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RRPA Clinical Decision Making I > Ross Trauma 2 (up to slide 62) > Flashcards

Ross Trauma 2 (up to slide 62) Flashcards

1
Q

What artery are you concerned about in hyperextension of the neck with compression against transverse process?

A

Vertebral artery

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2
Q

What artery are you concerned about with hyperflexion of the neck with compression between the mandible and spine?

A

Carotid artery

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3
Q

In what circumstances of blunt and vascular injury to the neck would you consider imaging?

A
  • Hyperextension w/ compression of art. against transverse process
  • Hyperflexion w/ compression btw mandible and spine
  • direct blows with mid face fx
  • intra-oral trauma
  • basilar skull fx
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4
Q

A pt presents with dizziness, vertigo, ataxia, nystagmus, dysarthria, and diplopia. What blood vessel is injured?

A

Vertebral a

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5
Q

A pt presents with bruits, TIA’s, and Horner Syndrome. What blood vessel is injured?

A

Carotids

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6
Q

What is Horner syndrome?

A

Disruption of sympathetic flow to eye

  • Constricted pupil
  • Droopy eyelid
  • Eye does not sweat

*miosis, ptosis, anhidrosis

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7
Q

If a pt presents with a blunt injury to the neck, are asympto with no signs (hard or soft) do they need imaging?

A

No, imaging is low yield - can d/c home

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8
Q

Any penetration into the platysma needs what type of consult?

A

Trauma Surgeon consult

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9
Q

What are the 3 zones of injury for the neck?

A
  1. Clavicles to cricoid
  2. Cricoid to mandible
  3. Mandible to base of skull
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10
Q

Work up for penetrating neck trauma

A
  1. If platysma is not penetrated - clean and close. If yes, need consult
  2. Consider zone of injury - if zone 2 may go to OR (moving more toward using Hard and Soft signs)
  3. If can’t tell how deep - look for Hard and Soft signs
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11
Q

What are vascular Hard Signs in a neck injury?

A
  • hematomas
  • bleeding
  • pulse deficit
  • shock and neuro deficit 2/2 to art. interruption
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12
Q

What are l_aryngeal and tracheal_ Hard Signs in a neck injury?

A
  • voice alteration
  • airway compromise
  • subQ emphysema
  • crepitus
  • hemoptysis
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13
Q

What are esophageal Hard Signs in a neck injury?

A
  • pain
  • neck tenderness
  • subQ emphysema
  • dysphagia
  • bleeding from NGT or mouth

*MOST common missed injury

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14
Q

What are Soft Signs in neck injury?

A
  • small hematoma
  • mild dysphagia
  • mild dysphonia
  • mild subQ emphysema
  • mild tenderness in neck
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15
Q

What are indications for a pt with penetrating neck trauma to go to surgery?

A
  • Unstable
  • Hard Signs
  • Arterial bleeding
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16
Q

What are indications for a pt with a penetrating neck trauma to get a CT?

A
  • Soft Signs
  • Zone 1 and 3 need CT angiography
  • Zone 2 Sx vs CT

*Glory CT

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17
Q

In a clothesline or strangulation injury what are PE findings that require further inquiry?

A
  • hoarseness
  • dysphagia
  • pain below hyoid
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18
Q

What are the 3 Le Fort maxillofacial trauma factures?

A
  1. maxillary teeth from face: malocclusion
  2. become pyramid shaped, involve nose: malocclusion (infraorbital V2, CN5)
  3. craniofacial dysfunction: airway compromise due to edema
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19
Q

A pt presents with a flattened cheekbone, diplopia, and an upward gaze. What fractures are you concerned about?

A
  • Zygomatic fx
  • Orbital floor (maxillary bone) fx
20
Q

In maxilofacial lacerations what potential injuries should you be aware of?

A
  • Nerve injury: CN 5, 7
  • Parotid gland esp Stenson’s duct
21
Q

What signs would a pt with an orbital blow out fx possibly present with?

A
  • enophthalmos
  • diplopia w/ upward gaze
  • dec eye mvmt
  • MCC bone = maxillary (entrapment of inf. rectus m)
  • infraorbital n entrapment (V2, CN 5)
22
Q

Orbital blow out fracture management

A

Generally no need for emergent SX but may need repair in 7-10 days, consult maxillofacial services

23
Q

What are you looking for on PE in chest trauma?

A
  • Bruising (patterns), open wounds, subQ air, JVD, breathing patterns
  • Listen to lungs, heart
  • Palpate for fx or areas of tenderness
  • Get CXR (don’t wait for this to tx unstable pt)
24
Q

What are the “Lethal Six” of the Deadly Dozen in chest trauma?

A
  1. Airway obstruction
  2. Tension pneumothorax
  3. Cardiac tamponade
  4. Open pneumothorax
  5. Hemothorax
  6. Flail chest
25
Q

What are the “Hidden Six” of the Deadly Dozen in chest trauma?

A
  1. Thoracic aorta injury
  2. Tracheal/bronch injuries
  3. Blunt myocardial injury
  4. Diaphragmatic tear
  5. Esophageal injury
  6. Pulm contusion
26
Q

What is the treatment for an open pneumothorax or “sucking chest wound”

A
  1. 3 sided flap dressing (only allows air to go out)
  2. Or social dressing
  3. Repair in OR
27
Q

Cardiac tamponade Sx, Dx, and Tx?

A

Sx: Beck’s Triad: JVD, muffled heart sounds, hypotension

Dx: FAST US

Tx: need OR but can do pericardialcentesis in emergent issue

28
Q

Thoracic aorta Sx, Dx, Tx?

A

Sx: presents with other significant chest trauma (rib fractures), hypotension with blunt chest force

Dx: wide mediastinum on CXR - order chest CT if stable w/ AND w/o contrast if high suspicion for Dx

Tx: Surgical

29
Q

Findings on a CXR for a thoracic aorta injury

A
  • mediastinal widening 8cm
  • indistinct aortic knob
  • left mainstream broncus depression
  • apical capping
  • obliteration of distance btw pulm art. and aorta
30
Q

Pulmonary Contusion MOA, Sx, Dx, and complications?

A

MOA: usually compression-decompression injury (high speed MVA)

Sx: edema, bleeding w/o lung tissue laceration, commonly assoc. w/ other chest trauma (rib fx) but not mandatory

Dx: CT much more sensitive - often initially silent injury, can present few hrs later

Comp: Pneumonia

31
Q

What is the most common chest injury?

A

Rib fractures

32
Q

A 1st rib fracture indicates high force so what should you be suspicious of?

A

More occult injury

(50% of rib fx are NOT seen on X-ray)

33
Q

What is flail chest and what is the tx?

A

Segment of chest cavity moving paradoxically due to rib fx

Tx: need OR

34
Q

What is the treatment for rib fractures?

A
  • Rib belts…not looking good (PNA formation and higher rate of pneumothorax) but provides comfort for pt
  • Internal fixation: to OR when significantly displaced and/or hemothorax
35
Q

What is the work up for an elderly pt with a rib fx?

A
  • Depends on their situation
  • Admit elderly with more than 2 rib fx
  • Must be able to control pain
  • low threshold for admit
36
Q

What are the indications for a thoracotomy in penetrating thoracic trauma?

A

Loss of vitals w/i 2-3 min of arrival with active CPR and penetrating trauma

37
Q

What are some special circumstances to consider when it comes to trauma?

A
  • Elderly: VERY low threshold for admit
  • Intoxicated: must wait until they are sober
  • Peds: cannot communicate so low threshold to admit
38
Q

What are some problems to consider with abdominal trauma?

A
  • Ruptured hollow viscus and bleeding from a solid organ are not easily recognized
  • Sig. blood loss in abd cavity w/o drastic change in external appearance of abdomen
  • large area from below nipple line to symphysis pubis
39
Q

What solid organs are most commonly injured in blunt abdominal trauma?

A

Spleen MC and liver

40
Q

Blunt abdominal trauma (from MVA, fall, handle bar, blasts) needs to be evaluated for what intervention?

A

surgical intervention

41
Q

When performing a PE for a blunt abdominal trauma pt what do you not want to forget to look at?

A
  • the back
  • scrotum/labia (swelling or laceration concern for pelvic fx)
  • anus
  • urethral meatus (blood = clue for renal injury or bladder injury)
42
Q

Blunt trauma Red Flags that have a high likelihood of abd injury

A
  • Seat belt and handle bar sign
  • Lumbar fx: chance fx
  • Presence of free fluid with no known solid organ injury is a hollow viscus injury
43
Q

The PE gives clues to the severity of what types of injuries?

A
  • Handle bar injury
  • Seat belt injury
  • Lower rib fx
44
Q

Blunt abdominal trauma work up

A
  • FAST US
  • Abd CT w and w/o contrast
  • Labs: CBC, BMP w amylase, lactate
  • Admit - re-eval

*Do not delay taking pt to OR or for transfer in order to obtain CT

45
Q

What are indications for emergent laparotomy?

A
  • diffuse peritonitis
  • penetrating gunshot w/ peritoneal violation
  • penetrating stab wound w/ evisceration
  • abd tenderness w/ hypotension (blunt trauma)
46
Q

In blunt abdominal trauma if tenderness is found on repeat abd exam what can this imply?

A

Deeper injury (Kehr’s sign, US helpful in FAST exam)

RRPA Clinical Decision Making I (17 decks)

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