Trauma Flashcards
Trauma is the number one cause of death in what ages?
How about overall?
1-44 years
3rd overall
What are the steps for trauma preparation?
STEP UP
* Self: prep for what is coming
* Team: go over roles
* Environment: get all the gear
* Patient: be ready to do initial survey
* Update: discuss what is going on
* Priorities: goal of team
What is the most common cause of preventative death?
Hemorrhage
What are the four broad catagories of shock?
- Distributive
- Hypovolemic
- Cardiogenic
- Obstructive
In the primary survey what is assessed first with A,B,C approach?
What is assessed first in MASH?
Airway
“What is your name”
- Check for chest rise, lung sounds, crepitus
- Maintain C-spine
- Secure the airway
Hemorrhage
Use common sense
What is included in NEXUS Cervical Spine Rules?
- Focal deficit
- Midline tenderness
- AMS
- Intoxicated
- Distracting injury
What imaging modality is preferred to diagnose C-spine injuries?
CT
Every patient with a suspected c-spine injury needs a CT
In trauma, if asked what is the fluid what is it…always unless the bladder is ruptured?
Per Piburn
BLOOD
What is the immediate treatment during the primary survey for a hemothorax?
Chest Tube
What is the immediate treatment during the primary survey for an open pneumothorax?
What is an open pneumothorax?
Dressing closed on 3 sides
Air builds in the pleural cavity
What Glasgow Coma Scale score requires intubation?
< 8
What is your first line pain control in a trauma?
100mcg of Fentanyl
What is the target SBP in a head trauma patient?
Why is it important to control BP?
<180
Don’t want them blowing a clot
What are signs of Elevated ICP?
- Mental status change
- Pupillary changes or papilledema
- HA, visual changes
- Focal neuro deficits (numbness/weakness)
- Nausea/vomitting
- Seizure
- Lethargy
- Elevated BP and bradycardia
- Agonal respirations
- Decerebrate or decorticate posturing
- CT findings
What is Cushing’s Triad?
- Hypertension
- Bradycardia
- Irregular respirations – primarily Cheyne-Stokes breathing
What is an equivalent to mannitol?
Hypertonic Saline
In a spinal trauma, an injury above C5 requires what intervention?
Intubation
What is the physical exam to rule out a Le Fort fracture?
Chew on a popsicle stick
In a chest trauma, do you want a contrast or non-contrast CT?
Contrast CT
What is the work-up for a thoracic trauma?
- ABC, IV/O2, Monitor
- E-FAST
- CXR
- ECG
- CT scan, consider CTA if concerned for vascular injury
- If patient worsens with PPV, reassess (think pneumo)
A 25-year-old male presents to the ER after a motor vehicle collision. He is alert but appears agitated and diaphoretic. His vital signs are stable. On examination, you note a 5 cm laceration on his forehead with a palpable skull deformity. What is the most appropriate next step in managing this patient’s head injury?
Order head CT
What is included on the E-FAST exam?
- Anterior Chest (right and left)
- RUQ
- LUQ
- Subxiphoid
- Suprapubic
A 19-year-old female sustains a traumatic injury to her right lower leg in a motorcycle accident. On examination, her right foot is pale, cold, and insensate. There is no pedal pulse. What is the most likely diagnosis?
Why is this not compartment syndrome?
Vascular Injury: Specifically arterial
Pulse is present and pain is not out of proportion
Paleness, cold, and insensate are also more indicative of a vascular injury due to poor perfusion.
What is the appropriate placement of a pelvic binder?
Right over greater trochanters, iliac crest is too high
