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Emergency Medicine > Shock + Trauma > Flashcards

Shock + Trauma Flashcards

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1
Q

Levels of care on wards

A 
0 = normal ward 
1 = CCOT
2 = single organ failure 
3 = ventilation or >2 organ failure
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2
Q

ABG pros + cons

A

Pros - pO2

Cons - VBG + SpO2 usually adequate, painful

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3
Q

What are the life threatening thoracic injuries?

A 
ATOM FC 
Airway obstruction 
Tension pneumothorax
Open chest wound 
Massive haemothorax 
Flail chest 
Cardiac tamponade
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4
Q

What is HEPB?

A

To assess circulation

Hands
End organ perfusion - urine output
Pulse
BP

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5
Q

What are the causes of reflex syncope?

A

Vasovagal
Situational
Carotid sinus syncope

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6
Q

What are the causes of syncope due to hypotension?

A

Primary autonomic failure (Parkinsons)
Secondary autonomic failure (diabetes, spinal cord injuries)
Drug induced
Volume depletion

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7
Q

What are the causes of cardiac syncope?

A

Tachycardia
Bradycardia
Drug induced
Structural heart disease

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8
Q

What are the 4 main causes of collapse?

A

Head
Heart
Vessels
Drugs

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9
Q

What is the San Francisco syncope rule?

A 
CHESS
Congestive HF 
Haematocrit <30% 
ECG abnormal 
SOB 
Systolic <90
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10
Q

What is the OESIL risk score?

A

Age >65
History of CVD
Syncope w/o prodrome
Abnormal ECG

Score >2 = increased risk of cardiac death

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11
Q

What is the risk of shock + reperfusion?

A

Intracellular calcium overload = reduced myocardial contractility + ATP reduction
H+ excess causing reduced myocardial function
Increased lactic acid

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12
Q

What type of nerve damage can an anterior shoulder dislocation cause?

A

Axillary nerve damage - numbness in regimental badge area

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13
Q

What is ISS used for?

A

Scoring system as indicator of major trauma

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14
Q

Describe the pathology of neurogenic shock

A

Damage to T1-3
This is where autonomic sympathetic nervous system branches out
Causes bradycardia + hypotension

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15
Q

What are the Canadian C Spine rules?

A

Statifying pts with ?c spine injury - who needs radiography
Age >65 y/o
Dangerous mechanism of injury
If they’re able to be examined + actively rotate neck - don’t need radiography

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16
Q

What 4 areas to assess when faced with hypotension?

A

Heart rate
Volume status
Cardiac performance
SVR

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17
Q

What type of shoulder dislocation do epileptics typically get?

A

Posterior - light bulb sign

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18
Q

Causes of cardiogenic shock

A 
Cardiomyopathies
Cardiac valve problems 
Arrhythmias 
CHF
Most commonly MI
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19
Q

Management of cardiogenic shock

A

Fluids, blood transfusions, vasopressors, ionotropes

Management of MI

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20
Q

What are the types of shock?

A

Hypovolemic, cardiogenic, obstructive, distributive

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21
Q

S+S of shock

A

Low BP, decreased urine output, confusion, high HR

Dry membranes, reduced skin turgor + reduced CRT

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22
Q

S+S hypovolemic shock

A 
Rapid, weak, thready pulse 
Cool, clammy skin 
Rapid + shallow breathing 
Thirsty 
Cold + mottled skin
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23
Q

How is hemorrhagic shock classified?

A

Class 1-4
1 = <15% blood loss (<750ml), normal BP
2 = 15-30% blood loss (750-1500), fast HR, low BP
3 = 30-40% blood loss (1500-2000), fast HR, low BP, confusion
4 = >40% blood loss (>2000), critical HR + BP

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24
Q

S+S of cardiogenic shock

A 
Distended jugular veins 
Weak or absent pulse 
Abnormal heart rhythms, tachycardia 
Pulsus paradoxus (in tamponade)
Low BP
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25
Q

S+S of distributive shock

A

High or low temp
Tachycardia
High RR

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26
Q

What are the types of distributive shock?

A

Sepsis, anaphylaxis + neurogenic

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27
Q

What are the general causes of each type of shock?

A 
Hypovolemic = fluid loss 
Cardiogenic = ineffective pumping due to heart damage 
Obstructive = blood flow to/ from heart is blocked 
Distributive = abnormal flow in small vessels
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28
Q

Causes of obstructive shock

A 
Cardiac tamponade 
Tension pneumothorax 
PE 
Aortic stenosis 
Constrictive pericarditis
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29
Q

Management of shock

A

Fluids
Vasopressors
Mechanical support

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30
Q

Pathology of compartment syndrome

A

Increased pressure in compartment bounded by unyielding fascial membranes compromises circulation + function of tissues within that space

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31
Q

Common causes of compartment syndrome

A

Trauma to limb eg long bone fracture, penetrating trauma, ischemic-reperfusion injury, coagulopathy, extravasation of IV fluids, limb compression

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32
Q

S+S of compartment syndrome

A

Progressive pain out of proportion to injury
Tense swollen compartments
Pain with passive stretching of muscles
Motor deficits = late

33
Q

Assessment of compartment syndrome

A

Surgeon review - measure compartment pressures

Use difference between diastolic BP + compartment pressure - <30 = elevated compartment pressure

34
Q

What is a normal pressure of a tissue compartment?

A

0-8 mmHg

35
Q

Management of compartment syndrome

A 
Remove pressure 
Keep limb level with torso 
O2 + analgesics 
Manage BP
Fasciotomy to fully decompress compartment
36
Q

Complications of long bone fracture

A

Hemorrhage, DVT, compartment syndrome

Osteomyelitis, nonunion + osteoarthritis

37
Q

What is a mangled extremity?

A 
Injury to 3 of the 4:
Bones
Soft tissue 
Nerves
 Vessels
38
Q

What are hard signs of vascular injury?

A

Pulsatile bleeding, expanding hematoma, distal ischemia

39
Q

What signs in a facial injury indicate airway compromise?

A

Dysphonia
Oedema of oropharynx
Stridor

40
Q

Mechanism of shoulder fracture

A

Falling from standing height

41
Q

What classification is used for proximal humerus fractures?

A

Neer system

42
Q

Management of proximal humerus fractures

A

Complex = refer to ortho
Immobilisation using sling
Closed management for impacted or non-displaced fractures (Neer one-part)
Early mobilisation with pendulum exercises

43
Q

Management of open fractures

A

Dose of broad spectrum abx

Referral to surgeons

44
Q

Management of hand fractures

A

Splinting

Referral to hand surgeons - within 2-3 days for closed unstable fractures, 7-10 days for closed stable fractures

45
Q

3 main categories of knee injuries

A

Acute knee pain
Chronic knee pain associated with overuse
Knee pain without trauma or overuse, associated with systemic symptoms

46
Q

Conditions causing anterior or medial knee pain

A 
Patllar fracture 
Patellar or quadriceps tendinopathy 
Patellofemoral pain 
Patellar subluxation 
Pes anserinus (medial hamstring) tendon + bursa 
Osteoarthritis 
Tibial tuberosity - Osgood Schlatter 
Medial plica syndrome
47
Q

Conditions causing lateral + posterior knee pain

A 
Iliotibial band 
Popliteus tendinopathy 
Biceps femoris tendinopathy 
Semimembranous-gastrocnemius bursitis 
Degenerative meniscal tear 
Baker's cyst
48
Q

Describe patellofemoral pain

A

Peri-patellar knee pain that increases with squatting, prolonged sitting, climbing or descending stairs, running downhill

49
Q

How to elicit pain in patellofemoral pain

A

Retropatellar tenderness
Patellar compression test
Patellar inhibition test (Clarkes)

50
Q

What muscles are weak in patellofemoral pain?

A

Vastus medialis oblique + gluteus medius

51
Q

What is patellar subluxation?

A

Pts with hx of patella dislocation can develop subluxation, Ehlers Danlos §or if vastus medialis is weak
Knee ‘gives way’
Patellar apprehension test = positive

52
Q

What is medial plica syndrome?

A

Trauma to peripatellar area or dislocations/ subluxation of patella, may develop thickening of medial patella plica
Causes impingement of medial edge of patella, causing pain worse with movement
Can cause audible pop

53
Q

Features of iliotibial band syndrome

A

Insidious lateral knee pain that worsens with prolonged exercise
Common in runners
Assessed with Noble tests
Associated with hip abduction weakness

54
Q

What structures are important in forefoot pain?

A 
First MTP joint 
5th MTP joint 
Plantar surface of MTP joint 
Intermetatarsal spaces 
Plantar calluses 
Dorsal proximal interphalangeal calluses
55
Q

What structures are important in midfoot pain?

A 
Navicular 
Dorsal tarsometatarsal joints 
Cuboid 
Base of 5th metatarsal 
Plantar fibromas 
Ganglia
56
Q

What structures are important in hindfoot pain?

A 
Medial insertion of plantar fascia on calcaneuus 
Plantar os calcis 
Insertion of Achilles tendon 
Tarsal tunnel
Peroneal tendons 
Anterior talotibial articulation 
Anterior talus - lateral corner 
Sinus tarsi
57
Q

What are the common conditions seen at first MTP joint?

A 
Bunions 
Hallux rigidus (arthritis) 
Turf toe (forced hyperextension of great toe)
Gout
58
Q

What is Ilizarov frame surgery?

A

Type of external fixation used in ortho surgery to lengthen or reshape limb bones

59
Q

Causes of distributive shock

A

Sepsis
Anaphylaxis
Neurogenic

60
Q

Causes of hypovolaemic shock

A

Hemorrhage
Burns
High output fistulas
Dehydration

61
Q

Common sites of bleeding

A 
On the floor + 4 more:
Floor (external)
Chest 
Abdo
Pelvis 
Long bones
62
Q

Maintenance fluids canadian rule

A 
4:2:1
0-10kg = 4ml/kg/h
10-20 = 2ml/kg/h
Remaining weight = 1ml/kg/hr 
Replace ongoing losses (estimated 10% of body weight)
63
Q

When can you clear a C spine?

A 
Orientated to time, person, place 
No evidence of intoxication 
No posterior midline cervical tenderness 
No focal neuro deficits 
No painful distracting injuries
64
Q

When should you get a CT of a C spine?

A

If X ray is unclear or suspicious
Any clinical indication of atlanto-axial subluxation
High suspicion but normal X ray

65
Q

What signs in Hx + O/E indicate a potential C spine injury?

A

Midline neck pain, numbness, distracting pain, head injury, intxication, LOC
Posterior neck spasm, tenderness or crepitus, neuro deficit or autonomic dysfunction, altered mental state

66
Q

What C spine x rays should be taken?

A

3 view:
Lateral C1-T1 + swimmer’s view
Odontoid view (open mouth)

67
Q

What is in a secondary survey?

A 
SAMPLE 
S+S
Allergies
Meds
Past medical hx 
Last ins + outs 
Events leading up to this

Physical exam
Initial imaging

68
Q

What views do you get on a FAST scan?

A

Subxiphoid pericardial window - shows heart chambers + pericardial effusion
Perisplenic - shows spleen, L kidney + any free fluid
Hepatorenal (Morrisons pouch) - shows liver, right kidney + any blood
Pelvic/ retrovesical (Pouch of Douglas) - shows bladder + any free fluid

69
Q

What is the best imaging for intracranial injury?

A

Non contrast CT

70
Q

what is the emergency rule for consent to treatment?

A

Consent is not needed when pt is at imminent risk from serious injury AND obtaining consent is not possible or would increase risk to pt

71
Q

What are the associated injuries with MVC?

A

Head on = head, thoracic, lower extremity
T bone = head, C spine, thoracic, abdo, pelvic, lower extremity \
Rear end = hyper-extension of C spine

72
Q

What is the cardiac box?

A

From sternal notch, nipples + xiphoid process

Any injury in this = be suspicious of cardiac injury

73
Q

What are high risk mechanisms of injury?

A

MVC at high speed causing ejection from vehicle
Motorcycle collisions
Vehicle vs pedestrian
Fall from height >12ft

74
Q

What is Waddle’s triad?

A

Vehicle vs pedestrian injuries
Tibia-fibula or femur fractures
Truncal injuries
Craniofacial injuries

75
Q

What injuries are caused by seatbelts?

A

Retroperitoneal duodenal trauma
Intraperitoneal bowel transection
Mesenteric injury
L spine injury

76
Q

When is an NG tube vs Foley used in abdo trauma?

A

Foley = unconscious pt who cannot void sponteneously

NG tube = used to decompress stomach. CI in basal skull fractures

77
Q

What is the rule of thirds for stab wounds?

A

1/3 do not penetrate peritoneal cavity
1/3 penetrate but are harmless
1/3 cause injury requiring surgery

78
Q

Management of open fractures

A 
STAND 
Splint 
Tetanus prophylaxis 
Abx 
Neurovascular status 
Dressings

Emergency Medicine (24 decks)

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