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BTK Review 2024 > Trauma > Flashcards

Trauma Flashcards

1
Q

Between what two structures is the circothyroid membrane?

A

the thyroid and cricoid cartilages

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2
Q

What volume of blood from a chest tube in a trauma patient should prompt thoracotomy?

A
  • 200cc/hr for four hours
  • 1500cc at placement
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3
Q

What are hard signs of vascular injury?

A
  • pulsatile bleeding
  • absent pulse
  • rapidly expanding or pulsatile hematoma
  • bruit/thrill
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4
Q

What are the soft signs of vascular injury?

A
  • history of significant bleeding
  • decreased pulses (ABI < 0.9)
  • non-expanding hematoma
  • proximity to neuromuscular structures
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5
Q

What are the key portions of the “disability” exam in the CCB?

A

GCS and pupillary exam

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6
Q

What are the four classes of shock?

A

I: < 15%
II: 15-30%
III: 30-40%
IV: > 40%

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7
Q

The first sign of shock is what?

A

tachycardia

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8
Q

In what class of shock is altered mental status typically seen?

A

class III-IV

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9
Q

How is GCS scored?

A

Eye
- 4: spontaneous
- 3: to voice
- 2: to pain
- 1: none
Verbal
- 5: oriented
- 4: confused
- 3: inappropriate
- 2: incomprehensible
- 1: none
Motor
- 6: obeys commands
- 5: localizes to pain
- 4: withdraws from pain
- 3: flexion
- 2: extension
- 1: none

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10
Q

What component of GCS has the most prognostic value?

A

motor

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11
Q

Bilateral pinpoint pupils can be a sign of what neurologic injury?

A

a pontine hemorrhage

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12
Q

A unilateral, fixed, dilated pupil can be a sign of what neurologic injury?

A

an ipsilateral space occupying lesion compressing the optic nerve

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13
Q

What are the components of a TEG and how are they corrected?

A
  • R time: FFP
  • K time: cryo
  • a-angle: cryo
  • MA: plts, DDAVP
  • LY30: TXA
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14
Q

What is the most common type of intra-cranial hemorrhage in trauma patients?

A

intra-parenchymal hematoma

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15
Q

ICP monitors are indicator for which trauma patients?

A

GCS < 8 with an abnormal head CT

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16
Q

What is the “golden rule” of head trauma?

A

avoid secondary injury by avoiding hypotension, hypoxia, fever, and hypo/hyperglycemia

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17
Q

What is Cushing’s reflex? What does it indicate?

A
  • hypertension
  • bradycardia
  • altered respirations
  • indicative of impending herniation
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18
Q

What is the target goal for ICP and CPP?

A
  • ICP < 20
  • CCP > 60
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19
Q

How is CPP calculated?

A

CPP = MAP - ICP

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20
Q

What are the reversal options for the following medications:
- warfarin
- dabigatran
- rivaroxaban
- apixaban

A
  • warfarin: vit K, FFP, PCC
  • dabigatran: dialysis or praxbind (idarucizumab)
  • rivaroxaban: andexanet alfa or PCC
  • apixaban: andexanet alfa or PCC
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21
Q

What is idarucizumab?

A

aka praxbind, an antibody used to reverse dabigatran

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22
Q

What antibody is used to reverse dabigatran?

A

idarucizumab (aka praxbind)

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23
Q

Describe the physiology of neurogenic shock?

A

injury to the sympathetic efferent signals leading to hypotension and bradycardia

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24
Q

What is the general rule for defining an unstable spinal fracture?

A

two or more columns are disrupted

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25
Q

What are the zones of the neck?

A
  • I: clavicle to cricoid cartilage
  • II: cricoid cartilage to angle of mandible
  • III: angle of mandible to skull base
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26
Q

What is the best first test if concerned for a traumatic esophageal injury?

A

water-soluble esophagram

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27
Q

If an esophageal injury is not amenable to primary repair, how should it be managed?

A
  • close over a large T-tube to create a controlled fistula
  • or complete diversion with a cervical esophagostomy, wide drainage, and gastrostomy
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28
Q

What are the principles of repairing an esophageal injury?

A
  • decried devitalized tissue
  • control the leak
  • buttress
  • drain widely
  • antibiotics
  • keep NPO with distal feeding access
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29
Q

What is the most common site for BCVI?

A

distal internal carotid

30
Q

What is the grading scale for BCVI?

A
  • grade I: mild intimal irregularity
  • grade II: > 25% stenosis due to dissection with raised flap, intramural hematoma, intraluminal thrombosis
  • grade III: pseudoaneurysm
  • grade IV: vessel occlusion
  • grade V: vessel transection with active extrav
31
Q

How should zone I vascular neck injuries be approached?

A
  • typically best approached endovascularly in a stable patient
  • sternotomy is the best open approach
32
Q

How should zone II vascular neck injuries be approached?

A

usually through an anterior SCM incision

33
Q

What are the most common EKG abnormalities in those with blunt cardiac injury?

A

sinus tach and PVCs

34
Q

What is the appropriate screening for BCI?

A

trops and an EKG

35
Q

What is the proper way to repair a blunt cardiac injury?

A
  • a pledgeted, 3-0 permanent monofilament taking muscular bites (not full thickness)
  • consider horizontal mattress sutures for friable tissue
36
Q

What is Beck’s triad?

A

a collection of symptoms including jugular distention, muffled hear sounds, and hypotension which suggest cardiac tamponade

37
Q

What clinical exam finding distinguishes cardiac tamponade from pneumothorax?

A

breath sounds, heart sounds, and midline trachea

38
Q

What is the most common location for a blunt aortic injury?

A

the ligamentum arteriosum

39
Q

How are blunt aortic injuries graded?

A
  • type I: intimal tear
  • type II: intramural hematoma
  • type III: pseudoaneurysm
  • type IV: rupture
40
Q

What is the most commonly missed blunt abdominal injury?

A

pancreatic or hollow viscus injury

41
Q

How are the zones of RP injury managed?

A
  • explore all zones for penetrating trauma
  • explore zone I for blunt
  • explore zone II for blunt if expanding or pulsatile
  • don’t explore zone III for blunt
42
Q

How long of a trial should you give for non-operative management of a duodenal hematoma?

A

21 days

43
Q

How should a duodenal hematoma be managed if patients fail non-operative repair?

A

drainage and then seromuscular closure over a T-tube

44
Q

What is the preferred method for drainage of an injured duodenum?

A

a post-pyloric NGT rather than a duodenostomy tube

45
Q

How should a duodenal injury be managed if there is > 50% tissue loss?

A
  • can’t perform primary repair
  • should instead perform duodenoduodenostomy or RNY duodenojejunostomy
46
Q

How are traumatic rectal injuries managed?

A

with diversion (drainage and irrigation are insufficient)

47
Q

How are traumatic pancreatic injuries graded?

A

I: superficial contusion/laceration not involving duct
II: major contusion/laceration not involving duct
III: distal transection or parenchymal injury with duct injury
IV: proximal transection or parenchymal injury with ampulla involvement
V: massive disruption of pancreatic head

48
Q

How are traumatic pancreatic injuries managed?

A
  • generally speaking, suck the head and bite the tail
  • can drain the tail if there is no ductal injury
49
Q

How are splenic injuries graded?

A

I: subcapsular hematoma < 10% or capsular tear < 1cm
II: subcapsular hematoma 10-50%, capsular tear 1-3cm
III: subcapsular hematoma > 50% or ruptured subcapsular hematoma or laceration > 3cm
IV: laceration involvement segmental or hilar vessels producing > 25% devascularization
V: completely shattered or with hilar vascular injury

50
Q

What organism is the most common cause of OPSI?

A

Streptococcus pneumoniae

51
Q

How are traumatic liver injuries graded?

A

Same as spleen for 1-3
I: subcapsular hematoma < 10% or tear < 1cm depth
II: subcapsular hematoma 10-50% or tear 1-3cm depth and < 10cm in length
III: subcapsular hematoma > 50%, ruptured subcapsular hematoma with active bleed, tear > 3cm
IV: lac disrupting 25-75% of lobe or 1-3 segments within 1 lobe
V: > 75% of lobe or > 1 segments in one lobe, or juxtahepatic venous injury
VI: hepatic avulsion

52
Q

What is the most common intra-abdominal organ to be injured in blunt trauma?

A

the liver

53
Q

What is the most common part of the liver to be injured in blunt trauma?

A

the right posterior segments

54
Q

Hematemesis that occurs one week after a blunt traumatic injury to the liver is suggestive of what pathology? How is it treated?

A

an arterial-biliary fistula which requires embolization

55
Q

What are the indications for hepatic necrosectomy after trauma?

A

uncontrolled pain or PO intolerance

56
Q

What type of suture should be used for a ureterouretal anastomosis?

A

a fine, absorbable suture

57
Q

How should the bladder be repaired?

A

in a two-layered fashion using absorbable suture

58
Q

Hip dislocation is most likely to injure which nerve?

A

sciatic

59
Q

Humeral shaft fracture is most likely to injure which nerve?

A

radial

60
Q

Knee dislocation is most likely to injure which nerve?

A

common peroneal nerve, leading to loss of dorsiflexion (deep peroneal) and to foot eversion (superficial peroneal)

61
Q

What are the objective criteria for diagnosing compartment syndrome?

A

a compartment pressure within 30mmHg of diastolic pressure

62
Q

How does a pediatric airway differ from an adult?

A

narrower, shorter, and more anterior

63
Q

Direct laryngoscopy is likely to trigger what in the pediatric population?

A

bradycardia

64
Q

What med should you have ready when preparing for direct laryngoscopy of a child?

A

atropine given the higher risk for inducing bradycardia

65
Q

What is different about ETT selection in pediatrics?

A

intubate with uncuffed tubes in infants

66
Q

How should you select ETT size for pediatric patients?

A
  • pinky bed width
  • age/4 + 4
67
Q

What physiologic respiratory changes are present in a pregnant woman?

A
  • increased TV
  • decreased FRC
  • increased O2 consumption
68
Q

Which trauma patients should succinylcholine not be used in?

A

burn patients, those with crush injuries (think hyperK+), and those with significant spinal cord trauma

69
Q

What operation should you perform for someone with an open pelvic fracture and complex perineal wound?

A

diverting colostomy

70
Q

What operation should you perform for someone who sustains a GSW and is found to have a rectal wall hematoma on rigid proctoscopy?

A

diverting colostomy

71
Q
A

BTK Review 2024 (19 decks)

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