Review Deck Flashcards
GCS categories
Mild 14-15
Moderate 9-13
Severe 3-8
What is the lower limit of autoregulation for CCP?
CCP <60
If you dont have a ICP monitor you must?
Keep MAP >80
MC type of brain herniation?
UNCAL herniation
- temporal lobe damage
- causes ipsilateral fixed dilated pupil
What is cerebellotonsillar herniation?
Cerebellum starts to herniate through foramen magnum
S/s of cerobellotonsillar herniation?
Pinpoint pupils
Flaccid paralysis
Sudden death
What is upper transtentorial herniation?
Caused by a lesion on the posterior fossa
S/s of upper transtentorial herniation?
Conjugate downward gaze
Absence of vertical eye movements
Pinpoint pupils
What are the intubation agents for brain injury?
Induction agent
- Etomidate .3mg/kg IV
- Propofol 1-3 mg/kg IV
Paralytics
- succinylcholine 1-1.5 mg/kg IV
- rocuronium .6-1 mg/kg IV
Etomidate factoids?
Induction agent
- .3 mg/kg IV
- Neuroprotective
- May lower ICP
- Adrenal suppression unlikely in 1 dose
Propofol factoids
Induction agent
- 1-3mg/kg
- anti-seizure properties
- HOTN (if inadequate fluids)
Succinylcholine factoids
Paralytics
- 1-1.5mg/kg
- short acting
Avoid in
- burns
- excessive muscle trauma
Rocuronium factoids?
Paralytics
- 0.6-1.0 mg/kg IV
- short active
- safe in hyperkalemia
A linear skull fracture with overlying laceration is?
An open fracture
Test for CSF?
Beta 2 transferring
- not found in mucous or tears, only CSF
Comparrison of head injurires
Lesson 2
Slide 66
“He said its a great chart”
Most frequently injured abdominal organ(s)?
Overall: liver
Sports: spleen
What is the greatest benefit of the FAST exam?
Rapid ID of free intraperitoneal fluid in the HYPOtensive pt in blunt abdominal trauma
Blunt trauma unstable + FAST:
Blunt trauma unstable - FAST:
Blnt trauma stable:
Blunt trauma unstable + FAST: OR
Blunt trauma unstable - FAST: repeat FAST/resuscitate
Blnt trauma stable: CT
Indications for laparotomy in blunt trauma pt?
Absolute
- anterior abd inj w HOTN
- abd wall disruption
- peritonitis
- free air under diaphragm
- FAST/DPL in hemodynamically unstable pt
- CT says you need it
Relative
- FAST/DPL in stable pt
- Solid visceral inj in stable pt
- hemoperitoneum on CT w/o clear source
Indications for laparotomy in penetrating trauma?
Absolute
- inj to abd, back, flank w HOTN
- abd tenderness
- GI evisceration
- High suspicion for transabdominally trajectory after GSW
- CT diagnosed inj req surgery
Relative
- + local wound exploration after stab wound
Spinal injury is most often?
Cervical spine is MC
- C2 MC of cervical
- C5-C7 2nd MC
Spinal nerve anatomy?
31 pairs of spinal nerves
- 8 cervical
- 12 thoracic
- 5 lumbar
- 5 sacral
- 1 coccygeal
Corticospinal tract
DO NOT cross so ipsilateral clinical findings
Controls motor
- muscle weakness
- spasticity
- increased DTR
- babinski’s sign (toes flare, extend)
Spinothalamic tract?
Crosses in spinal cord - contralateral findings
Pain and temp
- loss of pain ant temp (contralateral)
Dorsal columns?
Vibration and proprioception
Ipsilateral
What is required to see light touch sensation completely lost?
Damage to Both:
- spinothalamic tract
- dorsal columns
It says COMPLETE loss
Incomplete cord syndromes?
Anterior cord syndrome
Central cord syndrome
Brown sequard syndrome
Anterior cord syndrome?
Anterior cord compression
caused by
- flexion of c spine
- thrombosis of anterior spinal artery
Leads to
- complete paralysis below lesion
- loss of pain and temp
- preservation of vibratory function
Central cord syndrome?
Caused by
- hyperextension injuries
- disruption of blood flow to spinal cord
- c spine stenosis
Leads to quardraparesis
- greater in upper than lower extremities
Loss of pain and temp
- greater in upper than lower extremities
Brown sequard syndrome?
Transverse hemisection of spinal cord or unilateral cord compression
IPSILATERAL
- spastic paresis
- loss of proprioception and vibration
CONTRALATERAL
- loss of pain and temp
Only one with both ipsilateral and contralateral
Your amazing radiology trained eyes spot a throacolumbar spine fx, now what?
Get a CT
- you cant ignore that shit
Rule of 10s?
Burn treatment
Acute fluid resuscitiaon
Adults: = 80kg: 10ml/hr x %TBSA
>/= 80kg add 100 ml/hr q 10 kg over 80
Kids: 3x TBSA x kg - amount of fluid to give in 1st 24 hrs
- 1/2 of total amount in first 8 hrs
Preferred fluids for burns?
Lactated ringer
PlasmaLyte
Dont use NS
When treating burns how can you track fluid status?
Monitor urine output
Titrate to:
- adults: 30-50ml/hr
- kids: 0.5 - 1ml/kg/hr
level 1 trauma center characteristics?
24 hr availability of:
- surgeon: every type
- neuroradiology
- hemodialysis
Program that establishes and monitors effect of injury prevention and education efforts
Organized trauma research program
Blunt abdominal trauma unstable pts need?
FAST exam
+ : OR
- : stabilizer
Blunt abdominal trauma stable pts need?
Fast exam
+ : OR
- : CT
Penetrating trauma pts need?
Unstable : or
Any unstable pt needs?
OR or US
Any Stable trauma pt needs?
CT
What does FAST look for? (Limitations)
Fluid
- doesn’t ID blood or not
- doesn’t tell you what is bleeding
There will be a scenario
It will ask you if you should intervene on this pt
if HR is 100 in trauma:
- we expect that, dont make a big deal of it
Nexus criteria
Criteria for omitting c spine imaging
No posterior midline C spine tenderness No evidence of intoxication Altered mental status No focal neuro deficits No painful distracting injuries
Or
NEXUS N: neuro E: ETOH X: distracting inj U: unstable (alterd LOC) S: spine (midline tenderness)
Blood loss class I?
Blood loss: 750ml Blood loss %: 15% Pulse: <100 Blood pressure: normal Pulse pressure: normal/increased
Blood loss class II
Blood loss: 750-1500 Blood loss %: 15-30% Pulse: 100-120 Blood pressure: normal Pulse pressure: decreased
Blood loss Class III
Blood loss: 1500-2000 Blood loss %: 30-40% Pulse: 120-140 Blood pressure: decreased Pulse pressure: decreased
Blood loss Class IV
Blood loss: >2000 Blood loss %: 40% Pulse: >140 Blood pressure: decreased Pulse pressure: decreased
ED thoracotomy
Pts w:
- penetrating chest trauma
- witnessed signs of life during transport
- at least come cardiac electrical activity upon arrival
Pts who dont qualify for thorocotomy?
Penetrating trauma:
- CPR (pulseless)
- with out signs of life
Blunt trauma
- CPR (pulseless)
- myocardial electrical activity
Things that happen before transfer
The only thing I found was that they should be Hemodynamic stability
But then one of the slides says they can be transferred IOT get stabilized
So IDK, if you have any ideas please change this card
Difference between laparoscopy and laparotomy?
Laparoscopy: scope
Laparotomy: big cut
What kind of pt needs laparotomy?
All patients w
- persistent hypotension
- abdominal wall disruption
- peritonitis
Need surgical exploration
In penetrating and blunt trauma with concern for broken vessels you should get?
CT angiography
Gold standard test for abdominal injury?
CT w IV contrast
Definitive treatment?
Surgeons definitively treat
ED does not definitively treat
- only stabilize
