Trauma Flashcards
How does neurogenic shock work
Spinal chord transection either decreases sympathetic or increases parasympathetic tone leading to increased peripheral dilation
Examination findings of neurogenic shock
Low BP
Warm peripheries
What causes a low BP in trauma patients
Most commonly haemorrhage
Can be;
- tension pneumothorax
- spinal chord injury
- cardiac tamponade
- cardiac contusion
What is used to treat neurogenic shock
Vasopressors
What defines SIRS
Systemic inflammatory response
- temp 36-38
- HR >90
- RR >20
- WCC>12,000 or <4,000
What defines severe sepsis
Sepsis with organ failure
What defines septic shock
Sepsis with refractory hypotension
What is parkland formula
4ml x %body surface area x weight (kg)
50% given in first 8 hours
50% given in next 16 hours
What fluid is given in burns patients
Crystalloid- hartmanns
What drugs impair all wounds from healing
NSAIDs
Steroids
Immunosuppressive drugs
What can cause drop in sats on insertion of intubation tube
Oesophageal placement
What are indications for head CT within 1 hour
GCS <13 on assessment
GCS<15 at 2 hours post injury
Post traumatic seizure
Focal neurology
More than 1 vomiting episode
Any indication of skull fracture
- battle sign
- CSF leak
- panda eyes
What are indications for head CT within 8 hours
65 or older
History of coagulation disorder
On anticoagulants
Dangerous mechanism
30 minutes of retorgrade amnesia
What counts as dangerous mechanism for CT within 8 hours
Pedestrian struck by car
5 stairs fallen down
Fall over 1m
What do if patient onanticoagulant hits head
CT within 8 hours
Who does autonomic dysreflexia occur in
Those with spinal injury above T6
Presentation of autonomic dysreflexia
Sweating and flushing above the level of lesion
Severe HTN
What is management of autonomic dysreflexia
Manage HTN
Relieve cause- ie urinary retention or faecal impaction
How assess if endotracheal tube is in the oesophagus
End tidal CO2
When is ICP monitorning necessary
GCS 3-8
What is management if raised ICP from a bleed
Take to surgery
In meantime give IV mannitol
What vein does a central line go into
Subclavian
Patient with long term endotracheal tube starts choking after feeds and coughing sputum
Tracheo oesophageal fistula
What is the best investigation for diffuse axonal injury
MRI brain
What are panda eyes
Bruising around the eyes
Signs of basilar skull fracture
Battles sign
Panda eyes
CSF leakage from the ears and nose
If cant get IV access in an arrest call what do
Call trained individual who can get intraosseous access
What is difference between membranous and bulbar urethral injury
MB in terms of proximal to distal
What causes membranous vs bulbar urethral injury
Membranous- Pelvic fracture
Bulbar- straddle injuries
Signs of urethral injury
- urinary retention
- perineal and penile haematoma
- blood at the meatus
- prostate displaced upwards
How are urethral injuries investigated
Ascending urethrogram
What is immediate management of urethral injury
Suprapubic catheter
Investigation for bladder injury
IVU
What is a laryngeal mask
Mask which goes into cover airway during anaesthesia which channels oxygen to lungs
Problem of laryngeal mask
Poor control against reflux of gastric contents
What is tracheostomy
Where hole made in neck to gain access to airway
What is best IV induction agent if haemodynamically unstable
Ketamine as causes very little mycocardial depression
Management of haemothorax plus indications for second line
Chest drain
Thoracotomy if drain over 1.5L or 200ml/hour over 2 hours
Most common primary if bony mets ( man vs woman)
Woman= breasts
Men= prostate
