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Trauma 1 Flashcards

1
Q

Critical Scene Interventions on Trauma

A

SMR
Bleeding control
Needle decompression

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2
Q

Kinetic Energy

A

Energy of motion
Kinetic energy = mass x velocity ^2 /2
Velocity major factor

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3
Q

Inertia

A

Body in motion stays in motion unless acted on by outside force

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4
Q

Law of Conservation of Energy

A

Energy not created or destroyed, only changed/transferred

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5
Q

4 Impacts of MVC

A

Vehicle
Occupants
Occupant organs
Secondary collisions

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6
Q

To be cautious of in MVC

A

Upper body hitting steering wheel
Paper bag pneumothorax
Aortic tear
Pelvic fracture
Intracranial contusion/hemorrhage

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7
Q

Shearing Forces

A

Descending aorta fixed structure
Arch, aorta + heart are freely movable
Sheering forces create different forces across aorta, causing tear

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8
Q

Rear-End/Lateral Collision

A

Pt moves towards point of impact
Pts worse if 2 impacts
C-Spine
Head injury
Chest hits door
Hip hits door
Upper extremity fracture/dislocation

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9
Q

Roll-Over

A

Multiple impacts each time vehicle rolls
Unpredictable injuries

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10
Q

Ejection

A

27% of MVC deaths
1/13 spinal injuriy

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11
Q

Seatbelts above iliac crest

A

Compression injuries to abdominal organs
T12-L2 compression fractures

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12
Q

seatbelts too low

A

Hip dislocation

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13
Q

Seatbelts alone

A

Head, c-spine, maxillofacial injury

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14
Q

Shoulder straps alone

A

Neck injury
Decapitation

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15
Q

Cranium

A

Double layer of solid bone which surrounds spongy middle layer
Frontal, occipital, temporal, parietal, mastoid

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16
Q

Middle Meningeal Artery

A

Under temporal bone
Common source of epidural hematoma

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17
Q

Meningeal Membranes

A

Dura Mater
Arachnoid mater
pia mater

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18
Q

CSF

A

Clear, colourless
Circulates through brain and spinal cord
Cushions and protects
Secreted by Ventricles

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19
Q

ICP

A

Edema hemorrhage
Normal is 10mmHg
Elevated >15

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20
Q

CPP

A

Pressure moving blood through cranium
BP change but CPP maintained due to auto regulation
MAP - ICP
50 systolic to maintain CPP

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21
Q

Cerebral Blood Flow

A

Depends on CPP

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22
Q

Coup Injury

A

Directly posterior to point of impact
Front of head struck

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23
Q

Contre-coup

A

Directly opposite point of impact
Back of head struck

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24
Q

Diffuse Axonal Injury

A

Shearing, tearing, stretching of nerve fibres
Vehicle occupant + pedestrian

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25
Q

Focal Injury

A

Limited and identifiable site of injury

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26
Q

Direct Head Injury

A

Forces of an object striking head or by penetrating injury

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27
Q

Indirect Head Injury

A

Acceleration/Deceleration forces result in the movement of the brain inside the skull

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28
Q

Secondary brain injury

A

Intracranial hemorrhage + masses, cerebral edema, ischemia, hypoxia, hypotension, anemia, increased ICP

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29
Q

Mild TBI

A

GCS >14
Asymptomatic or confusion with amnesia
Brief LOC
Headache, n/v
Skull fracture, hematoma, swelling, neurologic findings, coagulopathies, drug/alcohol

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30
Q

Moderate TBI

A

GCS 9-13
10% pts with head injuries, roughly 10% of pt will deteriorate

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31
Q

Severe TBI

A

GCS <9
Mortality 40%
Priority to prevent secondary injuries

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32
Q

Subarachnoid Hemorrhage

A

Most common CT abnormality for moderate or severe TBI
Disruption of subarachnoid vessels
Blood in CSF
Diffuse headache, nausea, photophobia

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33
Q

Epidural Hematoma

A

Blow to head fractures temporal bone, ruptures branch of middle meningeal artery
Blood collects between inner table of skull and dura

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34
Q

Classic S/Sx Epidural Hematoma

A

LOC post injury, lucid interval, deteriorate in LOC
Fixed/dilated pupil on side of lesion + contralateral hemi paresis
Herniation within hours

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35
Q

Subdural Hematoma

A

Collection of venous blood between dura and arachnoid
Sudden acceleration-deceleration events
Symptomatic within 24 hours up to 14 days
Alcoholics + elderly with brain atrophy susceptible

36
Q

Causes of ICP

A

Cerebral edema
Blood due to hemorrhage
CSF accumulation due to blockage
Tumours
SBP
CO2

37
Q

Pathophysiology of Brain INjury

A

ICP increase towards MAP decreases cerebral blood flow, decreases CPP

Compensatory to increase MAP
Cerebral vasodilation occurs as CPP decreases
Increases ICP further, decreases CPP

38
Q

Hypercarbia + Brain Injury

A

Causes cerebral vasodilation
Increased blood volume, increased ICP + CPP

39
Q

Hypotension + Brain injury

A

Decreases CPP causing cerebral vasodilation

40
Q

Brain Stem + Brain injury

A

Increased BP and bradycardia 2º to vagal stimulation from pressure on brain
Irregular resps + tachypnea
Unequal pupils
Posturing
Altered LOC
Vomiting
Seizures
Herniation

41
Q

Herniation

A

Brain attempts to pass through foramen magnum
Death

42
Q

Transtentorial Herniation

A

Downward displacement of brain

43
Q

Uncle Herniation

A

Through tensorial notch by supratentorial mass exerting pressure on underlying structures including brain stem

44
Q

Cushing’s Triad

A

Hypertension + widened pulse pressure
Bradycardia
Diminished + irregular resps

45
Q

Cerebral t waves

A

Widespread deep T-wave inversion with bizarre morphology from rise in ICP

46
Q

Shaken Baby Syndrome

A

Cerebral edema, cerebral contusion, concussion, intracranial hemorrhage, neck injuries

<2yo particularly 6-8 weeks

47
Q

Linear skull Fracture

A

Not identified in field
Consider MOI, soft tissue trauma
Not emergency
Caution in temporal region for epidural hematoma

48
Q

Depressed Skull Fracture

A

Segment pushed inward
Pressure on brain causing injury

49
Q

Basilar Skull fractures

A

CSF otorrhea
CSF rhinorrhea
Periorbital ecchymosis
Battle’s sign

50
Q

Mandibular Fractures

A

Deformity along jaw
Potential for airway compromise
From high energy trauma

51
Q

Leforte I

A

Slight instability to maxilla, no displacement

52
Q

Leforte II

A

Fracture of both maxilla and nasal bones

53
Q

Leforte III

A

Fractures involving entire face below brow ridge

54
Q

Orbital Fractures

A

Zygoma, maxilla + interior shelf
Reduced eye movement
Limited jaw movement
injury to eye common

55
Q

Nose Fracture

A

Most frequent fracture of facial bones
Can depress, displace or result in epistaxis

56
Q

Waddell’s Triad

A

Paediatric struck
Bumper: femur fracture
Hood: chest injuries
Ground: head injuries

57
Q

O’donohue’s triad

A

Adult struck
Bumper: tib-fib
Knee: ligament tears
Hood: femur/pelvic fractures

58
Q

Complications of Thoracic trauma

A

Hypoxia
Hypercarbia
Acidosis

59
Q

Trauma Triad of Death

A

Hypothermia
Coagulopathy
Metabolic Acidosis

60
Q

Rib Fractures

A

Simple are painful but rarely life-threatening
Complications around pain
Risk of atelectasis, V/Q mismatch
Lower ribs risk to spleen, liver, kidneys

61
Q

First + Second Ribs

A

High forces required

62
Q

Underlying Injuries with Rib fracture

A

Myocardial contusion
Pericardial tamponade
Cardiac rupture
Pulmonary contusion

63
Q

Ribs 1-3

A

Great force to fracture
Possible underlying lung inury
Frequent injury to aorta or bronchi
Subclavian artery/vein risk
Pneumo risk

64
Q

Ribs 4-9

A

Most commonly fractured
Possibility of break in 2 places

65
Q

Ribs 9-12

A

Less likely to fracture
Energy to internal organs
Damage to liver, spleen, kidneys

66
Q

Flail Chest

A

Fractures of 3+ ribs in 2+ places
Paradoxical movement
Often associated with significant underlying injury
Reduces volume of respiration

67
Q

Mortality Risk + Flail Chest

A

Advanced age
7+ rib fractures
3+ associated injuries
Shock
Head injuries

68
Q

Sternal Fracture

A

Uncommon
Direct blow to front of chest
Associated trauma risk

69
Q

Associated trauma of Sternal fracture

A

Disruption of thoracic aorta
Tracheal or bronchial tear
Diaphragm rupture
Flail chest
Myocardial trauma
Myocardial contusion, cardiac tamponade, pulmonary contusion

70
Q

Pulmonary Contusion

A

Direct damage to lung tissue in absence of pulmonary laceration
Frequently associated with rib fracture

71
Q

Sources of Injury Pulmonary Contusion

A

Direct tissue injury
Increased capillary membrane permeability

72
Q

Simple Pneumothorax Incidence

A

10-30% blunt chest trauma
Almost 100% penetrating chest trauma

73
Q

Causes

A

Fractured rib
Paper bag effect
Spontaneously in tall, thin young men
Marfan’s syndrome

74
Q

Open Pneumothorax

A

Penetrating trauma
Communication between pleural space and atmosphere
Ipsilateral Lung collapse

75
Q

Patho of Open Pneumo

A

V/Q Mismatch
Pressure within pleural space
Impaired vena cava return

76
Q

Tension Pneumothorax

A

Lung tissue damage with one way valve effect, air trapped in pleural space

77
Q

Pathophysiology of tension pneumo

A

Lung collapse on affected side with mediastinal shift to contralateral side
Reduced cardiac output

78
Q

CO + Open Pneumo

A

Increased intrathoracic pressure
Cardiac tamponade
Deformed vena cava reducing preload
Twisting of great vessels

79
Q

Assessment findings in Tension Pneumo

A

JVD
Hyper-resonance
Subcutaneous emphysema
Tracheal deviation
Cyanosis

80
Q

Life threatening conditions of hemothorax

A

Hypovolemia
Hypoxia
Increased intrathoracic pressure

81
Q

Myocardial Contusion

A

Blunt injury to heart
Traumatic MI
Impairs CO
Dysrhythmias, failure
Appears like acute MI

82
Q

Pericardial Tamponade

A

In trauma from tear in coronary artery or penetration of myocardium
Compresses and impedes heart (diastolic failure)
As little as 150mL

83
Q

Beck’s Triad

A

Muffled heart sounds: reduced chamber filling in diastole
JVD: backup to IVC and SVC
Hypotension: decreased CO

84
Q

Diaphragmatic Rupture

A

Abdominal contents can rupture through diaphragm into chest
90% on left side due to protection on right by liver

85
Q

Intrathoracic Trauma

A

Any injury above umbilicus

86
Q

Intra-abdominal trauma

A

Any injury below 4th ICS

87
Q

Traumatic Asphyxia

A

Severe compressive force to thorax causing backwards flow of blood from right side of heart into SVC and upper extremities

Patient Care (11 decks)

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