Trauma

Question 1

4 main mechanisms of trauma

Answer 1

1. Blunt force
2. Penetrating
3. Acceleration/Deceleration
4. Crushing

Question 2

define monotrauma

Answer 2

single system injury and less likely to be life-threatening

Question 3

define polytrauma

Answer 3

two or more significant injuries/multiple body systems, assoc. w/ greater morbidity and mortality

Question 4

what are the two scoring systems specifically used to assess trauma in vet?

Answer 4

• animal trauma triage score (ATTS)

- modified glasgow coma scale (MGCS)

Question 5

what are 3 common risks to the CDV system?

Answer 5

1. Polytrauma assoc. w/ blood loss
2. Indirect myocardial injury (from shock/contusions)
3. Direct myocardial injury

Question 6

what are 3 causes of secondary brain injury?

Answer 6

inflammation, ischaemic injury, cerebral oedema

Question 7

CPP =

Answer 7

MAP - ICP

Question 8

Pressure autoregulation of CPP is intact between MAP of

Answer 8

50-150mmHg

Question 9

Common thoracic trauma

Answer 9

• pulmonary contusions
• pneumothorax
• rib fractures/flail chest
• diaphragmatic hernia
• haemothorax

Question 10

what are your four sites of an aFAST?

Answer 10

1. diaphragmatic hepatic (DH) site - bleeding around liver
2. Splenorenal (SR) site - bleeding around the spleen or in the retroperitoneum around the kidney
3. Cystocolic (CC) site - free fluid around the urinary bladder - urine/blood
4. Hepatorenal (HR) site - bleeding around the liver and right kidney in the peritoneum and retroperitoneum

Question 11

inspiratory dyspnoea is associated with

Answer 11

pleural space disease

Question 12

inspiratory dyspnoea + noise =

Answer 12

upper airway issue

Question 13

what do B-lines/Comet Tail artefacts indicate?

Answer 13

fluid/cells in the lungs where they shouldn’t be –> pulmonary contusions in the trauma patient

Question 14

what do you note on neurological exam (mGCS)?

Answer 14

• LOC
• CN/brainstem reflexes
• motor function
• external signs of head trauma
• evidence of spinal cord injury

Question 15

what are signs of impending cerebral herniation?

Answer 15

1. Cushings reflex:
   - deteriorating LOC
   - bradycardia (30-40bpm dogs)
   - reflex hypertension
2. Pupil changes (dilating, loss of PLR)
3. Resp. changes - ataxic/agonal
4. Decerebrate posture
   - hyperextension of all four limbs
   - dorsiflexion (hyperextension) of tail and head
   - extreme hyperextension of the spine (opisthotonus) produces concave configuration of the back
   - easily toppled if made to stand on four limbs

Question 16

how do you treat hypovol shock?

Answer 16

IVFT bolus 20-40ml/kg LRS over 10min

Hypertonic saline 3-5ml/kg slow IV if TBI

Question 17

medical management of haemoperitoneum?

Answer 17

• IV fluid resus
• transfusion (dependent on lost BV)
• abdominal wrap = external counterpressure

Question 18

thoracostomy tube indications

Answer 18

• > 2-3 thoracocentesis in <12-18h

- no end-point reached

Question 19

management of pulmonary contusions

Answer 19

• supplemental O2
• careful fluid resus
• rest + time
• intubation + ventilation if severe

Question 20

how can you reduce cerebral oedema?

Answer 20

• mannitol

- hypertonic saline

Question 21

approach to management of a TBI case

Answer 21

1. maintain MAP
2. reduce ICP:
   - encourage CSF drainage - elevate head
   - reduce cerebral oedema w/ hyperosmolar agents
3. Manage seizures, pain, anxiety
   NO STEROIDSS

Question 22

actions if signs of impending cerebral herniation

Answer 22

- intubate +
 hyperventilation ETCO2 (30-35mmHg) --> reduce ICP via chemical autoregulation