Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What part of the GCS has the most prognostic ability?

A

motor score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

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

A

a pontine hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the indication for an ICP monitor?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What should be done to avoid secondary brain injury?

A

avoid hypotension and hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Cushing’s reflex?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is cerebral perfusion pressure calculated?

A

as MAP - ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are targets for CPP and ICP?

A

ICP < 20, CPP > 60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the main regulator of CPP?

A

PaCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

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

A

because they have loss of vascular autoregulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the symptoms of Brown Sequard syndrome?

A
  • ipsilateral motor deficits
  • contralateral pain/temp deficits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is SCIWORA?

A

a pediatric condition known as spinal cord injury without radiographic abnormality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is an unstable spine fracture?

A

one with 2-3 columns disrupted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What neck injuries are taken directly to the OR?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

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

A

the distal ICA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the general treatment for BCVI?

A
  • anti-platelet therapy for most
  • pseudoaneurysms or AVFs may require endovascular intervention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

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

A

the underlying pulmonary contusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How is flail chest managed?
pain control, positive pressure ventilation, and rib plating
26
What is concerning about a sternal injury?
a possible underlying blunt cardiac injury
27
What are the most common EKG findings for those with suspected blunt cardiac injuries?
sinus tachycardia and PVCs
28
What is the preferred screening test for blunt cardiac injury?
a normal EKG and negative troponin has high negative predictive value
29
How should a blunt cardiac injury be worked up?
- screen with EKG and troponin - further concern (hemodynamic instability or persistent new arrhythmia) warrants an echo
30
What is the most common site of blunt aortic injury?
the proximal descending aorta where the mobile arch moves against the fixed aorta (ligamentum arteriosum)
31
What is the diagnostic study of choice to look for blunt aortic injury?
CT angio
32
How are blunt aortic injuries classified?
- type I: intimal tear - type II: intramural hematoma - type III: pseudoaneurysm - type IV: rupture
33
What are the two primary agents for impulse control in patients with blunt aortic injuries?
esmolol and nitroprusside
34
What is the next step in a patient with blunt aortic injury who undergoes end-vascular repair and then develops left hand ischemia?
the subclavian is covered and they need a carotid to subclavian bypass
35
For blunt abdominal trauma, what injuries are most common and which are most often missed?
- solid organ injuries are most common - hollow viscus injuries and pancreatic injuries are most commonly missed
36
Abdominal seat belt sign should raise the suspicion for what injuries?
bowel and pancreatic injuries
37
In a patient who sustains blunt abdominal injury and has ascites without solid organ injury, what should your suspicion be high for?
hollow viscus injury
38
What are the indications for operative intervention after an abdominal stab wound?
- hemodynamic instability - evisceration - peritoneal signs
39
For an anterior abdominal stab wound, what would wound exploration at the bedside do for you?
- 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
How should flank stab wounds be evaluated?
with a triple contrast CT scan to better evaluate the retroperitoneal structures
41
What is the best way to evaluate for a diaphragmatic injury?
with a diagnostic laparoscopy as the sensitivity of CT scan is somewhat low
42
What are the indications for bowel resection for a trauma patient?
> 50% circumferential involvement or devascularization
43
What should be done about a bucket handle injury to the bowel?
it should be resected
44
How are pancreatic injuries managed?
- distal without PD involvement: wide drainage - distal with PD involvement: distal pancreatectomy with splenectomy - head with or without PD injury: wide local drainage
45
What are the zones of the retroperitoneum?
- zone 1: central (cava and aorta) - zone 2: lateral (renals) - zone 3: pelvis (iliacs)
46
How are retroperionteal hematomas managed?
- penetrating: explore all three - blunt: explore zone 1 or expanding/pulsatile zone 2
47
What are the classes of hemorrhage?
- 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
What are the earliest signs of shock?
tachycardia and narrowed pulse pressure (class II hemorrhage with 15-30% blood loss)
49
What is the triad of death in trauma patients?
hypothermia, coagulopathy, and acidosis
50
What threshold is used to diagnose abdominal compartment syndrome?
a bladder pressure in a paralyzed patient of greater than 20
51
How does management of abdominal compartment syndrome differ in burn patients?
decompressive laparotomy is a high mortality procedure so the preferred intervention is drain placement
52
What is the window for TXA?
first 1g within 3hrs of injury
53
What is the difference between R time and K time?
- R: time to start of clot formation - K: time until clot reaches a fixed strength
54
How are bladder injuries managed?
- intra-peritoneal: operative repair - extra-peritoneal: drainage with foley
55
How are urethral injuries repaired?
- mid: primary repair with spatulated ends - distal: re-implantation +/- psoas hitch
56
How is a urethral injury diagnosed?
retrograde urethrogram
57
What are the hard signs of vascular injury?
- pulsatile bleeding - expanding hematoma - absent pulses - bruit/thrill
58
What are the soft signs of vascular injury?
- non-expanding hematoma - decreased ABI - injury in proximity to neuromuscular structures
59
What is the best next step in a patient with hard or soft signs of vascular injury?
- hard: operative exploration - soft: CT angio
60
What is special about intubating pediatric patients?
- use an uncuffed tube in infants - use an ETT the size of the patient's pinky nail - bradycardia is common, have atropine ready
61
What hemodynamic change is common when performing direct laryngoscopy/intubating a pediatric patient?
bradycardia requiring atropine
62
What is the standard bolus for crystalloid or blood in a pediatric patient?
- 20cc/kg of crystalloid - 10cc/kg of blood
63
What are the physiologic changes in pregnancy?
- increased circulating volume leading to dilutional anemia - increased RR and decreased TV leading to respiratory alkalosis
64
How should a pregnant trauma patient be positioned?
left lateral decubitus to take pressure off the IVC
65
What is a Kleihauer Betke test?
looks for fetal blood cells in maternal circulation indicating a need for RhoGAM
66
Which trauma patients need fetal monitoring?
those with a viable pregnancy (generally > 24 weeks)
67
What do bubbles indicate when seen in the coronaries during a resuscitative thoracotomy?
pulmonary injury
68
What should you think of when a kid presents with handle bar sign?
duodenal hematoma
69
What is the next step in someone who presents with a left thoracoabdominal stab injury with negative imaging and normal exam?
diagnostic laparoscopy looking for diaphragmatic injury
70
What should you think about in a tracheostomy patient with a new report of 10cc bright red blood from the site?
possible tracheoinnominate fistula
71
What is the presumed injury in a patient who has unchanged bleeding after a Pringle maneuver?
hepatic vein or retrohepatic caval injury
72
What is the gateway structure to the carotid bifurcation?
the common facial vein
73
What is the gateway structure to the great vessels in a sternotomy?
the innominate vein
74
What should you think about in a patient who presents with hematemesis 2 weeks after sustaining a grade IV liver injury in an MVC?
pseudo aneurysm with haemobilia, send for IR
75
What is the best next step in a patient who sustains a GSW to the pelvis with rectal wall hematoma seen on rigid proctoscopy?
diverting colostomy

BTK Review 2023 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions