T R A U M A Flashcards
What are the components of an AMPLE history?
Allergies Medications/Mechanism of injury Past medical hx/Pregnant? Last meal Events surrounding mechanism of injury
When does placement of foley catheter take place during trauma assessment?
PRIMARY survey. It is the F in the ABCEDF*.
Important for monitoring urinary output (reflection of renal perfusion and volume status.)
4 signs of urethral transection
Blood at meatus
High riding prostate
Perineal/scrotal hematoma
Any signs of pelvic fx
How much blood loss before AMS occurs?
30-40% (1500-2000 cc). DEF need blood products!! This is Grade III Hemorrhagic Shock.
Tx of Grade IV Hemorrhagic Shock
> 40% blood loss. These pts need 2L Crystalloid bolus followed by uncrossed (o negative) blood because death is imminent.
Which CN runs along the edge of the tentorium cerebelli?
CN III
Explain Cushing’s Reflex
When ICP increases (e.g., head injury), the cerebral arteries get compressed, causing decreased perfusion of the brain. There is immediate increase in pCO2 and decrease in pH because CO2 generated from brain tissue is not adequately removed by blood flow. The medullary chemoreceptors respond to these changes by directing an increase in sympathetic outflow to the alpha 1 receptors on the blood vessels –>increasing TPR, dramatically increasing Pa (causing HTN). Blood flow is thereby redirected to the brain to maintain its perfusion. The second stage of Cushing’s (bradycardia) occurs because the baroreceptors in the aortic arch detect this increase in blood pressure and trigger a parasympathetic response via the vagus nerve, inducing bradycardia.
Enlarging pupil with concurrent decrease in LOC is strongly suggestive of…?
Uncal herniation.
Anterior cord syndrome sx
Full or partial loss of bilateral pain and temperature sensation (spinothalamic tract) and paraplegia (corticospinal tract)
Brown-sequard syndrome sx
Ipsilateral loss of motor function (CST) and positional/vibratory sense/light touch sensations (posterior columns) with contralateral loss of pain and temperature sensation (spinothalamic tract)
Sx of central cord syndrome
Pt had pre-existing stenosis. Weakness greater in UE, distal worse than proximal.
5 indications for C-spine film
Tenderness along C spine Neurologic deficit Good mechanism of injury Presence of distracting injury Puts with altered sensorium (e.g. drunk)
Most common cervical spinal level fractured
C5
Most common level of subluxation in cervical spine
C5 on C6
Why are thoracic spinal fx particularly devastating?
The spinal canal through this area is narrow and the blood supply is a watershed area – artery of Adamkiewicz enters spinal canal around L1 but provides blood flow as high as T4, so blood loss may infarct spinal canal – > anterior spinal artery syndrome.
Beck’s triad
Tamponade:
Hypotension + JVD + muffled heart sounds.
Can also see electrical alternans on ECG (alternating heights of Rs on QRS complexes)
Tx of pericardial tamponade
Immediate needle pericardiocentesis decompression, pericardial window, or thoracotomy with manual decompression.
Tx of post-pericardiotomy syndrome
Dresslers syndrome is a self-limiting syndrome of unknown etiology presenting with fever, chest pain, pericardial effusion, rub, ECG abnormalities. Tx is with ASA or indomethacin and occasionally steroids.
25 y.o. female presents after high speed MVC with dyspnea and tachycardia. There is local bruising over right side of her chest. CXR shows right upper lobe consolidation. Most likely dx?
Pulmonary contusion. Most frequent complication is pneumonia. Treat with pain control
Where is thoracotomy performed ?
4th-5th intercostal space
What travels through diaphragm with esophagus?
Vagus nerves at T10
What travels with aorta through diaphragm?
Thoracic duct and azygos vein at T12
Members of peritoneal viscera
Liver spleen stomach small bowel sigmoid + transverse colon
Members of retroperitoneal viscera
Majority of duodenum, pancreas, kidneys and ureters, sac and descending colon, and major vessels such as abdominal aorta, IVC, renal and splenic vessels
Which viscera are iliac vessels part of?
Pelvic viscera
Which hemidiaphragm more frequently injured?
Left. Right is protected by the liver. This is also why the right hemidiaphragm is higher on CXR.
Most common reason for splenectomy
Trauma
Why do transverse lacerations often stop bleeding spontaneously?
They are parallel to blood vessels – not likely to disrupt them.
How can you prevent renal failure in rhabdomyolysis?
Rhabdomyolysis causes myoglobin release, which can cause renal failure. Maintaining a high urine output together with alkalization of the urine can help prevent the renal failure by reducing precipitation of myoglobin in the kidney.
