Ross Trauma Flashcards
first consideration in trauma management
well being of you and your staff → scene safety
protective gear includes (4)
gown
gloves
goggles
hair bonnet
3 types of parameters that help identify a trauma pt
mechanistic
anatomic
physiologic
fall indications for major trauma in peds pt
fall is:
2-3 times the height of the child
>10 ft
fall indications for major trauma for adult pt
>20 ft
how many feet in 1 story
10
mechanism criteria for major MVA trauma (6)
death in same vehicle
pt ejection
vehicle rollover
intrusion
auto-pedestrian/bicycle > 20 mph
MVA > 20 mph
intrusion guidelines for major MVA trauma (2)
>12 in in occupant
>18 in anywhere
anatomic criteria for major MVA trauma (8)
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
physiologic criteria for major MVA trauma (3)
vitals:
conscious state GCS < 13
hypotn sys <90
rr <9 OR > 30
primary survey consists of (5)
airway
breathing
circulation
disability
environment/expose pt
disability in primary survey represents
neuro
how should provider proceed with primary survey
one step at a time
when can primary survey be completed simultaneously
if more than one provider can perform ABC
airway management includes
c spine precaution
circulation management includes
stop bleeding
2 methods of airway management
oral airway
intubate
indications for intubation (4)
massive facial injury
GCS 8 or less
significant neck trauma
penetrating head injury
do not miss in breathing management
PTX/tension PTX
management of sucking chest wound
cover on 3 sides
3 indications for tension PTX
distended neck veins
absent breath sounds unilaterally
deviated trachea
management of tension PTX
immediately decompress
2 methods of bleeding management
pressure
tourniquet
first steps in advanced trauma life support
activate trauma team
designate captain
AMPLE hx
ABC
vitals/monitor
undress
what does AMPLE stand for
allergies
medications
PMH
last meal (what time)
events surrounding time of injury
what is this showing
tension PTX
signs and symptoms of hemorrhage by class
what hemorrhage class does HR begin to rise
class II (mild) → 15-30% blood loss
what hemorrhage class does bp begin to go down
class III (moderate) → 31-40% blood loss
what hemorrhage class indicates need for blood products
class II (mild ) = possible
class III (moderate) = definitely
do not forget exam on everyone (even unconscious)
neuro
triangle of death
bleeding
hypothermic
coagulopathy
GCS eye scale
1-4
GCS verbal scale
1-5
GCS motor scale
1-6
GCS severe coma indications
3-8
GCS moderate coma indications
9-12
GCS mild coma indications
13-15
pt undressed
full head to toe exam is done
better history obtained
secondary survey
pt undressed
full head to toe exam is done
better history obtained
secondary survey
t/f: FAST exam can be done before OR after the secondary survey
T
IVs to obtain
2 large bore
t/f: IV’s can be obtained before or after secondary survey
T
all trauma pt’s who are women of child bearing age need
tetanus booster
pregnancy test
clinical clearance protocol used to exclude c-spine injury
nexus criteria
5 nexus criteria
awake and alert
no e.o intoxication
no midline cervical tenderness
no focal neuro deficits
no painful distracting injury
if pt meets nexus criteria you can
take off backboard and remove c-collar clinically
nexus criteria is meant to identify
low risk neck pain that does NOT need xray
4 stages of hypovolemic shock
initial
compensatory
progressive
refractory
where is tourniquet placed
as proximal as possible
structures mc injured in blunt neck trauma
hard structures:
larynx
trachea
c spine
structures less commonly injured in blunt neck injury
soft structures (vascular):
carotid a
vertebral a
horner’s syndrome in trauma pt might indicate
carotid dissection
miosis, ptosis, anhidrosis
vertigo in trauma pt might indicate
vertebral dissection
c-spine injury has high association w. __ trauma
blunt
med that prevents cleavage of plasmin and degradation of fibrin → decreases bleeding w.o significant adverse s.e
TXA (tranexamic acid)
when must TXA be given
early in bleeding process
after 3 hours can be harmful
dosing for TXA
adults: 1 gm
kids: 0.5 gm
imaging for blunt neck trauma
neck CT w. and w.o contrast
will cover c-spine as well
drops of __ are concerning in GCS monitoring
drops of __ are very bad in GCS monitoring
2
3
strangulation injury is concerning for damage to __ structures (2)
hard and soft
imaging for strangulation injury
CT w. and w.o contrast
indication for surgery consult in strangulation injury
LOC
hard signs
3 indications for d.c for strangulation injury
asymptomatic
no soft signs
imaging of low yield
if the __ is penetrated, pt. will need trauma or surgical consult regardless of zone
platysma
what does FGH stand for
fetus → pregnant?
glucose
hypertet → tetanus
what does FAST exam stand for
focused
assessment
(with)
sonography
(for)
trauma
zone 1 of the neck
clavicle/sternum to cricoid cartilage
zone 2 of the neck
cricoid cartilage to angle of the mandible
zone 3 of the neck
superior mandible to skull
landmarks for zones of neck:
1:
2:
3:
1: sternal notch
2: cricoid cartilage
3: angle of mandible
penetrating injuries to which neck zones do not immediately go to OR
1 and 3
penetrating injuries to zone __ need surgical consult in OR
2
neck hard signs
ha2spnmc
hematoma
hemoptysis
active bleeding
subq emphysema
pulse deficit
neuro deficit
mouth/NGT bleed
crepitus
neck soft signs
hsv + mild tenderness
hematoma, small
sub q emphysema
voice changes
mild neck tenderness
GI/airway hard signs
hcpts3d2
hemoptysis
cyanosis
ptx
tracheal deviation
stridor
sucking wound
subq emphysema
distress, respiratory
dysphagia/phonia
management of foreign body in neck
do not remove
may be auto tamponade
what should be avoided in maxillofacial injury
NGT
maxillary bone fx w. sx of malocclusion
le fort fx 1
fx w. involvement of nasal bone, malocclusion, +/- V2 involvement (anesthesia of skin of face/teeth)
le fort 2 fx
how would you classify this injury
penetrating neck injury
neck trauma is classified into
blunt
penetrating
fx thru zygomatic arches and orbits
le fort 3
management of le fort 3 fx
prophylactic intubation or transfer
major concern in le fort 3 fx
edema → airway compromise
management of nasal bone fx
no x-ray
look for intranasal hematoma → drain
ENT if reduction needed
what is this showing
carotid artery dissection
carotid a dissection typically occurs w. __ injury
hyperflexion
nasal lacerations are concerning for damage to which CN
V
VII
structures of concern in nasal laceration
parotid gland
stenson’s duct
structures of concern in nasal laceration
parotid gland
stenson’s duct
lethal 6 to look for in primary survey
oh fact
airway obstruction
tension ptx
cardiac tamponade
open PNX
HTX
flail chest
management of airway obstruction
manage airway
intubate
management of tension PTX
needle decompression
chest tube
management of cardiac tamponade
needle drainage
xiphoid window
beck’s triad
JVD
hypotn
muffled heart sounds
management of HTX
CT
+/- OR based on CT output
paradoxical movement of chest wall dt 2-3 fx in consecutive ribs → prevents oxygenation and increases WOB
flail chest
management of flail chest
intubation if severe
OR for fixation
indication of significant thoracic aorta injury w. blunt chest trauma
hypotn
imaging for significant thoracic aorta injury w. blunt chest trauma
CXR if unstable
CT w. contrast if stable
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
parameter for widened mediastinum
8 cm
mc moi for thoracic aorta injury
large velocity changes:
high speed MVA from 75 mph to 0 in short distance
what is this showing
tension PTX
3 indications of tension PTX on CXR
mediastinal shift
collapsed lung
depressed hemidiaphragm
problem w. xray in rib fx
only seen 50% of the time
concern w. rib fx in elderly
atelectasis
PNA
indication for admit for rib fx in elderly
more than 2 or 3 fx
indication for emergent care in rib fx
flail chest → 2-3 fx in consecutive ribs → increases wob
what is this showing
massive tension PTX
consider abdominal trauma if injury is below the __
down to the __
nipple line
pubis
4 indications for emergent laparotomy
diffuse peritonitis
penetrating GSW w. peritoneal violation
evisceration
abd tenderness w. hypotn
what is this showing
cardiac tamponade
enlarged bottle shaped heart
2 PE findings that require work up of abd CT scan dt high likelihood of injury
chance fx
handlebar or seatbelt sign
what is this showing
HTX
damage to great vessels of lung
what is a chance fx
lumbar fx
what is this showing
handlebar sign
what is this showing
seatbelt sign
imaging that is done as part of PE
FAST US →
quick method to find blood
abd tenderness in light of blunt trauma indicates __
ruptured hollow viscus
easily missed
significant blood loss in abd cavity w.o drastic change in external appearance of abd
ruptured hollow viscus
easily missed even w. CT
what is this showing
pulmonary contusion
28 yo s/p fall off bike
what do you think?
PTX w. rib fx
fx of __ ribs indicates high force fx w. likely occult injury
ribs 1-2
do not d.c pt if they have fx to which ribs
1-2
t/f: flail chest can occur w. 1 rib fx
f! must be multiple rib fx
complication of rib belts
atelectasis → PNA
indication for thoracotomy
loss of vitals w.in 2-3 min of arrival
pelvic fx classifications (3)
lateral compression
vertical shear
AP compression
indication for high mortality with pelvic fx
hypotn
dt bleeding into the pelvis
type of pelvic fx esp high risk for hypotn → mortality
open book
what classification is an open book pelvic fx
AP compression
immediate tx for pelvic fx (2)
pelvic binders
0 neg blood
pelvic binders are a part of the __ survey
primary
indication for OR in extremity trauma
hard signs
extremity trauma hard signs (5)
5p hot
pain
paralysis
paresthesia
pulselessness
palor
hematoma, large
obvious arterial bleeding
thrill/bruit
what are the 5 p’s
pain
pallor
pulse
paresthesia
paralysis
mc injured organ in abd trauma
liver
indications for CT scan for extremity trauma
soft signs
extremity trauma soft signs that indicate CTA (6)
h3pcn
hematoma, small
hemorrhage hx
hypotn, unexplained
proximal to major vessel
complex fx
nerve damage
resuscitation fluid/blood protocol
1 L crystalloid solution
3 L blood products
+/- tranexamic acid
test to perform in extremity trauma if no hard/soft signs
ABI
parameter for abnormal ABI
< 0.9
what do you order in extremity trauma, if ABI is < 0.9 (2)
CT angiogram
+/- ortho consult
3 special populations in trauma care
peds
geriatrics
pregnant
4 complicating factors in peds trauma pt’s
big heads/thinner skull bones
less calcified skeletal system
different vitals
tachycardic first → bp drop later
__ 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
3 complicating factors for geriatric trauma pt’s
sicker for any given pathology
meds can blunt responses
pre-existing conditions → 2x higher mortality
4 pre existing conditions of concern in geriatric trauma pt’s (the ones listed on study guide)
cirrhosis
coagulopathy
COPD
ischemia
management of pregnant trauma pt (2)
take care of MOC first
perform radiological studies to determine injury
if pt has calcaneus fx, also look for __ fx
lumbar
indications for admit in pregnant trauma pt (3)
vaginal bleeding
abd tenderness
changes in fetal heart tones
when should the lethal 6 be identified
primary survey
t/f: the lethal 6 all have immediate remedies
t!
soft signs in extremity trauma are an indication for
CTA
hard signs in extremity trauma are an indication for
ortho consult/OR
steps in evaluation of extremity trauma (5)
- evaluate for hard/soft signs in primary survey
- soft signs → CTA
- hard signs → ortho consult
- if no hard or soft signs → ABI
- if ABI < 0.9 → CTA
do not delay ortho consult for abdominal injury if pt has (2)
red flags
abnormal vitals
t/f: rib fractures in young pt’s are generally benign
T!
painful, but benign
HTX is often due to
vessel injury
what does widened mediastinum make you think of
thoracic aorta injury
fxn of V1
sensation to forehead
corneal reflex
fxn of V2
sensation to cheek
fxn of V3
sensation to jaw/chin
jaw opening
bite strength
PE findings of V1 injury
loss of sensation to forehead
loss of corneal reflex
PE findings of V2 damage
loss of sensation mid face
PE findings of V3 damage
weakness/paralysis of muscles of mastication
deviation of mandible toward side of lesion
basic fxn of CN VII
facial expressions
taste anterior ⅔ of tongue
corneal reflex
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
must to exam for nasal lacerations
PE exams for CNV and CNVII
where is exam of zone 2 penetrating neck trauma done
OR
