Trauma

Question 1

Cardiogenic shock

Answer 1

Systolic and diastolic myocardial dysfuncfion resulting in hypo perfusion

Question 2

Cardiac contusion or blunt myocardial injury

Answer 2

Ectopy, heart sounds, low voltage

Question 3

Obstructive shock

Answer 3

Inadequate CO causes by obstruction of great vessels or heart. Tension PTX, hemothorax, tamponade, PE

Question 4

Spinal Shock

Answer 4

Spinal shock refers to a loss or depression of function below the site of a complete or incomplete spinal cord injury. It occurs within 24 hours of the injury (Taylor et al., 2017).

Question 5

Neurogenic shock

Answer 5

• Neurogenicshock is a form of distributive shock associated with a loss of sympathetic innervation. Basically, an injury damages the CNS or spinal cord and this results in a loss of arterial tone. The loss of arterial tone causes vasodilation which leads to pooling in the peripheralcirculation.
• Patients may also experience bradycardiaor a loss of reflex tachycardia if the site from T1-T4 is injured as this causes unopposed parasympatheticstimulation of the heart (Stapcynzskiet al., 2016).

Question 6

Trauma-induced coagulopathy is the sum of two distinct processes

Answer 6

acute coagulopathy of trauma (TC), resuscitation-induced coagulopathy(IC).

Question 7

Iatrogenic Trauma induced coagulopathy includes:

Answer 7

includes loss, consumption and dilution of coagulation factors, the latter often being related to uncritical volume administration during the initial phase of care to stabilize circulatory function

Question 8

Kinetic Energy

Answer 8

KE = (mass/2)x(velocity^2)

Question 9

Newton’s second law

Answer 9

F= ma

Question 10

Impulse momentum theorem

Answer 10

F= △p/△T

Question 11

How do crumple zones and airbags work

Answer 11

Crumple zones and airbags prolong the change in time taken for a given impact

Question 12

Target BP in isolated SCI

Answer 12

SBP >120mmHg

Question 13

Target BP in head injury

Answer 13

MAP > 80 mmHg

Question 14

Monro-Kellie Doctrine

Answer 14

Within a fix container, the volume of the occupying matter must compensate in the face of an increased internal pressure.

Question 15

Epidural hematoma

Answer 15

Arterial in nature
Midline shifts on CT due to the dura encapsulating the bleed (poor blood distribution along the membrane)
Most salvageable TBI if caught on time and managed appropriately
Brain death within 1-2h if left untreated

Question 16

Subdural hematoma

Answer 16

Venous bleed mostly caused by blunt trauma
Lower pressure bleed as it is venous in nature
Slower to elevate ICP and less prone to herniation
Contained between the dura and arachnoid, blood follows the sulcus.

Question 17

Subarachnoid Hemorrhage

Answer 17

Different than the aneurysmal non-traumatic SAH
Mostly venous in nature and less likely to cause midline shift
Focal point seen on CT at impact location of the skull, however blood migrates along the sub-arachnoid space
Vessels in Circle of Willis not usually affected

Question 18

Intracranial hemorrhage

Answer 18

Rare occurrence in the trauma setting
Usually occurs in conjunction with another injury (sub-arachnoid, contusions..)
Localized intra-parenchymal
Size of injury is vessel dependent.

Question 19

Contusions

Answer 19

Typically occurs in the frontal lobe
Presents with edema ++
Usually is found with adjacent bleeds
Contusion and edema can cause increased ICP
High risk for bleeds and / or bleeds to occur in the following hours.
Coup/ Contracoup

Question 20

Cushing’s triad

Answer 20

Dysregulation of the sympathetic and parasympathetic impulses
Characterized by: Hypertension, Bradycardia and apnea (some literature states irregular breathing)

Question 21

Jefferson Fracture

Answer 21

Anterior and posterior arches of C1

Question 22

Hangman’s fracture

Answer 22

Posterior Lateral C2

Question 23

Clay Shovele’s Fracture

Answer 23

C6-C7 spinous process fracture

Question 24

Anterior Cord Injury

Answer 24

Vibrations and proprioception remains normal even below the injury
Contra-lateral pain and temperature sensation loss below the injury
Ipsilateral motor loss below the injury

Question 25

Central Cord Syndrome

Answer 25

Affects motor skill more than sensory
Weakness greater seen in superior limbs than inferior limbs
Loss of bladder function leading to urine retention
If complete cord severance: Total loss of sensation and movement below the injury.

Question 26

Brown-Séquard

Answer 26

Contra-lateral loss of pain and temperature
Ipsilateral motor, proprioception and vibration loss
All below the injury

Question 27

Flail Segment

Answer 27

3 consecutive ribs or more

Question 28

Potential lung blood volume

Answer 28

Each cavity can hold up to 1500ml of blood

Question 29

Target BP in burns

Answer 29

SBP >120mmHg

Question 30

What are the 4 types of burns?

Answer 30

Superficial, Superficial-partial thickness, deep- partial thickness, full thickness