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FACEM > Trauma > Flashcards

Trauma Flashcards

1
Q

Unreliable bloods with IO

A 
WBC
Plt
Na
K
Ca
CO2
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2
Q

Compartment syndrome pressures

A

30mmHg

Delta pressure: DBP - CP (<30)

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3
Q

Classify open fracture

A

1: <1cm, clean
2: 1-5cm, clean
3: >5cm, contaminated, arterial bleed
4: amputated

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4
Q

Causes of rhabdo

A 
Trauma (crush/prolonged lie)
Prolonged seizure
Thyroid storm
Electrocution
Drugs (SS, sympathomimetics)
Envenomation: Snake, Funnel Web
Sepsis (Nec Fasc, TSS)
Burns
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5
Q

Management Rhabdo

A

IV fluids (UO >2ml/hr)

Bicarbonate 2ml/kg if:

  • no hypocalcaemia
  • ph <7.5
  • urinary ph <7
  • bicarbonate <30

Treat hyperkalaemia with calcium gluconate

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6
Q

Indications for RRT in rhabdo

A

Oliguria
Fluid overloaded
Refractory hyperkalaemia

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7
Q

Bites requiring Abx

A 
Delayed presentation 8hrs
Site: Face, Hands, Feet
Tendon, joint, nerve involvement
Deep (cannot debride)
Immunocompromised
Cat & Human > dog

Augmentin prophylaxis
Cef & Metro if established infection
ADT, rabies vaccine with bats

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8
Q

Complications of Extensor finger injury

A 
Mallet finger
Swan Neck (hyperextended PIP from delayed Mallet finger repair)
Boutonnière deformity (PIP injury)
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9
Q

Indications for FB removal

A 
Vegetative (will rot)
Infection (contaminated)
Allergic reaction to FB
Close to fracture site
Intra-articular
Pressing on surrounding structures
Toxicity (lead, spike with venom)
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10
Q

Grading urethral injury

A

1: contusion
2: stretch
3: partial tear
4: complete <2cm separation
5: complete >2cm separation

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11
Q

Features suggesting urethral injury

A

Blood at meatus
High riding prostate
Perineal/scrotal bruising
Bruising tracks to abdomen

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12
Q

XR features suggesting urethral injury

A

Separation PS
APC II or III
Displaced superior pubic rami fracture
Bilateral rami fractures

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13
Q

Indications for surgery for testicular trauma

A

Open
Large haematoma
Testicular rupture
Haematocoele

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14
Q

Indications for conservative management liver

A

Grade 1 or 2
Uni-lobar fracture
No devascularised segments
Minimal peritoneal blood

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15
Q

Indications for conservative splenic injury management

A 
Haemodynamically stable
Hb stable
Young <55
Grade 1 or 2
Not anticoagulated
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16
Q

Indications for IR management of pelvic injury

A

Stable (<2 units per hour)
Blush >1.5cm on CT
Ongoing blood loss with no other source

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17
Q

Reasons to operate in pelvic injury

A

Unstable & eFAST positive
Going in anyway (other injuries)
Open pelvic fracture (PR/PV bleeding)
Needing >6 units despite binder

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18
Q

Pelvic fracture classification

A

Young-Burgess

APC

1: PS <2cm
2: PS and anterior SI
3: PS and both SI (open book)

Lateral:

1: Rami and ala
2: Rami and Iliac crest
3: 2 with APC 3

Vertical shear: upward displacement of rami, acetabulum with SI dislocation

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19
Q

Renal trauma grading

A

1: capsular haematoma
2: <1cm cortex
3: >1cm cortex
4: involves collecting system or vessels
5: shattered

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20
Q

Seat belt injuries

A

Chance fracture
Pancreatic injury
Mesenteric injury

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21
Q

Indications for traumatic laparotomy

A 
Unstable with FAST
Evisceration
Penetrating through fascia
Peritonism 
Diaphragmatic rupture
Refractory shock
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22
Q

Dissection CXR

A 
Apical capping
Left pleural effusion
Downward left bronchus 
Right NGT 2cm at T4
Loss of aortic knob
Loss of PA window
Widened mediastinum

Fracture scapula or 1/2nd rib

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23
Q

Oesophageal perforation features

A

Retrosternal pleuritic pain
Dysphagia/Odynophagia
Subcut emphysema
Left pleural effusion (particular matter)
V sign on CXR: at aorta and left diaphragm
Hamman sign: crunching sound with HB

Give IV ceftriaxone, no NGT

24
Q

Indications for thoracotomy in haemothorax

A

Bloods loss >1.5L on insertion
Loss >200ml/hr for 3 hours
Loss >150ml/hr for 6 hours
Refractory shock

Note PPH (massive)
150ml/min
50% in 3hrs
100% in 6hrs

25
Q

PECARN C-spine

A 
Exam:
Focal deficits
GCS <15
Torticollis
Substantial torso injury
History:
Midline neck pain
Diving
Pre-existing condition
High risk MVA
26
Q

Ophthalmology for eyelid lac

A 
Within 6mm medial canthus
Involving border/inside
Through tarsal plate
Involving lacrimal duct
Ptosis
Perpendicular to lid margin
27
Q

Neck wounds theatre (hard and soft)

A 
Hard:
Bubbling neck wound
Blood in mouth
Pulsatile
Shocked with active bleeding
Reduced GCS
Soft:
Small haematoma
Subcut emphysema
Dysphagia
Dysphonia
28
Q

Unstable C-spine fracture

A

Peg fracture: 1 tip, 2 waist, 3 C2
Bilateral facet dislocation C5/6 (flexion)
Jefferson (crushed C1) (diving)
Tear drop C5 (flexion & compression)
Atlanto-occipital dislocation (decel)
Hangman (pars interarticularis C2) (extend)

29
Q

Complications orbital blowout fracture

A 
Eye injuries
EOM (trapped)
Infraorbital nerve
Enophthalmos
Epistaxis
30
Q

Tripod fracture

A

Zygomatic arch
Zygomatico-frontal suture
Zygomatico-maxillary suture

31
Q

Traumatic SAH classification

A

1: normal neuro
2: confused with no motor
3: confused with motor
4: GCS 7-12
5: GCS <6

32
Q

SAH complications

A 
Vasospasm
Seizure
Hydrocephalus
Re-bleeding
Death
Residual neurological deficits
33
Q

PECARN Head

A

Evidence of skull fracture & GCS not 15 then image

If not above:
Observe +\- image if:
Non-frontal haematoma
Vomiting
Severe headache
Mechanism (5ft/3ft)
34
Q

Position of spinal tracts

A

Spinothalamic (pain & temp)
Anterolateral

Corticospinal (motor)
Posterolateral

Dorsal (fine touch, proprioception)
Posterior

35
Q

Central Cord Syndrome

A

Hyperextension
Motor, pain and temp mainly upper
Bladder and bowel ok

36
Q

Anterior cord syndrome

A

Flexion or diving
Anterior spinal infarct

All except dorsal column

37
Q

Brown sequard

A

Hemisection

Ipsilateral motor and dorsal loss
Contralateral pain and temp loss (2 levels lower)

38
Q

Dorsal Column injury

A

Penetrating or hyperextension

Loss of dorsal column only

39
Q

Burns BSA

A 
Adults (Wallace)
Head and neck 9%
Upper limb 9%
Front chest & abdo 18%
Leg 18%

Babies (Lund & Browder)
Head and neck 20%
1% to legs every year from 1yr
Buttock 2% each

40
Q

Indications to intubated smoke inhalation

A

Stridor
Signs of smoke inhalation
Swelling to neck
Usual (GCS, combative, unprotected)

41
Q

When to use Parkland formula

A

Partial/Full thickness burns only
>10% children
>15% adults

Superficial consider Brooks 2ml/kg
Deep consider Parkland 4ml/kg

Half over 8 hours, remaining over 16 hours

42
Q

Indications for MTP

A 
2 of 4:
SBP <90
HR >120
Penetrating injury
FAST positive
43
Q

Classification of shock

A

1: 750ml, 15%, HR normal
2: 750-1500ml, 30%, HR 120
3: 1500ml to 2000ml, 40%, HR 140
4: >2000ml, >40%

In trauma also use:
Rapid responder
Transient responder
Non-responder

44
Q

Massive transfusion

A

4 units per hour (MTP)

>10 units in 24 hours

45
Q

Trauma Call Criteria

A

Mechanism with age/co-morbidities

Vitals: HR 120, BP 90, RR 30, GCS 13, Sats 90%

Injuries:

  • high voltage
  • penetrating
  • blunt to high risk (skull/flail)
  • open fracture or amputation
  • serious crush
  • spinal injury
  • burns (10% child, 15% adult)
  • 2+ long bone fractures
46
Q

Physiological difference with kids

A 
MV determined by RR
CO determined by HR
Sensitive to catecholamines (late crash)
High metabolic demand (hypoglycaemia)
Higher O2 demand (desaturate faster)
Less type 1 respiratory fibres (tire faster)
47
Q

Hypotension in Paeds

A

SBP less than 70 + (age x 2)

48
Q

Anatomical difference in kids

A 
Bigger head (scalp lac)
High fulcrum (C1/2)
SCIWORA
Small airway (obstruction)
Contusions
Large unprotected abdo organs
Abdominal bladder
Thick capsule (less haemoperitoneum)
Fractures: greenstick & plastic deformity
Large BSA (hypothermia)
Fontanelle (late clinical IOP)
49
Q

Physiological differences pregnancy

A 
Airway hyperaemia
FRC reduced (desat)
Higher diaphragm (ICC)
Dilutional anaemia
Increased clotting factors (5-10)
25% placenta with no autoregulation (will dump volume here)
Uterus pressing IVC
Lax oesophageal tone (aspiration)
PVR reduced 20%
50
Q

Pregnancy specific traumatic injuries

A 
Placental abruption
Uterine rupture
Uterine irritation (PPROM)
Isoimmunisation
Direct Fetal Injury (pelvic fracture)
51
Q

Indications for C-section on CTG

A

HR >160 or <100
Decelerations
Loss of variability

52
Q

Geriatric physiological differences

A 
Delicate mucous membranes (bleed)
Slow gastric emptying (aspiration)
C-spine arthritis (fracture)
Osteoporosis (fractures)
Drug sensitivity
Increase pulm contusions 
Pressure areas (bony)
Vascular disease (AAA, dissection, MI, AKI)
Higher risk of fluid overload
53
Q

Types of blast injuries and areas affected

A

Spalling: shock wave fluid/air interface
Implosion-explosion: gas areas (lung)
Shearing force: brain from bone (SDH)

ENT: TM rupture, dislocation ossicles
Lungs: pulm oedema
GIT: perforations
CNS: ICH
Placenta: abruption
54
Q

Immediate complications to high voltage injury

A

Vascular compromise
Rhabdomyolysis
Compartment Syndrome
Arrhythmias

55
Q

Contrast risk factors

A 
Anaphylaxis
Metformin (hold if eGFR <30)
eGFR <30ml/min (x7)
Age >70
Concurrent nephrotoxic drugs
Hyperthyroidism
56
Q

What is ramping and 6 factors contributing

A

Unable to transfer CARE of patient within clinically appropriate timeframe due to lack of space.

Factors:

  • Inpatient access block
  • SSU access
  • communication with AV (bypass)
  • Review & treat AV corridor patients
  • Stream cubicle pts (can move out?)
  • monitoring Flow (oversight)
57
Q

Indications for TXA

A 
Trauma
PPH
Hereditary angioedema
Thrombolysis bleed
Traumatic hyphema 
Dental bleeding topically 
Menorrhagia

FACEM (8 decks)

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