Trauma Flashcards
Most common indication for establishment of a definitive airway
Altered mental status
Others are:
Apnea
Impending airway compromise (facial bleeding, inhalation injury)
Inability to maintain oxygenation
Most common technique used in establishing an airway
Orotracheal intubation
Cricothyroidotomy is contraindicated in:
Patients <8
Laryngotracheal separation or laryngeal fractures
In tension pneumothorax, are the neck veins distended or flat?
May be both.
Distended due to SVC impedance;
Flat due to hypotension
What qualifies pneumothorax as tension (vs simple)?
Hypotension
Landmark for needle thoracostomy
2nd ICS MCL
Landmark for tube thoracostomy
4th - 5th ICS, MAL
Management of open pneumothorax
Cover wound with occlusive dressing taped on three sides
Estimated SBP with the palpable pulses:
- Carotid
- Femoral
- Radial
- 60 mmHg
- 70 mmHg
- 80 mmHg
Saphenous vein cutdowns at the ankle provide excellent access. The vein is reliably found ____.
1 cm anterior, 1 cm superior to the medial malleolus
What is the immediate management to reduce bleeding from:
- Open fracture
- Scalp laceration
- Fracture reduction with splinting
2. Skin staples, Rainey clips, full thickness continuous nylon stitch
The ‘big three’ radiographic exams for patients with severe blunt trauma
CXR
Pelvic radiograph
Lateral cervical spine
Massive hemothorax is defined as:
> 1500 mL or blood
In cardiac tamponade, a SBP < ___ warrants emergency department thoracototmy
70 mmHg
Indications for emergency department thoracotomy include salvageable post-injury cardiac arrest.
How is ‘salvageable post-injury cardiac arrest’ defined?
Penetrating trauma with <5 minutes of prehospital CPR
Normal urine output for:
- Adults
- Children
- Infants <1y
- 0.5 mL/kg/h
- 1.0 mL/kg/h
- 2.0 mL/kg/h
Most causes of hypotension in the trauma bay are due to hemorrhagic and cardiogenic shock.
When does one suspect:
- Septic shock
- Neurogenic shock
- Patient transferred >12 h from injury
2. (+) Paralysis
Most frequent cause of cardiac failure
Tension pneumothorax
Indications for operative treatment in penetrating trauma
Massive hemothorax
Initial chest tube output >1L with outgoing output of >200 mL/h
Abdominal trauma with UTZ evidence of hemoperitoneum
Blood loss associated with fracture of:
- Rib
- Tibia
- Femur
- Pelvis
- 100 - 200 mL
- 300 - 500 mL
- 800 - 1000 mL
- > 1000 mL
3 signs of urethral injury
Blood at the meatus
Perineal or scrotal hemaotma
High-riding prostate
CT findings in diffuse axonal injury
- Blurring of gray and white matter interface
- Multiple small punctate hemorrhages on CT
(MRI is still more sensitive.)
Signs of laryngeal fracture
Hoarseness
Subcutaneous emphysema
Palpable fracture
What is the pattern of motor and sensory deficit in:
- Central cord syndrome
- Anterior cord syndrome
- Brown Sequard syndrome
- Motor, pain and temperature deficits in upper extremities (preserved in LE)
- Motor, pain and temperature deficits below level of injury; intact position, vibration and crude touch
- Ipsilateral motor, proprioception and vibration loss; contralateral pain and temperature loss
TRAUMA DRILLS
Neck injury between the cricoid and angle of mandible; hemodynamically unstable. What to do?!
Operative exploration
All hemodynamically unstable patients with neck injury are operated ASAP.
TRAUMA DRILLS
Neck injury above mandible; asymptomatic
Observe
Asymptomatic Zone I and transcervical GSW in Zone II > CT Neck
Neck injury between cricoid and angle of mandible; symptomatic. What to do?!
Operative exploration
Symptomatic Zone I > CT Neck/Chest
Symptomatic Zone III > Angio + IR/Embo
All anterior truncal gunshot wounds between 4th ICS and pubic symphysis warrant surgical exploration except:
RUQ trauma
Trajectory confined to liver
Criteria for (+) findings on DPL:
RBC in:
- Anterior abdominal
- Thoracoabdominal
- > 100,000/mL
2. >10,000/mL
Criteria for (+) findings on DPL:
- WBC
- Amylase
- Alkaline phosphatase
- Bilirubin
- > 500/mL
- > 19 IU/L
- > 2 IU/L
- > 0.01 mg/dL
FAST is sensitive for detecting fluid > ___.
250 mL
TRAUMA DRILLS
Patient with abdominal trauma. Hemodynamically unstable. Next step in management?
FAST
If (+), do lap, if equivocal, DPA.
TRAUMA DRILLS
Patient with abdominal trauma. Hemodynamically stable. What will be the next step in management if:
- Patient has signs of peritonitis
- Patient has no signs of peritonitis
- Laparotomy
2. FAST
TRAUMA DRILLS
Patient with abdominal trauma. Hemodynamically stable, with (-) FAST and no peritoneal signs. What are the indications for doing CT on this patient?
- Altered mental status
- Confounding injury
- Gross hematuria
- Pelvic fracture
- Abdominal tenderness
- Unexplained Hct < 35%
Transfusion pRBC when Hgb is <___.
7 g/dL
Aim for 10g/dL.
FFP is transfused with:
- INR > ___
- PTT > ___
- 1.5
2. 45 s
In trauma, extended post-op antibiotics are only administered for:
Open fractures
Significant intraabdominal contamination
Target CPP in patients with head injuries
35 - 40 mmHg
In head injuries, vasoconstriction is attained by hyperventilation to a PCO2 < ____.
30 mmHg
What is the organ most susceptible to blunt trauma?
Liver
Most commonly missed gastric injury
Posterior wound of a through and through penetrating injury
