Trauma 1

Question 1

Peaks of Trauma death

Answer 1

1: 0-30 mins -> heart lac, aorta, brain/spinal cord
2: 30 mins - 4 hrs -> head injury then hemorrhage (can be saved in golden hour)
3: days to weeks -> multisystem organ failure/sepsis

Question 2

MC organ injured in blunt injury

Answer 2

Liver

Question 3

Falls survival predictors

Answer 3

Age and body orientation biggest predictors of survival

LD 50 = 4 stories

Question 4

MC injury in penetrating

Answer 4

SB

Question 5

MC cause of death in 1st hour

Answer 5

hemorrhage, BP okay until 30% of blood volume gone

Question 6

MC cause of death after getting to ER alive

Answer 6

Head injury

Question 7

MC cause of long term death

Answer 7

infection

Question 8

MC cause of upper airway obstruction

Answer 8

Tongue -> perform jaw thrust

Question 9

MC injury from seat belts

Answer 9

SB perf, lumbar spine fracture, sternal fractures

Question 10

Best cutdown venous access site

Answer 10

Saphenous vein cutdown @ ANKLE

Question 11

Hemostatic resuscitation for patients receiving how many pRBCs in how many hours?

Answer 11

4 U in 1st hour

10 U in >= 24 hrs

Question 12

Coagulopathy in severly injured patient before or after resuscitation?

Answer 12

Before

Question 13

What is Hemostatic resuscitation?

Answer 13

RBCs:FFP:platelets 1:1:1

Question 14

Principles of Damage control surgery

Answer 14

Control bleeding and contamination
Give blood
Hemostatic resuscitation
Limit crystalloids (2 L initially)
Allow permissive hypotension (SBP > 70) until hemorrhage controlled then SBP > 90; unless TBI then want > 90 initially
Correct hypothermia, hypocalcemia, acidosis early

Question 15

When to use DPL

Answer 15

Hypotensive pts w/ blunt trauma
Must be supraumbilical if pelvic fracture
Misses retroperitoneal bleeds and contained hematomas

Question 16

+ DPL?

Answer 16

> 10 cc blood, > 100,000 RBCs/cc, food particles, bile, bacteria, > 500 WBC/cc
If + then Ex lap

Question 17

Where FAST

Answer 17

Perihepatic fossa, perisplenic fossa, pelvis, pericardium

Ex lap if +

Question 18

Downside of FAST

Answer 18

operator dependent, obesity obstrucs view, hard to detect fluid < 50-80 cc, misses retroperitoneal bleed and hollow viscous organs

Question 19

If hypotensive with - FAST -> where to look?

Answer 19

Chest, pelvic fracture, extremities

Question 20

CT scan for blunt trauma w/

Answer 20

Abd pain, getting general anesthesia, close head injury, intoxicants, paraplegia, hematuria, distracting injury
Misses hollow viscous injury and diaphragm injury

Question 21

Need Ex lap for

Answer 21

Peritonitis, evisceration, + DPL/FAST, uncontrolled visceral hemorrhage, free air, diaphragm injury, intraperitoneal bladder injury, contrast extrav from hollow viscous organs, usually penetrating abd injury

Question 22

Local penetrating abd injury next step (knife, low velocity injury)

Answer 22

Local wound exploration to see if fascia violated

Question 23

Abd compartment syndrome

Answer 23

HypoTN, distended abd, low UOP, Inc airway pressures, prolonged transport time
Bladder pressure > 25-30
IVC compression (dec cardiac output)
Visceral and renal malperfusion (dec urinary output)
Tx: Decompressive laparotomy

Question 24

When does abd compartment syndrome happen

Answer 24

After massive fluid resusciation, trauma, abd surgery

Question 25

Pneumatic shock garment

Answer 25

Controversial

For SBP < 50 and no thoracic injury, release compartments one at a time in ED

Question 26

ED thoracotomy

Answer 26

Blunt: Only if pulse lost in the ED
Penetrating if pulse/pressu lost on way to or in ED
Thoracotomy: oper pericardium anterior to phrenic nerve, cross clamp aorta, was for esophagus