Trauma 101 Flashcards by Stephanie Escobar

(imaging) in patients with penetrating injuries to the thorax or abdomen; ALWAYS

CXR

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Imaging for hemodynamically unstable patients

FAST exam

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Imaging for hemodynamically stable patient

`CT scan

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Any penetrating wound below the nipple requires a(n)

______

exploratory laparotomy

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High-energy trauma + widened mediastinum on CXR →

Next best step in management?

CT Angiography for aortic injury

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Blunt trauma + subcutaneous emphysema →

Next best step in management?

Bronchoscopy for tracheal injury

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Signs of peritonitis (abdominal tenderness, rebound, guarding, rigidity) → Next best step in management?

exploratory laparotomy

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Pt with Blood at the urinary meatus → Next best step in management?

Retrograde URETHRO-gram

might be bladder injury, but need to r/o urethral injury first

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Pt presents with no blood at the urinary meatus, but has hematuria in the Foley catheter → Next best step in management?

Retrograde CYSTO-gram to r/o bladder injury

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Pt presents with hematuria in Foley catheter.

Retrograde urethrogram and cystogram have been normal → Next best step in management?

CT scan to r/o kidney injury

why not retrograde pyelography?

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Pts pupils are fixed (non-reactive to light) and dilated.

What 2 things can result in this finding?

Brain bleeds & herniation

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Pt presents with narrowing Pulse Pressure (SBP–DBP) list one possible cause

Hemorrhage
→ cause SBP to drop & DBP to rise
→ this helps maintain MAP >65 for adequate perfusion

MAP = CO x TPR → DBP + 1/3 (PP)

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Pt needs fluid resuscitation. What IVs are used?

2 large bore (16 gauge) peripheral IVs

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Patient needs transfusion for massive hemorrhage what is given to the patient?

Whole blood

1:1:1 of pRBC, Plasma, Platelets

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Most common injuries in trauma (5)

[SPLUGeD in trauma]

Splenic injury/rupture
Pancreatic injury (handlebar injury)
Liver injury/rupture
Genital  trauma
Urinary trauma
Duodenal rupture/ hematoma (kids mostly–Handlebar injury)

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Handlebar injury should raise concerns for what 3 injuries?

Pancreatic injury
Splenic
Duodenal

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Patient with Ecchymoses over the right chest &
pain in the right shoulder
should raise concerns for what injury?

Liver hematoma

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Patient with Hematuria, Pain, bruising, &
Flank discoloration/ecchymoses
should raise concerns for what injury?

Renal hematoma

Blunt chest trauma should be considered in patients with what physical exam finding?

JVD

Best initial test for all blunt chest trauma patients?

Chest x-ray

and FAST, ECG, Troponin

Pt presents with flail chest injury and begins to have dyspnea with dropping oxygen saturations. What is the next best step in management before bridging pt to surgery for rib fixation with plate?

Flail chest: 3+ ribs are broken in 3+ places creating 1 floating segment

Intubate on PPV

1st line: Oxygen, analgesia, and monitoring vitals/pulmonary edema →

If showing signs of impending respiratory failure → Intubate on PPV

2nd line: Once on PPV → surgical rib fracture fixation via Rib cage Plate (sx indicated if rib is very displaced even in the absence of RF)

Trauma pt presents has CXR showing Ipsilateral diaphragmatic elevation.
Diagnosis and next best step in management?

Phrenic (C3–C5) nerve paralysis → Intubate

*Unilateral paralysis → Asymptomatic/ exertional dyspnea
Bilateral paralysis → severe dyspnea

Pulmonary contusion on CXR → Patchy alveolar infiltrates (White out or diffuse opacity)
Next best step in management?

Monitor blood gasses (ABG)

*Cx → ARDS

Trauma pt presents with:

subcutaneous emphysema w/o tracheal midline shift nor distended neck veins

Next best step in management?

CXR

Tracheobronchial injury

``` Pt in ED with chest pain, dyspnea Subcutaneous emphysema crepitus on chest auscultation synchronous to the heartbeat +/- hoarse voice Dx & next best step in management? ``` *List 3 possible causes of this presentation?

1. Pneumomediastinum: presence of gas (usually air) in the mediastinum 2. Get a CXR 3. Causes: Rupture of pulmonary blebs Boerhaave (esophageal rupture) Iatrogenic (post-procedure: endoscopy) *(Hamman's crunch: crepitus w/ heart beat)

Pt in ED with recent h/o Strangulation, intubation, or penetrating trauma to neck or chest who presents with Hoarseness, Dyspnea, Hemoptysis, Palpable crepitus, Hamman's sign (crepitus on chest auscultation) Diagnosis & Next best step in management?

Tracheal Rupture Chest x-ray → Bronchoscopy→ Chest CT (if you think it might be Pneumomediastinum the answer is still get a CXR)

Tracheal Rupture: Partial or complete puncture or laceration of the trachea or the main bronchi (bronchial disruption) Management for stable versus unstable patient?

In stable patients: conservative management → Neck immobilization. Unstable patient (vascular injury, hard signs) → Surgery

Presents with the all/some of the following: unequal leg length w/ reduced ROM Labial/Scrotal, flank, or inguinal hematomas Urethral injury

Pelvic Fractures (Tilted/ Unstable pelvis) Diagnostics: Pelvic X-ray → CT (in stabilized patients)

Trauma pt with a high-riding or nonpalpable prostate, perineal swelling, & hematuria. Concerns for ____

Urethral injury ( blood at urethral meatus) *If suspected injury of the urinary tract → Retrograde urethrogram, cystogram, & pyelourethrogram (Contrast is injected into the ureters to make the ureters & kidneys easily seen on the x-ray)

If pt has confirmed urinary injury on imaging what is the next best step in management?

Suprapubic catheterization | not transurethral

Management of Pelvic Fractures includes: Prompt ____ If, stable fracture → If open, unstable fracture, or urological injury →

pelvic stabilization with an external binder/brace Conservative treatment → stable Surgical treatment → unstable/open/urologic injury

Pt with pelvic fracture is hemorrhaging → | Next best step in management?

Angiography w/ Embolization | +/- external fixation

List 2 possible complications of pelvic fractures:

Hemorrhagic shock → intra/retroperitoneal bleeding Abdominal compartment syndrome → blood filling peritoneal spaces

Extremity Pain Worse with passive stretching or extension of muscles Very tight, wood-like muscles that are extremely tender out of proportion to the extent of injury Paresthesia & Soft tissue swelling Diagnosis & Next best step in management?

Acute compartment syndrome (ACS) Bedside fasciotomy

Acute limb ischemia presents with what 4 early sxs and what 2 late sxs?

Early: Pain, Pallor, Paresthesias & Poikilothermia (cold) Late: Pulselessness & Paralysis *Pulse is usually still palpable but pulselessness is a very bad sign

How to tell apart acute compartment syndrome from acute limb ischemia?

ACS: extreme pain worse with passive flexion, rock hard muscles, WARM, swelling ALI: moderately painful, Pale & COLD Both: paresthesia & late paralysis (consider pt hx)

____ can turn a simple pneumothorax into a life-threatening tension pneumothorax.

Positive pressure ventilation

In Penetrating abdominal trauma, surgical repair is done after ___

hemodynamic stabilization | IVFs, blood, pressors

Can present with cutaneous crepitus (4)

Pneumomediastinum/pneumothorax Tracheobronchial Rupture Esophageal Rupture Hemothorax

Trauma pt presents with FLAT neck veins, dullness on percussion, Decreased tactile fremitus +/-Crepitus on palpation +/-Paradoxical chest wall movement Diagnosis & Next best step in management?

Traumatic hemothorax (blood within the pleural space) Get CXR (Looks like pleural effusion; blunting of the costophrenic angle, tracheal deviation/ mediastinal shift) *Ultrasound (can detection of smaller amounts of fluid/blood)

CXR shows hemothorax what is the next best step in management?

Chest tube insertion

In Hemothorax a Thoracotomy is indicated if (2)

Initial chest tube output is > 1500 mL or chest tube output is >200 mL/hour for 2–4 hours

What is the main complication associated with Hemothorax

Pleural empyema | Thoracentesis