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Senior - Emed 4 > Review Deck > Flashcards

Review Deck Flashcards

1
Q

GCS categories

A

Mild 14-15
Moderate 9-13
Severe 3-8

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2
Q

What is the lower limit of autoregulation for CCP?

A

CCP <60

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3
Q

If you dont have a ICP monitor you must?

A

Keep MAP >80

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4
Q

MC type of brain herniation?

A

UNCAL herniation

  • temporal lobe damage
  • causes ipsilateral fixed dilated pupil
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5
Q

What is cerebellotonsillar herniation?

A

Cerebellum starts to herniate through foramen magnum

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6
Q

S/s of cerobellotonsillar herniation?

A

Pinpoint pupils
Flaccid paralysis
Sudden death

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7
Q

What is upper transtentorial herniation?

A

Caused by a lesion on the posterior fossa

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8
Q

S/s of upper transtentorial herniation?

A

Conjugate downward gaze
Absence of vertical eye movements
Pinpoint pupils

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9
Q

What are the intubation agents for brain injury?

A

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
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10
Q

Etomidate factoids?

A

Induction agent

  • .3 mg/kg IV
  • Neuroprotective
  • May lower ICP
  • Adrenal suppression unlikely in 1 dose
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11
Q

Propofol factoids

A

Induction agent

  • 1-3mg/kg
  • anti-seizure properties
  • HOTN (if inadequate fluids)
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12
Q

Succinylcholine factoids

A

Paralytics

  • 1-1.5mg/kg
  • short acting

Avoid in

  • burns
  • excessive muscle trauma
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13
Q

Rocuronium factoids?

A

Paralytics

  • 0.6-1.0 mg/kg IV
  • short active
  • safe in hyperkalemia
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14
Q

A linear skull fracture with overlying laceration is?

A

An open fracture

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15
Q

Test for CSF?

A

Beta 2 transferring

- not found in mucous or tears, only CSF

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16
Q

Comparrison of head injurires

A

Lesson 2
Slide 66

“He said its a great chart”

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17
Q

Most frequently injured abdominal organ(s)?

A

Overall: liver
Sports: spleen

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18
Q

What is the greatest benefit of the FAST exam?

A

Rapid ID of free intraperitoneal fluid in the HYPOtensive pt in blunt abdominal trauma

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19
Q

Blunt trauma unstable + FAST:

Blunt trauma unstable - FAST:

Blnt trauma stable:

A

Blunt trauma unstable + FAST: OR

Blunt trauma unstable - FAST: repeat FAST/resuscitate

Blnt trauma stable: CT

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20
Q

Indications for laparotomy in blunt trauma pt?

A

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
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21
Q

Indications for laparotomy in penetrating trauma?

A

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

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22
Q

Spinal injury is most often?

A

Cervical spine is MC

  • C2 MC of cervical
  • C5-C7 2nd MC
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23
Q

Spinal nerve anatomy?

A

31 pairs of spinal nerves

  • 8 cervical
  • 12 thoracic
  • 5 lumbar
  • 5 sacral
  • 1 coccygeal
24
Q

Corticospinal tract

A

DO NOT cross so ipsilateral clinical findings

Controls motor

  • muscle weakness
  • spasticity
  • increased DTR
  • babinski’s sign (toes flare, extend)
25
Q

Spinothalamic tract?

A

Crosses in spinal cord - contralateral findings

Pain and temp
- loss of pain ant temp (contralateral)

26
Q

Dorsal columns?

A

Vibration and proprioception

Ipsilateral

27
Q

What is required to see light touch sensation completely lost?

A

Damage to Both:

  • spinothalamic tract
  • dorsal columns

It says COMPLETE loss

28
Q

Incomplete cord syndromes?

A

Anterior cord syndrome
Central cord syndrome
Brown sequard syndrome

29
Q

Anterior cord syndrome?

A

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
30
Q

Central cord syndrome?

A

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

31
Q

Brown sequard syndrome?

A

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

32
Q

Your amazing radiology trained eyes spot a throacolumbar spine fx, now what?

A

Get a CT

- you cant ignore that shit

33
Q

Rule of 10s?

A

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

34
Q

Preferred fluids for burns?

A

Lactated ringer
PlasmaLyte

Dont use NS

35
Q

When treating burns how can you track fluid status?

A

Monitor urine output

Titrate to:

  • adults: 30-50ml/hr
  • kids: 0.5 - 1ml/kg/hr
36
Q

level 1 trauma center characteristics?

A

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

37
Q

Blunt abdominal trauma unstable pts need?

A

FAST exam
+ : OR
- : stabilizer

38
Q

Blunt abdominal trauma stable pts need?

A

Fast exam
+ : OR
- : CT

39
Q

Penetrating trauma pts need?

A

Unstable : or

40
Q

Any unstable pt needs?

A

OR or US

41
Q

Any Stable trauma pt needs?

A

CT

42
Q

What does FAST look for? (Limitations)

A

Fluid

  • doesn’t ID blood or not
  • doesn’t tell you what is bleeding
43
Q

There will be a scenario

A

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

44
Q

Nexus criteria

A

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)
45
Q

Blood loss class I?

A 
Blood loss: 750ml
Blood loss %: 15%
Pulse: <100
Blood pressure: normal
Pulse pressure: normal/increased
46
Q

Blood loss class II

A 
Blood loss: 750-1500
Blood loss %: 15-30%
Pulse: 100-120
Blood pressure: normal
Pulse pressure: decreased
47
Q

Blood loss Class III

A 
Blood loss: 1500-2000
Blood loss %: 30-40%
Pulse: 120-140
Blood pressure: decreased
Pulse pressure: decreased
48
Q

Blood loss Class IV

A 
Blood loss: >2000
Blood loss %: 40%
Pulse: >140
Blood pressure: decreased
Pulse pressure: decreased
49
Q

ED thoracotomy

A

Pts w:

  • penetrating chest trauma
  • witnessed signs of life during transport
  • at least come cardiac electrical activity upon arrival
50
Q

Pts who dont qualify for thorocotomy?

A

Penetrating trauma:

  • CPR (pulseless)
  • with out signs of life

Blunt trauma

  • CPR (pulseless)
  • myocardial electrical activity
51
Q

Things that happen before transfer

A

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

52
Q

Difference between laparoscopy and laparotomy?

A

Laparoscopy: scope
Laparotomy: big cut

53
Q

What kind of pt needs laparotomy?

A

All patients w

  • persistent hypotension
  • abdominal wall disruption
  • peritonitis

Need surgical exploration

54
Q

In penetrating and blunt trauma with concern for broken vessels you should get?

A

CT angiography

55
Q

Gold standard test for abdominal injury?

A

CT w IV contrast

56
Q

Definitive treatment?

A

Surgeons definitively treat

ED does not definitively treat
- only stabilize

Senior - Emed 4 (6 decks)

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