Ross Trauma Flashcards
1
Q
first consideration in trauma management
A
well being of you and your staff → scene safety
2
Q
protective gear includes (4)
A
gown
gloves
goggles
hair bonnet
3
Q
3 types of parameters that help identify a trauma pt
A
mechanistic
anatomic
physiologic
4
Q
fall indications for major trauma in peds pt
A
fall is:
2-3 times the height of the child
>10 ft
5
Q
fall indications for major trauma for adult pt
A
>20 ft
6
Q
how many feet in 1 story
A
10
7
Q
mechanism criteria for major MVA trauma (6)
A
death in same vehicle
pt ejection
vehicle rollover
intrusion
auto-pedestrian/bicycle > 20 mph
MVA > 20 mph
8
Q
intrusion guidelines for major MVA trauma (2)
A
>12 in in occupant
>18 in anywhere
9
Q
anatomic criteria for major MVA trauma (8)
A
penetrating injury to head, neck, torso
2 or more proximal long bone fx
amputation proximal to wrist or ankle
open or depressed skull fx
crushed or mangled extremity
neuro deficits
pelvic fx
flail chest
10
Q
physiologic criteria for major MVA trauma (3)
A
vitals:
conscious state GCS < 13
hypotn sys <90
rr <9 OR > 30
11
Q
primary survey consists of (5)
A
airway
breathing
circulation
disability
environment/expose pt
12
Q
disability in primary survey represents
A
neuro
13
Q
how should provider proceed with primary survey
A
one step at a time
14
Q
when can primary survey be completed simultaneously
A
if more than one provider can perform ABC
15
Q
airway management includes
A
c spine precaution
16
Q
circulation management includes
A
stop bleeding
17
Q
2 methods of airway management
A
oral airway
intubate
18
Q
indications for intubation (4)
A
massive facial injury
GCS 8 or less
significant neck trauma
penetrating head injury
19
Q
do not miss in breathing management
A
PTX/tension PTX
20
Q
management of sucking chest wound
A
cover on 3 sides
21
Q
3 indications for tension PTX
A
distended neck veins
absent breath sounds unilaterally
deviated trachea
22
Q
management of tension PTX
A
immediately decompress
23
Q
2 methods of bleeding management
A
pressure
tourniquet
24
Q
first steps in advanced trauma life support
A
activate trauma team
designate captain
AMPLE hx
ABC
vitals/monitor
undress
25
what does AMPLE stand for
allergies
medications
PMH
last meal (what time)
events surrounding time of injury
26
what is this showing
tension PTX
27
signs and symptoms of hemorrhage by class
28
what hemorrhage class does HR begin to rise
class II (mild) → 15-30% blood loss
29
what hemorrhage class does bp begin to go down
class III (moderate) → 31-40% blood loss
30
what hemorrhage class indicates need for blood products
class II (mild ) = possible
class III (moderate) = definitely
31
do not forget exam on everyone (even unconscious)
neuro
32
triangle of death
bleeding
hypothermic
coagulopathy
33
GCS eye scale
1-4
34
GCS verbal scale
1-5
35
GCS motor scale
1-6
36
GCS severe coma indications
3-8
37
GCS moderate coma indications
9-12
38
GCS mild coma indications
13-15
39
pt undressed
full head to toe exam is done
better history obtained
secondary survey
40
pt undressed
full head to toe exam is done
better history obtained
secondary survey
41
t/f: FAST exam can be done before OR after the secondary survey
T
42
IVs to obtain
2 large bore
43
t/f: IV's can be obtained before or after secondary survey
T
44
all trauma pt's who are women of child bearing age need
tetanus booster
pregnancy test
45
clinical clearance protocol used to exclude c-spine injury
nexus criteria
46
5 nexus criteria
awake and alert
no e.o intoxication
no midline cervical tenderness
no focal neuro deficits
no painful distracting injury
47
if pt meets nexus criteria you can
take off backboard and remove c-collar clinically
48
nexus criteria is meant to identify
low risk neck pain that does NOT need xray
49
4 stages of hypovolemic shock
initial
compensatory
progressive
refractory
50
where is tourniquet placed
as proximal as possible
51
structures mc injured in blunt neck trauma
hard structures:
larynx
trachea
c spine
52
structures less commonly injured in blunt neck injury
**soft structures (vascular):**
carotid a
vertebral a
53
horner's syndrome in trauma pt might indicate
carotid dissection
## Footnote
*miosis, ptosis, anhidrosis*
54
vertigo in trauma pt might indicate
vertebral dissection
55
c-spine injury has high association w. __ trauma
blunt
56
med that prevents cleavage of plasmin and degradation of fibrin → decreases bleeding w.o significant adverse s.e
TXA (tranexamic acid)
57
when must TXA be given
early in bleeding process
*after 3 hours can be harmful*
58
dosing for TXA
adults: 1 gm
kids: 0.5 gm
59
imaging for blunt neck trauma
neck CT w. and w.o contrast
*will cover c-spine as well*
60
drops of __ are concerning in GCS monitoring
drops of __ are very bad in GCS monitoring
2
3
61
strangulation injury is concerning for damage to __ structures (2)
hard and soft
62
imaging for strangulation injury
CT w. and w.o contrast
63
indication for surgery consult in strangulation injury
LOC
hard signs
64
3 indications for d.c for strangulation injury
asymptomatic
no soft signs
imaging of low yield
65
if the __ is penetrated, pt. will need trauma or surgical consult regardless of zone
platysma
66
what does FGH stand for
fetus → pregnant?
glucose
hypertet → tetanus
67
what does FAST exam stand for
**f**ocused
**a**ssessment
(with)
**s**onography
(for)
trauma
68
zone 1 of the neck
clavicle/sternum to cricoid cartilage
69
zone 2 of the neck
cricoid cartilage to angle of the mandible
70
zone 3 of the neck
superior mandible to skull
71
landmarks for zones of neck:
1:
2:
3:
1: sternal notch
2: cricoid cartilage
3: angle of mandible
72
penetrating injuries to which neck zones do not immediately go to OR
1 and 3
73
penetrating injuries to zone __ need surgical consult in OR
2
74
neck hard signs
**ha2spnmc**
hematoma
hemoptysis
active bleeding
subq emphysema
pulse deficit
neuro deficit
mouth/NGT bleed
crepitus
75
neck soft signs
**hsv + mild tenderness**
hematoma, small
sub q emphysema
voice changes
mild neck tenderness
76
GI/airway hard signs
**hcpts3d2**
hemoptysis
cyanosis
ptx
tracheal deviation
stridor
sucking wound
subq emphysema
distress, respiratory
dysphagia/phonia
77
management of foreign body in neck
do not remove
*may be auto tamponade*
78
what should be avoided in maxillofacial injury
NGT
79
maxillary bone fx w. sx of malocclusion
le fort fx 1
80
fx w. involvement of nasal bone, malocclusion, +/- V2 involvement (anesthesia of skin of face/teeth)
le fort 2 fx
81
how would you classify this injury
penetrating neck injury
82
neck trauma is classified into
blunt
penetrating
83
fx thru zygomatic arches and orbits
le fort 3
84
management of le fort 3 fx
prophylactic intubation or transfer
85
major concern in le fort 3 fx
edema → airway compromise
86
management of nasal bone fx
no x-ray
look for intranasal hematoma → drain
ENT if reduction needed
87
what is this showing
carotid artery dissection
88
carotid a dissection typically occurs w. __ injury
hyperflexion
89
nasal lacerations are concerning for damage to which CN
V
VII
90
structures of concern in nasal laceration
parotid gland
stenson's duct
91
structures of concern in nasal laceration
parotid gland
stenson's duct
92
lethal 6 to look for in primary survey
**oh fact**
airway obstruction
tension ptx
cardiac tamponade
open PNX
HTX
flail chest
93
management of airway obstruction
manage airway
intubate
94
management of tension PTX
needle decompression
chest tube
95
management of cardiac tamponade
needle drainage
xiphoid window
96
beck's triad
JVD
hypotn
muffled heart sounds
97
management of HTX
CT
+/- OR based on CT output
98
paradoxical movement of chest wall dt 2-3 fx in consecutive ribs → prevents oxygenation and increases WOB
flail chest
99
management of flail chest
intubation if severe
OR for fixation
100
indication of significant thoracic aorta injury w. blunt chest trauma
hypotn
101
imaging for significant thoracic aorta injury w. blunt chest trauma
CXR if unstable
CT w. contrast if stable
102
5 cxr findings of thoracic aorta injury
widened mediastinum
loss of aortic knob
left mainstem bronchus depression
apical capping
obliteration of distance btw pulm art and aorta
103
parameter for widened mediastinum
8 cm
104
mc moi for thoracic aorta injury
large velocity changes:
high speed MVA from 75 mph to 0 in short distance
105
what is this showing
tension PTX
106
3 indications of tension PTX on CXR
mediastinal shift
collapsed lung
depressed hemidiaphragm
107
problem w. xray in rib fx
only seen 50% of the time
108
concern w. rib fx in elderly
atelectasis
PNA
109
indication for admit for rib fx in elderly
more than 2 or 3 fx
110
indication for emergent care in rib fx
**flail chest** → 2-3 fx in consecutive ribs → increases wob
111
what is this showing
massive tension PTX
112
consider abdominal trauma if injury is below the \_\_
down to the \_\_
nipple line
pubis
113
4 indications for emergent laparotomy
diffuse peritonitis
penetrating GSW w. peritoneal violation
evisceration
abd tenderness w. hypotn
114
what is this showing
cardiac tamponade
*enlarged bottle shaped heart*
115
2 PE findings that require work up of abd CT scan dt high likelihood of injury
chance fx
handlebar or seatbelt sign
116
what is this showing
HTX
*damage to great vessels of lung*
117
what is a chance fx
lumbar fx
118
what is this showing
handlebar sign
119
what is this showing
seatbelt sign
120
imaging that is done as part of PE
FAST US →
*quick method to find blood*
121
abd tenderness in light of blunt trauma indicates \_\_
ruptured hollow viscus
*easily missed*
122
significant blood loss in abd cavity w.o drastic change in external appearance of abd
ruptured hollow viscus
*easily missed even w. CT*
123
what is this showing
pulmonary contusion
124
28 yo s/p fall off bike
what do you think?
PTX w. rib fx
125
fx of __ ribs indicates high force fx w. likely occult injury
ribs 1-2
126
do not d.c pt if they have fx to which ribs
1-2
127
t/f: flail chest can occur w. 1 rib fx
f! must be multiple rib fx
128
complication of rib belts
atelectasis → PNA
129
indication for thoracotomy
loss of vitals w.in 2-3 min of arrival
130
pelvic fx classifications (3)
lateral compression
vertical shear
AP compression
131
indication for high mortality with pelvic fx
hypotn
*dt bleeding into the pelvis*
132
type of pelvic fx esp high risk for hypotn → mortality
open book
133
what classification is an open book pelvic fx
AP compression
134
immediate tx for pelvic fx (2)
pelvic binders
0 neg blood
135
pelvic binders are a part of the __ survey
primary
136
indication for OR in extremity trauma
hard signs
137
extremity trauma hard signs (5)
**5p hot**
pain
paralysis
paresthesia
pulselessness
palor
hematoma, large
obvious arterial bleeding
thrill/bruit
138
what are the 5 p's
pain
pallor
pulse
paresthesia
paralysis
139
mc injured organ in abd trauma
liver
140
indications for CT scan for extremity trauma
soft signs
141
extremity trauma soft signs that indicate CTA (6)
**h3pcn**
hematoma, small
hemorrhage hx
hypotn, unexplained
proximal to major vessel
complex fx
nerve damage
142
resuscitation fluid/blood protocol
1 L crystalloid solution
3 L blood products
+/- tranexamic acid
143
test to perform in extremity trauma if no hard/soft signs
ABI
144
parameter for abnormal ABI
\< 0.9
145
what do you order in extremity trauma, if ABI is \< 0.9 (2)
CT angiogram
+/- ortho consult
146
3 special populations in trauma care
peds
geriatrics
pregnant
147
4 complicating factors in peds trauma pt's
big heads/thinner skull bones
less calcified skeletal system
different vitals
tachycardic first → bp drop later
148
\_\_ may be the only keys to early recognition of hypovolemia in peds trauma pt's (2)
**tachycardia**
narrowed **pulse pressure** → poor skin perfusion
*pulse pressure over systolic pressure*
149
3 complicating factors for geriatric trauma pt's
sicker for any given pathology
meds can blunt responses
pre-existing conditions → 2x higher mortality
150
4 pre existing conditions of concern in geriatric trauma pt's (the ones listed on study guide)
cirrhosis
coagulopathy
COPD
ischemia
151
management of pregnant trauma pt (2)
take care of MOC first
perform radiological studies to determine injury
152
if pt has calcaneus fx, also look for __ fx
lumbar
153
indications for admit in pregnant trauma pt (3)
vaginal bleeding
abd tenderness
changes in fetal heart tones
154
when should the lethal 6 be identified
primary survey
155
t/f: the lethal 6 all have immediate remedies
t!
156
soft signs in extremity trauma are an indication for
CTA
157
hard signs in extremity trauma are an indication for
ortho consult/OR
158
steps in evaluation of extremity trauma (5)
1. evaluate for hard/soft signs in primary survey
2. soft signs → CTA
3. hard signs → ortho consult
4. if no hard or soft signs → ABI
5. if ABI \< 0.9 → CTA
159
do not delay ortho consult for abdominal injury if pt has (2)
red flags
abnormal vitals
160
t/f: rib fractures in young pt's are generally benign
T!
*painful, but benign*
161
HTX is often due to
vessel injury
162
what does widened mediastinum make you think of
thoracic aorta injury
163
fxn of V1
sensation to forehead
corneal reflex
164
fxn of V2
sensation to cheek
165
fxn of V3
sensation to jaw/chin
jaw opening
bite strength
166
PE findings of V1 injury
loss of sensation to forehead
loss of corneal reflex
167
PE findings of V2 damage
loss of sensation mid face
168
PE findings of V3 damage
weakness/paralysis of muscles of mastication
deviation of mandible toward side of lesion
169
basic fxn of CN VII
facial expressions
taste anterior ⅔ of tongue
corneal reflex
170
PE findings of CN VII damage
loss of corneal reflex
oss of facial muscle expresion
mouth droop
loss of nasolabial fold
loss of taste anterior ⅔ of tongue
171
must to exam for nasal lacerations
PE exams for CNV and CNVII
172
where is exam of zone 2 penetrating neck trauma done
OR
