Trauma Flashcards
Cardiogenic shock
Systolic and diastolic myocardial dysfuncfion resulting in hypo perfusion
Cardiac contusion or blunt myocardial injury
Ectopy, heart sounds, low voltage
Obstructive shock
Inadequate CO causes by obstruction of great vessels or heart. Tension PTX, hemothorax, tamponade, PE
Spinal Shock
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).
Neurogenic shock
- 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).
Trauma-induced coagulopathy is the sum of two distinct processes
acute coagulopathy of trauma (TC), resuscitation-induced coagulopathy(IC).
Iatrogenic Trauma induced coagulopathy includes:
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
Kinetic Energy
KE = (mass/2)x(velocity^2)
Newton’s second law
F= ma
Impulse momentum theorem
F= △p/△T
How do crumple zones and airbags work
Crumple zones and airbags prolong the change in time taken for a given impact
Target BP in isolated SCI
SBP >120mmHg
Target BP in head injury
MAP > 80 mmHg
Monro-Kellie Doctrine
Within a fix container, the volume of the occupying matter must compensate in the face of an increased internal pressure.
Epidural hematoma
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
Subdural hematoma
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.
Subarachnoid Hemorrhage
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
Intracranial hemorrhage
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.
Contusions
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
Cushing’s triad
Dysregulation of the sympathetic and parasympathetic impulses
Characterized by: Hypertension, Bradycardia and apnea (some literature states irregular breathing)
Jefferson Fracture
Anterior and posterior arches of C1
Hangman’s fracture
Posterior Lateral C2
Clay Shovele’s Fracture
C6-C7 spinous process fracture
Anterior Cord Injury
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
Central Cord Syndrome
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.
Brown-Séquard
Contra-lateral loss of pain and temperature
Ipsilateral motor, proprioception and vibration loss
All below the injury
Flail Segment
3 consecutive ribs or more
Potential lung blood volume
Each cavity can hold up to 1500ml of blood
Target BP in burns
SBP >120mmHg
What are the 4 types of burns?
Superficial, Superficial-partial thickness, deep- partial thickness, full thickness
