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BTK Review 2023 > Trauma > Flashcards

Trauma Flashcards

1
Q

What is the preferred procedure for an emergent airway in patient’s that can’t be successfully intubated?

A

cricothyroidotomy

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2
Q

What part of the GCS has the most prognostic ability?

A

motor score

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3
Q

Bilateral pinpoint pupils in a trauma patient are potentially suggestive of what intracranial process?

A

a pontine hemorrhage

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4
Q

What is the indication for an ICP monitor?

A

patient’s with a GCS < 8 who have an abnormal head CT

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5
Q

What should be done to avoid secondary brain injury?

A

avoid hypotension and hypoxia

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6
Q

What is Cushing’s reflex?

A

bradycardia, hypertension, and altered respirations which is a triad indicating impending herniation

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7
Q

What options are there for medical management of elevated intracranial pressures?

A
  • hypocarbia
  • elevated HOB
  • remove anything around the neck/obstructing the jugular veins
  • mannitol
  • hypertonic saline
  • sedation and paralysis
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8
Q

How is cerebral perfusion pressure calculated?

A

as MAP - ICP

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9
Q

What are targets for CPP and ICP?

A

ICP < 20, CPP > 60

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10
Q

What is the main regulator of CPP?

A

PaCO2

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11
Q

What is CPP so sensitive to MAP in patient’s with a TBI?

A

because they have loss of vascular autoregulation

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12
Q

Why is hypertonic saline preferred over mannitol in trauma patient’s with intracranial hypertension?

A

hypertonic saline has a lower risk of hypotension

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13
Q

How are the following agents reversed:
- coumadin
- pradaxa
- apixaban
- rivaroxaban

A
  • coumadin: KCentra (PCC), FFP, vit K
  • pradaxa: praxbind (idarucizumab)
  • apixaban: PCC gives partial
  • rivaroxaban: PCC gives partial
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14
Q

What are the symptoms of Brown Sequard syndrome?

A
  • ipsilateral motor deficits
  • contralateral pain/temp deficits
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15
Q

What is anterior cord syndrome?

A

due to a vascular injury to the anterior spinal artery it gives a motor deficit below the level of the injury

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16
Q

What is SCIWORA?

A

a pediatric condition known as spinal cord injury without radiographic abnormality

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17
Q

What is an unstable spine fracture?

A

one with 2-3 columns disrupted

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18
Q

What are the zones of the neck?

A
  • zone 1: clavicles to cricoid cartilage
  • zone 2: cricoid cartilage to angle of mandible
  • zone 3: angle of mandible to skull base
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19
Q

What neck injuries are taken directly to the OR?

A

those that present with hemodynamic instability or hard signs of vascular injury

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20
Q

How is a traumatic esophageal injury repaired?

A

extend the myotomy to visualize the mucosal injury and repair in 2 layers before buttressing and draining

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21
Q

What is the most common site for a blunt cerebrovascular injury?

A

the distal ICA

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22
Q

What is the general treatment for BCVI?

A
  • anti-platelet therapy for most
  • pseudoaneurysms or AVFs may require endovascular intervention
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23
Q

What are the indications for operative intervention based on chest tube output?

A

> 1500cc at placement or >200cc/hr for 4hrs

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24
Q

What is the cause of hypoxia in patient’s with a flail chest?

A

the underlying pulmonary contusion

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25
Q

How is flail chest managed?

A

pain control, positive pressure ventilation, and rib plating

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26
Q

What is concerning about a sternal injury?

A

a possible underlying blunt cardiac injury

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27
Q

What are the most common EKG findings for those with suspected blunt cardiac injuries?

A

sinus tachycardia and PVCs

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28
Q

What is the preferred screening test for blunt cardiac injury?

A

a normal EKG and negative troponin has high negative predictive value

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29
Q

How should a blunt cardiac injury be worked up?

A
  • screen with EKG and troponin
  • further concern (hemodynamic instability or persistent new arrhythmia) warrants an echo
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30
Q

What is the most common site of blunt aortic injury?

A

the proximal descending aorta where the mobile arch moves against the fixed aorta (ligamentum arteriosum)

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31
Q

What is the diagnostic study of choice to look for blunt aortic injury?

A

CT angio

32
Q

How are blunt aortic injuries classified?

A
  • type I: intimal tear
  • type II: intramural hematoma
  • type III: pseudoaneurysm
  • type IV: rupture
33
Q

What are the two primary agents for impulse control in patients with blunt aortic injuries?

A

esmolol and nitroprusside

34
Q

What is the next step in a patient with blunt aortic injury who undergoes end-vascular repair and then develops left hand ischemia?

A

the subclavian is covered and they need a carotid to subclavian bypass

35
Q

For blunt abdominal trauma, what injuries are most common and which are most often missed?

A
  • solid organ injuries are most common
  • hollow viscus injuries and pancreatic injuries are most commonly missed
36
Q

Abdominal seat belt sign should raise the suspicion for what injuries?

A

bowel and pancreatic injuries

37
Q

In a patient who sustains blunt abdominal injury and has ascites without solid organ injury, what should your suspicion be high for?

A

hollow viscus injury

38
Q

What are the indications for operative intervention after an abdominal stab wound?

A
  • hemodynamic instability
  • evisceration
  • peritoneal signs
39
Q

For an anterior abdominal stab wound, what would wound exploration at the bedside do for you?

A
  • if there’s no penetration of the anterior rectus sheath, they would be safe for discharge
  • if there is penetration then they would need serial exams with or without a CT or diagnostic laparoscopy
40
Q

How should flank stab wounds be evaluated?

A

with a triple contrast CT scan to better evaluate the retroperitoneal structures

41
Q

What is the best way to evaluate for a diaphragmatic injury?

A

with a diagnostic laparoscopy as the sensitivity of CT scan is somewhat low

42
Q

What are the indications for bowel resection for a trauma patient?

A

> 50% circumferential involvement or devascularization

43
Q

What should be done about a bucket handle injury to the bowel?

A

it should be resected

44
Q

How are pancreatic injuries managed?

A
  • distal without PD involvement: wide drainage
  • distal with PD involvement: distal pancreatectomy with splenectomy
  • head with or without PD injury: wide local drainage
45
Q

What are the zones of the retroperitoneum?

A
  • zone 1: central (cava and aorta)
  • zone 2: lateral (renals)
  • zone 3: pelvis (iliacs)
46
Q

How are retroperionteal hematomas managed?

A
  • penetrating: explore all three
  • blunt: explore zone 1 or expanding/pulsatile zone 2
47
Q

What are the classes of hemorrhage?

A
  • class I: 0-15% blood loss, no signs
  • class II: 15-30% loss, tachycardia and narrowed pulse pressure
  • class III: 30-40%, hypotension
  • class IV: >40%
48
Q

What are the earliest signs of shock?

A

tachycardia and narrowed pulse pressure (class II hemorrhage with 15-30% blood loss)

49
Q

What is the triad of death in trauma patients?

A

hypothermia, coagulopathy, and acidosis

50
Q

What threshold is used to diagnose abdominal compartment syndrome?

A

a bladder pressure in a paralyzed patient of greater than 20

51
Q

How does management of abdominal compartment syndrome differ in burn patients?

A

decompressive laparotomy is a high mortality procedure so the preferred intervention is drain placement

52
Q

What is the window for TXA?

A

first 1g within 3hrs of injury

53
Q

What is the difference between R time and K time?

A
  • R: time to start of clot formation
  • K: time until clot reaches a fixed strength
54
Q

How are bladder injuries managed?

A
  • intra-peritoneal: operative repair
  • extra-peritoneal: drainage with foley
55
Q

How are urethral injuries repaired?

A
  • mid: primary repair with spatulated ends
  • distal: re-implantation +/- psoas hitch
56
Q

How is a urethral injury diagnosed?

A

retrograde urethrogram

57
Q

What are the hard signs of vascular injury?

A
  • pulsatile bleeding
  • expanding hematoma
  • absent pulses
  • bruit/thrill
58
Q

What are the soft signs of vascular injury?

A
  • non-expanding hematoma
  • decreased ABI
  • injury in proximity to neuromuscular structures
59
Q

What is the best next step in a patient with hard or soft signs of vascular injury?

A
  • hard: operative exploration
  • soft: CT angio
60
Q

What is special about intubating pediatric patients?

A
  • use an uncuffed tube in infants
  • use an ETT the size of the patient’s pinky nail
  • bradycardia is common, have atropine ready
61
Q

What hemodynamic change is common when performing direct laryngoscopy/intubating a pediatric patient?

A

bradycardia requiring atropine

62
Q

What is the standard bolus for crystalloid or blood in a pediatric patient?

A
  • 20cc/kg of crystalloid
  • 10cc/kg of blood
63
Q

What are the physiologic changes in pregnancy?

A
  • increased circulating volume leading to dilutional anemia
  • increased RR and decreased TV leading to respiratory alkalosis
64
Q

How should a pregnant trauma patient be positioned?

A

left lateral decubitus to take pressure off the IVC

65
Q

What is a Kleihauer Betke test?

A

looks for fetal blood cells in maternal circulation indicating a need for RhoGAM

66
Q

Which trauma patients need fetal monitoring?

A

those with a viable pregnancy (generally > 24 weeks)

67
Q

What do bubbles indicate when seen in the coronaries during a resuscitative thoracotomy?

A

pulmonary injury

68
Q

What should you think of when a kid presents with handle bar sign?

A

duodenal hematoma

69
Q

What is the next step in someone who presents with a left thoracoabdominal stab injury with negative imaging and normal exam?

A

diagnostic laparoscopy looking for diaphragmatic injury

70
Q

What should you think about in a tracheostomy patient with a new report of 10cc bright red blood from the site?

A

possible tracheoinnominate fistula

71
Q

What is the presumed injury in a patient who has unchanged bleeding after a Pringle maneuver?

A

hepatic vein or retrohepatic caval injury

72
Q

What is the gateway structure to the carotid bifurcation?

A

the common facial vein

73
Q

What is the gateway structure to the great vessels in a sternotomy?

A

the innominate vein

74
Q

What should you think about in a patient who presents with hematemesis 2 weeks after sustaining a grade IV liver injury in an MVC?

A

pseudo aneurysm with haemobilia, send for IR

75
Q

What is the best next step in a patient who sustains a GSW to the pelvis with rectal wall hematoma seen on rigid proctoscopy?

A

diverting colostomy

BTK Review 2023 (18 decks)

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