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Emergency Medicine > Trauma > Flashcards

Trauma Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Trauma is the number one cause of death in what ages?

How about overall?

A

1-44 years

3rd overall

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2
Q

What are the steps for trauma preparation?

A

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

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3
Q

What is the most common cause of preventative death?

A

Hemorrhage

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4
Q

What are the four broad catagories of shock?

A
  • Distributive
  • Hypovolemic
  • Cardiogenic
  • Obstructive
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5
Q

In the primary survey what is assessed first with A,B,C approach?

What is assessed first in MASH?

A

Airway

“What is your name”

  • Check for chest rise, lung sounds, crepitus
  • Maintain C-spine
  • Secure the airway

Hemorrhage

Use common sense

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6
Q

What is included in NEXUS Cervical Spine Rules?

A
  • Focal deficit
  • Midline tenderness
  • AMS
  • Intoxicated
  • Distracting injury
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7
Q

What imaging modality is preferred to diagnose C-spine injuries?

A

CT

Every patient with a suspected c-spine injury needs a CT

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8
Q

In trauma, if asked what is the fluid what is it…always unless the bladder is ruptured?

Per Piburn

A

BLOOD

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9
Q

What is the immediate treatment during the primary survey for a hemothorax?

A

Chest Tube

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10
Q

What is the immediate treatment during the primary survey for an open pneumothorax?

What is an open pneumothorax?

A

Dressing closed on 3 sides

Air builds in the pleural cavity

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11
Q

What Glasgow Coma Scale score requires intubation?

A

< 8

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12
Q

What is your first line pain control in a trauma?

A

100mcg of Fentanyl

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13
Q

What is the target SBP in a head trauma patient?

Why is it important to control BP?

A

<180

Don’t want them blowing a clot

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14
Q

What are signs of Elevated ICP?

A
  • 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
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15
Q

What is Cushing’s Triad?

A
  • Hypertension
  • Bradycardia
  • Irregular respirations – primarily Cheyne-Stokes breathing
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16
Q

What is an equivalent to mannitol?

A

Hypertonic Saline

17
Q

In a spinal trauma, an injury above C5 requires what intervention?

A

Intubation

18
Q

What is the physical exam to rule out a Le Fort fracture?

A

Chew on a popsicle stick

19
Q

In a chest trauma, do you want a contrast or non-contrast CT?

A

Contrast CT

20
Q

What is the work-up for a thoracic trauma?

A
  • 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)
21
Q

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?

A

Order head CT

22
Q

What is included on the E-FAST exam?

A
  • Anterior Chest (right and left)
  • RUQ
  • LUQ
  • Subxiphoid
  • Suprapubic
23
Q

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?

A

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.

24
Q

What is the appropriate placement of a pelvic binder?

A

Right over greater trochanters, iliac crest is too high

25
Q

What is the immediate treatment for an airway obstruction during the primary survey?

A

Chin lift, jaw thrust, positioning

26
Q

What is the immediate treatment of a tension pneumothorax during the primary survey?

A

Needle decompression

27
Q

What is the immediate treatment of a hemothorax during the primary survey?

A

Chest Tube

28
Q

Does flail chest require treatment during the primary survey?

A

Yes, but just supportive measures

29
Q

What is the treatment for a pulmonary contusion during the primary survey?

A

Supportive care, PPV

30
Q

What is the immediate treatment of cardiac tamponade during the primary survey?

A

Pericardiocentesis

31
Q

The third step of the primary survey assess for circulation. What areas should you focus on in your exam to look for significant blood loss?

A
  • Chest
  • Abdomen
  • Pelvis
  • Long bone
  • Floor
32
Q

Per the Canadian CT Head Rules, what are high risk factors to consider for neurologic intervention?

A
  • GCS < 15 at 2 hours after injury
  • Suspected open or depressed skull fracture
  • Any sign of basal skull fracture
  • Vomiting >/= 2 episodes
  • Age > 65
33
Q

A 45 year old male presents to the ED via AMS after a motor vehicle accident. He is unresponsive and has blown pupils. You immediately elevate the head of the bed to 30 degrees to maintain ICP. What pharmacological agents should be considered for maintaining BP, specifically targeting SBP < 180

A

IV nicardipine, labatelol

34
Q

What are the H-bombs?

A
  • Hypotension: Goal MAP > 90
  • Hypoxia: Goal > 90% SpO2
  • Hypo/hypercarbia: Goal 35-45
  • Hyper/hypothermia
  • Hypoglycemia: Goal 100-180
35
Q

What are ominous signs of brain herniation?

A

Posturing and Cushing’s Triad

36
Q

In a spinal trauma when should you intubate?

What is the imaging modality of choice?

A

If injury is C5 or above

CT Scan

37
Q

What is neurogenic shock and at what level of the spine is the injury seen?

What is the initial treatment?

A

A type of distributive shock with hypotension, bradycardia, warm/flushed skin, good pulses.

Seen with injury above T6

Treat with fluids and norepinephrine. Atropine for bradycardia. legs up

Emergency Medicine (19 decks)

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