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CCFP-EM > trauma > Flashcards

trauma Flashcards

1
Q

Hard Signs of Penetrating Neck Trauma

A

Expanding or pulsatile hematoma
Loss of airway
Stridor or hoarse voice
Audible bruit or palpable thrill
Massive subcutaneous emphysema
Wound bubbling
Shock refractory to resuscitation

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2
Q

Soft signs of penetrating neck trauma

A

Mild hemoptysis
Dysphonia
Dysphagia
Subcut or mediastinal air, non-expanding hematoma

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3
Q

Spinal Levels and Loss of Function

A

C2- occiput
C3 - Thyroid Cartilage
C4 - Breathing / Sternal notch
C5 - Shrugging / Below the clavicles
C6 - Elbow flexion / Thumb
C7 - Extension / middle finger
C8 -Finger Flexion

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4
Q

Anterior Spinal Column Contents

A

Anterior: Anterior spinal ligament, ant vertebral body and disc

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5
Q

Middle Spinal Column Contents

A

posterior annulus of disc, posterior vertebral wall, posterior longitudinal ligament, spinal cord, laminae and pedicles, articulating facets, transverse process, nerve roots, vertebral arteries and veins

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6
Q

Posterior Spinal Column Contents

A

Posterior: spinous process, nuchal ligament, interspinous and supraspinous ligaments, and ligamentum flavum

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7
Q

Corticospinal Tract Location and Function

A

Postero-lateral and anterior cord. Ipsilateral motor.

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8
Q

Spinothalmic Tract Location and Function

A

Anterolateral. Pain and temperature.

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9
Q

Posterior Columns Locations and Function

A

Posterior central. Light touch Vibration and proprioception ipsilateral.

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10
Q

Canadian C-Spine Rule High Risk Features

A

1) Age > 65
2) High Energy Mechanism
- Fall > 3 ft, axial load, high speed MVC, ATVs, bicycle hit by car
3) Parasthesias in extremities

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11
Q

Canadian C-Spine Low Risk Features

A

1) Ambulated at any point
2) Seated in ED
3) Simple rearend MVC
4) Delayed onset of neck pain
5) Absence on C-spine tenderness

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12
Q

Canadian C-Spine Inclusion

A

GCS 15
Stable vital signs
Age > 16
No paralysis
No known vertebral disease
Previous c-spine surgery

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13
Q

Canadian CT Head Inclusion

A

LOC, definite amnesia or witnessed disorientation in GCS 13-15
Age >= 16
No anticoags

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14
Q

Canadian CT Head Rule High Risk

A

1) GCS < 15 @ 2 hrs
2) Suspected open or depressed #
3) Any sign basal skull #
4) Vomiting > 2 episodes
5) Age > 65

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15
Q

Canadian CT Head Medium Risk

A

Amnesia > 30 minutes before impact
Dangerous mechanism

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16
Q

Cervical Spine Injuries and Stability - Flexion

A

1) Wedge - Stable
2) Flexion Tear Drop - Anterior vertebral body teardrop with interspinous ligament disruption. VERY unstable
3) Clay Shoveler’s - Spinous process #. Stable
4) Subluxation - Atlantooccipital misalignment. Possibly unstable
5) Bilateral Facet Dislocation - Unstable
6) Anterior atlantoaxial dislocation w or w/o # - Unstable
7) A-A dislocation - stable
8) Odontoid # - Unstable
9) Fracture of transverse process - stable.

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17
Q

C-Spine Injuries Flexion - Rotation

A

Unilateral Facet Dislocation - stable
Rotary A-A dislocation - unstable

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18
Q

C-Spine Injuries Extension

A

Posterior Neural Arch (C1) - Unstable
Hangman’s (C2) - # of bilateral pars interarticularis
Extension teardrop - Unstable in extension
Proper A-A dislocation w or w/o # - unstable
All extension injuries unstable

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19
Q

C-Spine Injuries Compression

A

Bursting - stable
Jefferson (C1) - Extremely unstable if ligamentous injury
Isolated # of articular pillar and vertebral body

20
Q

Types of Odontoid Fractures

A

Type 1: Uncommon - tip of the dens. Avulsion of alar ligaments
Type 2: Most common - Waist of the dens near the ligament insertion
Type 3: Base of dens into the body

Type go in order from superior to inferior

21
Q

Central Cord Syndrome Mechanism and Symptoms

A

Hyperextension in an already narrowed canal. ?Ligamentum flavum protrusion into cord and injures central portion of cord.
- Weakness more in upper than lower.
- Variable sensory changes

22
Q

Anterior Cord Syndrome

A

Hyperflexion injury with disc protrusion into anterior cord.
- Motor paralysis below level
- Pain affected, fine touch and prioprioception spared
- Worst prognosis of partial cord injuries

23
Q

Define Spinal Shock vs Neurogenic Shock

A

Spinal shock is reversible impairment of spinal cord injury - can lead to neurogenic shock. Often leads to loss of f’n below the level of the injury.

Neurogenic Shock: Uncontrolled parasympathetic activation in complete spinal cord injury above T6 (location of sympathetic chain), bradycardia and vasodilation. Can see priapism as well.

24
Q

Brown Sequard / Hemi Cord Syndrome

A

Penetrating injury or lateral masses fracture
Weakness or paralysis with contralateral loss of sensation.

25
Q

Myocardial Concussion

A

Think commotio cordis - blunt trauma during repol. Can lead to asystole or vfib. No structural damage.

26
Q

Myocardial Contusion

A

Chest trauma with heart compressed by sternum. ECG abnormalities, tachy, PVCs, heart block, ischemia, arrhythmia, trop elevation.
- N ECG and N trop = rule out

27
Q

Rib Fractures

A

If 3 or more - Consider admission. Treat pain to avoid splinting and atelectasis

28
Q

WEST Guidelines for Traumatic Arrest

A

If no signs of life:
Blunt > 10 min
Penetrating > 15 min
= Dead
If < time limit Consider resuscitative thoracotomy

29
Q

Pneumothorax Mgmt

A

If small < 2cm to chest wall then conservative
If > 3 cm chest tube.

30
Q

Signs of Tension Pneumo

A

Deviated Trachea
Hypotension
Tachycardia, tachypnea
Altered LOC
Hypoxia

31
Q

Indications for laparotomy following penetrating trauma

A

Evisceration
Diaphragm injury
Hemodynamic Instability
Peritoneal signs

OR:
Intraperitoneal air
Implement in situ
Gastrointestinal hemorrhage

32
Q

Diaphragm Injury Assess

A

can be missed on CT
If L thoracoabdo penetrating trauma - need thoracoscopy or laparoscopy with N CT.

33
Q

Indications for laparotomy after blunt trauma

A

Hemodynamic Instability with suspected abdomen injury
Peritonitis (Unequivocal)
Pneumoperitoneum
Diaphragmatic injury
GI bleeding

34
Q

If multisystem trauma, hemodynamic unstable, with unstable pelvis and N CXR - next steps

A

If FAST + : laparotomy with packing and fixation

If FAST - : Usually* angiography embolization and pelvic fixation. THEN look for intraabdominal injury on CT +/- laparotomy

35
Q

If combined blunt head with lateralizing and blunt abdo trauma

A

BRAIN TRUMPS EVERYTING:
- Consider CT head and craniotomy
then laparotomy vs angiography with pelvic fixation

36
Q

Types of brain herniation

A

Subfalcine
Transalar / transphenoidal
Transtentorial uncal
Central transtentorial
Cerebellar Tonsillar Herniation
Transcalvarial

37
Q

Tentorial (Uncal) Symptoms

A

3 nerve palsy - unilateral fixed, blown
Contralateral hemiparesis
Brain stem compression

38
Q

Subfalcine (midline shift) herniation Signs

A

Papilledema
Contralateral leg paralysis

39
Q

Central (tentorial) herniation Signs

A

Pupils fixed, mid-dilated.
Decerebrate posturing
(Similar to transtent)

40
Q

Upward transtentorial signs

A

Hydrocephalus and increased ICP
N/V, headache and ataxia
Progressive LOC and brain stem reflexes
Ataxia and dysarthria
Respiratory irregularities

41
Q

Tonsillar Herniation Sign (cerebellar tonsil)

A

Acute hydrocephalus with impaired consciousness, headache vomiting, and meningismus,
Dysconjugate gaze and nystagmus
Death

42
Q

massive transfusion def’n

A

Massive transfusion has been defined as transfusion of ≥10 units of whole blood (WB) or packed red blood cells (pRBCs) in 24 hours, ≥3 units of pRBCs in one hour, or ≥4 blood components in 30 minutes

43
Q

risks / adverse events of massive transfusion

A

coagulopathy

44
Q

Zone 1 Neck Anatomy

A

Base of neck to cricoid cartilage
- Prox carotid artery
- Vertebral artery
- Subclavian
- Mediastinal vessels
- Apices of lungs
- Esophagus
- Trachea
- Thyroid
- Thoracic Duct
- Spinal Cord

45
Q

Zone 2 Neck Anatomy

A

Base of cricoid to angle of jaw
- Carotid artery
- Vertebral artery
- Larynx
- Pharynx
- Jugular Vein
- Esophagus
- Trachea
- Vagus Nerve
- Recurrent Laryngeal Nerve
- Spinal Cord

CCFP-EM (20 decks)

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