Trauma

Question 1

Areas of Exsanguination

Answer 1

-Chest
-Abdomen/Pelvis
-Femur
-Floor (external)
-Pelvis
*unstable patients should not go to radiology

Question 2

Glasgow Coma Scale

Answer 2

-E (eye opening) + V (verbal response) + M (motor response)
-Eye opening : highest is 4 points
-Verbal response: highest is 5 points
- Motor response: highest is 6 points
-Highest score altogether is 15
- <8 = intubate

Question 3

Intracranial Hemorrhage: Subdural Hemorrhage

Answer 3

-Subdural space
-Crescent: conform to contour of the brain on imaging
-Injury is a tear of bridging of bridging vessels

Question 4

Intracranial Hemorrhage: Subarachnoid Hemorrhage

Answer 4

-Subarachnoid space
-Blood in sulci and fissures on imaging
-Tear of the subarachnoid vessels

Question 5

Intracranial Hemorrhage: Epidural Hemorrhage

Answer 5

-Epidural space
-Most common in temporoparietal region (middle meningeal artery)
-Biconvex (football) on imaging
-Injury is a tear of meningeal arteries

Question 6

AC/Antiplatelet with ICH

Answer 6

-Prevalence of immediate intracranial hemorrhage: Clopidogrel > Warfarin
-Warfarin: delayed intracranial hemorrhage
-May get a repeat head CT 6 hours after the fall d/t delayed bleeding

Question 7

ICH Management

Answer 7

-CT Scan
-Serial neuro exams
-ICP & CPP monitoring/management
-Anticonvulsants-early seizure prophylaxis 7 days
-Surgery (shift in 5 mm or greater)

Question 8

Cushing Triad/Reflex

Answer 8

-Signs of increased ICP
-Imminent brain herniation
-Increased PP
-Irregular respirations
-Bradycardia

Question 9

Cervical Spine Injury

Answer 9

-Imaging positive for bony injury
Maintain cervical spine precautions
Spine consultation
Consider specialty beds
-Neck CTA for high impact trauma
Vertebral artery injury/dissection

Question 10

Rib Fractures

Answer 10

-Ribs 1-3: High impact force, Plexus injuries
-Ribs 4-9: Pneumothorax
-Ribs 10-12: Solid Organ Injury
-Flail Segment: Increased mortality, 16-17%, Pulmonary contusion
-CT imaging vs. Rib specific radiograph-Cxr misses up to 50% of rib fractures
-Non-operative management: Multi-modal pain regimen, pulmonary hygiene, vital capacity
-Operative management

Question 11

Pneumothorax

Answer 11

-Imaging
-Management: Chest tube, observation (35 mm parietal-visceral pleura)
-Tension ptx

Question 12

Pulmonary Contusion

Answer 12

-Appears within 6 hours (Reabsorbed & disappear within 72 hours)
-Mostly associated with rib fractures

Question 13

Sternal Fracture

Answer 13

-High impact force
-Imaging best seen on CT chest sagittal recons
-Management (pain control, pulmonary hygiene, address associated injuries (EKG and CXR)

Question 14

Cardiac Contusion

Answer 14

-Direct impact
-Sternal fracture does not indicate blunt cardiac injury
-Workup: EKG, troponins, 24 hr Telemetry, TTE
-Monitoring: Hemodynamic instability
-Hypoperfusion
-Differentiate blunt cardiac injury from peri-traumatic MI

Question 15

Tamponade

Answer 15

-Beck’s Triad (Hypotension, Distant/muffled heart sounds, JVD)
-Imaging: CXR-widened mediastinum (non-specific). US
-Management: Temp drainage, surgery

Question 16

Aortic Injury

Answer 16

-Common cause of sudden death
-Uncommon in restrained motorists
-Imaging: CXR-may show widened mediastinum, CT is gold standard
-Management:
CTA to define injury more clearly, if needed
BP control, anti-platelet therapy
Surgery vs. endovascular graft

Question 17

Diaphragmatic Rupture/Injury

Answer 17

-Delayed presentation
-More common on left side
-Elevated hemidiaphragm, abnormal NG position
-Commonly found during exploratory laparotomy for another reason
-Surgical primary repair

Question 18

Pelvic Fractures

Answer 18

-Physical Exam
Limb length discrepancy
Ecchymosis: flank, perineal, scrotal
Rotation deformity
Instability/pain
-Management
Unstable-pelvic binder
Ortho consult
Shift towards non-operative management (acetabular fractures)

Question 19

Management of Extremity Injuries

Answer 19

-Realignment
-Neurovascular Checks before and after
-Immobilization & splinting (control blood loss, reduces pain, prevents further soft tissue injury)
-Imaging
-Pain control
-Surgical Consult

Question 20

Genitourinary Injuries

Answer 20

-Blood at the uretheral meatus-don’t place foley
-Known or suspected flank or back injuries
-Associated with pelvic fractures
-Imaging:
CT cystogram/urogram
-Consult Urology
-Management usually catheterization for weeks to months
—bladder irrigation to prevent blood clots

Question 21

Face and Eye Trauma

Answer 21

-Basilar skull fracture
-Rhinorrhea/Otorrhea (possible CSF leak)

Question 22

Basilar Skull Fracture

Answer 22

-Battle sign
-Racoon eyes

Question 23

Rhinorrhe