THEME 4 - TRAUMA I Flashcards
Tension pneumothorax
life-threatening condition caused by the continuous entrance and entrapment of air into the pleural space
Tension pneumothorax findings (4)
Tracheal deviation to affected lung, asymmetric thorax excursions, absent breath sounds, hypersonoric perscussion
Tension pneumothorax treatment
Needle thoracocentesis followed by chest drain
Ruptured bronchus findings (2)
Difficulty breathing. Coughing up blood.
Ruptured bronchus treatment
Acute surgical repair
Pneumothorax
AKA collapsed lung, air within pleural space
Pneumothorax signs (3)
Asymmetric thorax excursions, absent breath sounds, hypersonoric percussion
Pneumothorax treatment
If hypoxia –> tube thoracostomy?
Heamatothorax
Collection of blood in pleural space
Heamatothorax findings (2)
Absent breath sounds, dull percussion
Heamatothorax treatment
With hypoxia or haemodynamic instability → tube thoracostomy
Uncontrolled bleeding → Surgical intervention: thoracotomy
Sucking chest wound
When object penetrated through the chest, creating an air passage between outside and chest
Sucking chest wound treatment
Place air-occlusive dressing + tube thoracostomy
Flail segment thorax
when a segment of the rib cage breaks due to blunt thoracic trauma and becomes unattached from the chest wall
Flail segment thorax findings (3)
Paradoxical indrawing thorax, shortness of breath, crepitations
Flail segment thorax treatment
Positive pressure ventilation if hypoxic + tube thoracostomy,
Diaphragmatic rupture findings (3)
Diminished breathing signs affected side, dyspnea, bowel sounds in chest
Diaphragmatic rupture treatment
Based on severity, surgical repair
Types of shock
Obstructive, hypovolemic, cardiogenic, distributive (septic, anaphylactic, neurogenic)
Cardiac tamponade
fluid accumulates in the pericardial sac, compressing the heart (leading to a decrease in cardiac output and shock)
Cardiac tamponade findings (1,2)
Inaudible heart sounds, can cause obstructive shock
Cardiac tamponade treatment
Long needle aspiration
What is the most common cause of burns in children under 4 years old?
Hot water
Burns in this age group are primarily due to scalding from hot liquids.
What temperature threshold leads to protein denaturation in thermal injuries?
> 43 degrees
Permanent damage occurs at temperatures above 45 degrees.
What is the zone of stasis in burn injuries?
A zone that can still be saved
This area may have reduced blood flow but has the potential for recovery.
How long does the zone of hyperemia take to heal?
<7 days
This zone is superficial and generally heals quickly.
What systemic effects are caused by burns?
Loss of water and systemic inflammatory response
This includes exudation and evaporation, along with cytokines in circulation.
What percentage of burn unit admissions are due to electrocution burns?
3%
Electrocution burns involve both thermal and non-thermal injuries.
What are the two types of injuries caused by electrocution?
- Thermal: electrical energy converted to heat
- Non-thermal: depolarization of conductive tissue
Non-thermal injuries affect muscle and nerve tissues.
What is the primary treatment for chemical burns?
Removing the chemical agent and irrigation with water
After achieving neutral pH, they should be treated like thermal burns.
What are the key steps in the assessment of burn injuries?
- History and nature of injury
- Calculating burnt area
- Assessing depth
These steps help determine the extent and severity of the burns.
What is the first aid treatment for burn injuries?
- Remove clothes
- Stop burning
- Active cooling for >10 min
Pain management may include cooling and analgesic drugs.
What is used to dress burn injuries as initial treatment?
Cling film
Cling film is preferred due to its pliability, non-adherence, and impermeability.
What should be done to blisters at the hospital?
Deroof blisters
This involves removing the top layer of the blister to prevent infection.
ARDS characteristics (6)
Resp. distress, reduced compliance, x-ray shows bilateral pulmonary infiltrates, non-cardiac cause of pulmon. edema, P/F ratio <300
What is the treatment for circumferential burns that restrict blood flow?
Escharotomy
This procedure relieves pressure caused by swelling and necrosis.
What is the initial treatment for inhalation injuries?
Administer humidified air by mask and antibiotics
This helps to prevent chest infections following inhalation injuries.
What are the next steps for more severe inhalation injuries?
O2 mask or endotracheal intubationedit
These interventions ensure adequate oxygenation in severe cases.
Clinical features ARDS(4)
Tachypnea, hypoxemia, bilateral crackles, bilateral diffuse shadowing on X-ray
Physiological changes AKI (3)
Water retention –> high bp
hyperkalemia
metabolic acidosis
Nerve affected in facial injuries
Facial nerve (CN VII)
Nerve affected in temporal bone or base of skull fracture
Trigeminal nerve (CN V)
Nerve affected in petrous bone fracture
Vestibulocochlear nerve (CN VIII)
Options for free fluid in abd. cavity (4)
- Blood (worst case)
- Urine
- GI fluids from rupture
- Bile from the liver
EDH (4)
Lemon shaped, often arterial bleeding so quick progression
Tx immediate surgery
SDH (3)
Mostly venous, slower progression, moonshaped
Tx Benzo overdose
Flumazenil
Tx opioid overdose
Naloxone
Tx antipsychotic overdose
Maagspoeling, one course of active charcoal
no antidote, supp tx
Anticholinergic overdose Tx
Physostigmine
Pesticides/cholinergic overdose tx
Atropine and pralidoxime
+ supportive and fluids
Tx GHB overdose
Atropine ico severe resp depr. No antidote, no act charcoal
Benzo’s ico convulsions
Tx alcohol overdose
Tx acidosis most important
dialysis and stomach pumping
Montegga fracture
Fracture proximal ulna w/ dislocated radial head
kids > adults
Galeazzi fracture
Radial fracture with dislocated ulna distally
Duloxetine
SSRI
Cetrizine
Antihistamine
Temazepam
Benzodiazepam
