need to get 3 x-rays
Do a primary survey and put in a pelvic binder
Complications = urological injury/VTE
What are red flag signs for a base of skull fracture? How can it be diagnosed?
Traumatic head injury e.g. RTC Reduced consciousness bruising around the eyes rhinorrhoea - possibly leaking CSF cranial nerve palsy bleeding from nose or ears
CT head required
DO NOT INSERT NASOPHARYNGEAL AIRWAY!
What is pre-operative fracture management?
- Effective analgesia
- Reduction of deformity
- Irrigation and debridement of open fractures
- Administration of antibiotics where indicated
- Immobilisation of fracture
What are the two types of urethral injury?
Bulbar rupture and membranous rupture
What are the features of a bulbar rupture of the urethra?
- Urinary retention
- Perineal haematoma
- Blood at the meatus
What are the features of a membranous rupture of the urethra?
Penile/perineal oedema or haematoma
PR will show upwards displacement of prostate
How can you investigate urethral injury?
Ascending urethrogram
How can you manage a urethral injury?
Suprapubic catheter
What are signs of a bladder injury? How can you investigate this?
Haematuria + suprapubic pain
Cystogram
What are features of acute urinary retention?
Acute suprapubic pain
Unable to pass urine
Palpable distended bladder
How should you investigate acute urinary retention? How is it managed?
PR + post-void bladder scan
May need to do an ultrasound to assess for hydronephrosis
management = immediate catheterisation
If hydronephrosis then nephrostomy may be needed(?)
What is the main complication of draining an acute bladder retention?
Post-obstructive diuresis
When there was a large retention volume
AKI after urinary retention
need to monitor urine output closely
