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CCFP EM > Trauma > Flashcards

Trauma Flashcards

1
Q

most common causes of death in trauma pt?

A

hemorrhage and head in ury

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2
Q

thing to not forget before paralyzing trauma pt?

A

quick neuro exam: pupils, GCS, gross motor

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3
Q

run through primary survey

A

ABCDE

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4
Q

GCS

A

E4: spont, voice, pain, nothing
V5: oriented, confused, inappro words, sounds, nothing
M6: follows commands, localizes pain, withdraws from pain, flexor, extensor, none

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5
Q

dose and timing of TXA

A

2g, less than 3 hrs from injury

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6
Q

classes of hemorrhage

A

class 1: Hr < 100 (<15% blood)
class 2: 100-120 (15-30%)
class 3: 120-140 (30-40%)
class 4: >140 (>40%)

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7
Q

who gets O+ in trauma

A

everyone, except females of childbearing age get O-

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8
Q

ED thoracotomy indications/contraindications for penetrating trauma

A

Prehospital/hospital signs of life
-Eco evidence of cardiac activity with tamponade
-unresponsive hypotension [SBP less than 70] despite resuscitation
-Availability of surgeon and or operating room for definitive management

Contraindications:
-pre hospital CPR greater than 15 minutes without response
-asystole as presenting rhythm and no evidence for cardiac tamponade on bedside ultrasound
-Significant head trauma

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9
Q

ED thoracotomy indications/contraindications for blunt trauma

A

-unresponsive hypotension [SBP less than 70] despite resuscitation 3
-Prehospital signs of life with lots of life less than 10 minutes
-Rapid exsanguination from chest tube , greater than 1500 ML output upon insertion
–Availability of surgeon and or operating room for definitive management

Contraindications:
-pre hospital CPR greater than 10 minutes without response
-asystole as presenting rhythm and no evidence for cardiac tamponade on bedside ultrasound
-Significant head trauma

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9
Q

Secondary survey ample history mnemonic

A

all, meds, pmhx, last meal, events

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10
Q

CPP equation and ideal values for each

A

CPP= MAP - ICP
CPP > 60, MAP >80, ICP <15

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11
Q

Uncal herniation syndrome

A

blown/down and out pupil… temporal lobe swelling, uncus pushed on brainstem, compresses ipsilateral CN 3

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12
Q

CT can CT head rules

A

go

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13
Q

PECARN head rules

A

go

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14
Q

dose of hyperosmolar agents in adults and kids

A

NaCl: 3% NaCl 3 mL/kg over 10 mins, max 250 mL, repeat once prn. adults 250 mL
mannitol: 1g/kg, max 100 g

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15
Q

head trauma cushing reflex

A

bradycardia, hypertension, irreg resps

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16
Q

things to avoid in head injury

A

hypotension, hypoxemia, hypoglycemia, hyperpyrexia

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17
Q

mgmt of severe TBI

A

HOB > 30 deg, neuroprotective RSI (exam first), SBP > 90, MAP 80, optimize vitals to reduce secondary injury, rapid CT HEAD, reverse anticoagulation

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18
Q

age group, location, CT finding, common cause and classic symptoms of: Epidural hematoma

A

age group: young (rare in elderly and in less than 2)
location: potential space between dura and skull
CT finding: convex lesion, lemon-shaped
common cause: lateral blow with skull # and tear of MMA
classic symptoms: immediate LOC, then lucid period then deterioration (only in 20%)

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19
Q

age group, location, CT finding, common cause and classic symptoms of: subdural hematoma

A

age group: elderly
location: sace between dura and arachnoid
CT finding: concave, banana shaped lesion
common cause: shearing force on bridging VEINS from accel/decel, more common in elderly d/t smaller brain
classic symptoms: rapid LOC in acute, progressive HA, progressive aLOC/behavior changes in chronic

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20
Q

age group, location, CT finding, common cause and classic symptoms of: subarachnoid (traumatic)

A

age group: any with trauma
location: between arachnoid and pia
CT finding: blood in basal cisterns or hemispheric sulci and fissure
common cause: accel/decel with tearing of aub arachnoid vesseles
classic symptoms: mild, mod or severe TBI with MENINGEAL signs/symptoms

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21
Q

age group, location, CT finding, common cause and classic symptoms of: contusion/intraparenchymal

A

age group: any with trauma
location: usually anterior temporal lobs or posterior frontal lobe
CT finding: intraparenchymal blood, can also be normal initially.
common cause: severe or penetrating trauma, shaken baby
classic symptoms: normal to LOC

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22
Q

In context of had trauma: persistent dec LOC and normal CT head, consider

A

DAI, better dx’d on MRI

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23
Q

timeline grading of subdural bleeds

A

acute <24hr, subacute < 14 days, chronic > 14 days

surgery usually for acute or subacute hemm and bleeds with midline shift/aLOC

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24
Q

basal skull # presenting s/s

A

hemotympanum, CSF rhinorrhea (target lesion on filter paper), hearing difficulty, vertigo, 7th nerve palsy, Battle Sign, raccoon eyes.

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25
Q

mgmt of basal skull #

A

generally, pain mgmt, antiemetics and observation. no consensus on prophylactic abx

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26
Q

how to classify # of skull convexity

A

location and type (linear, comminuted, depressed)

operative repair if depressed beyond one full thickness of skull

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27
Q

causes of pharyngeoesophageal injury

A

Boerhave, penetrating trauma, caustic or foreign body ingestion
rarely blunt trauma

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28
Q

mechanisms of blunt cerebrovascular injury

A

-direct impact (seatbelt, strangulation, etc)
-hyperextension with lateral rotation –> carotid lacerates on lateral process
-intraoral trauma
-basal skull #

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29
Q

signs of cerebrovascular injury from blunt neck trauma, including hard signs

A

most have initial NORMAL neuro exam, often only symptom is pain in neck… need high index of suspicion.. get CTA if mechanism concerning.

HARD signs: expanding hematoma, bruits, active bleeding, stroke/TIA, airway compromise (?)

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30
Q

HARD signs of major injury in penetrating neck trauma (8)

A

-airway compromise
-air bubbling from wound
-shock
-severe active bleeding
-expanding/pulsatile hematoma
-neuro deficit
-hematemesis
-massive SQ emphysema

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31
Q

if wound does not violate ______ it can be closed

A

platysma

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32
Q

zone 1 of neck: landmarks

A

clavicles to cricoid cartilage

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33
Q

zone 2 of neck: landmarks

A

cricoid to mandible

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34
Q

zone 3 of neck: landmarks

A

mandible to base of skull

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35
Q

work up of neck zone injuries

A

zone 1 and 3 –> CTA
zone 1 also consider bronch and endoscopy to look for tracheal and esophgeal injury respectively
zone 2: if hard sings –> explore surgically, if no hard signs, treat like zone (as above)

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36
Q

NEXUS for c-spine

A

validated 16 and over

NSAID

neuro deficit
spinal tenderness (midline), NOT pain
alert
intoxicated
distracting injury

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37
Q

3 lines on lateral c spine xr

A

anterior contour line
posterior contour line
spinolaminar line

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38
Q

soft tissues values for later c spine xr:

A

> 7 mm at c2 or > 21 mm at c6 is abn

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39
Q

c-spine #: wedge
stable vs unstable
mechanism
notes

A

stable
flexion
multiple wedge or >50% loss of height may be unstable

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40
Q

c-spine #: transverse process
stable vs unstable
mechanism
notes

A

stable
flexion
benign

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41
Q

c-spine #: clay shoveler
stable vs unstable
mechanism
notes

A

stable
flexion against contracted posterior neck muscle
usually c7

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42
Q

c-spine #: unilateral facet
stable vs unstable
mechanism
notes

A

stable
flexion+rotation
anterior displacement <50% of width

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43
Q

c-spine #: burst
stable vs unstable
mechanism
notes

A

stable
vertical compression
can be unstable if fragments enter canal

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44
Q

c-spine #: jefferson
stable vs unstable
mechanism
notes

A

unstable
axial load/vertical compression
seen on odontoid view (asymmetry and widening of lateral masses)

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45
Q

c-spine #: bilateral facet dislocation
stable vs unstable
mechanism
notes

A

unstable
flexion
anterior displacement >50%

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46
Q

c-spine #: odontoid 2&3
stable vs unstable
mechanism
notes

A

unstable
flexion
usually high energy, look for other injuries

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47
Q

c-spine #: antlantooccipatal dislocation
stable vs unstable
mechanism
notes

A

unstable
flexion or extension
usually results in immediate death

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48
Q

c-spine #: hangmans
stable vs unstable
mechanism
notes

A

unstable= bilat c2 pedicle with C2 displace anteriorly on c3
extension

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49
Q

c-spine #: teardrop
stable vs unstable
mechanism
notes

A

unstable
flexion or extension
anteroinferior portion of vertebrae

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50
Q

3 types of odontoid fractures

A

T1= tip = stable
t2= junction of body of c2 and base of odontoid = unstable = most common
t3= fracture at base of dens

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51
Q

T spine: wedge
mechanism
xr findings

A

unstable/major
flexion injury
= loss of anterior vetebral body height

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52
Q

T spine: chance #
mechanism
xr findings

A

flexion around anterior axis (SEATBELT)
horizontal # through vert body and all posterior elements, unstable,

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53
Q

T spine: burst #
mechanism
xr findings

A

vertical compression
loss of height through whole vert body

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54
Q

T spine: flexion-distraction injury
mechanism
xr findings

A

compression of anterior & distraction of posterior
fanning = increased posteior interspinous space

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55
Q

T spine: translational #
mechanism
xr findings

A

shear force
shift of vertebral body causing disruption

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56
Q

anterior- cord

A

-poor prognosis
-loss of pain/temp and motor, preservation of vib and prop

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57
Q

brown sequard

A

-hemisection of cord from penetration, -best prognosis
-ipsilateral motor, vib/prop
-contralteral pain/temp

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58
Q

posterior cord

A

-loss of vib and prop, preservation of motor

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59
Q

complete SCI

A

everything is fucked

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60
Q

central cord syndrome

A

-hyperextension injury, most comon incomplete SCI
-numbness/weakness > in arms than legs

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61
Q

neurogenic shock=

A

hypotension due to lack of sympathetic tone. pt is warm, vasodilated and bradycardic, type of distributive shock
think sepsis but brady

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62
Q

spinal schock

A

transient depression of all spinal function below level of injury, can make incomplete SCI look complete. usually resolves in 24-48 hrs.

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63
Q

SCIWORA

A

neuro deficits with normal XR and CT, often MRI findings. most common in kids

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64
Q

upright cxr findings of PTX in trauma

A

absent lung markings, subQ emphysema, depressed diaphragm on injured side

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65
Q

finding of PTX on supine CXR

A

deep sulcus sign

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66
Q

simple traumatic pneumo TX

A

if less than 15-25%, can tx with NRB and rpt cxr
if large or any hemodynamic compromis–> chest tube (size depends on if there is blood or not, 24F is a good size for hemothor!), consider chest tube if intubating (can convert to tension on PPV)

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67
Q

findings in tension pneumo

A

distended neck veins, decreased/absent breath sounds, shifted mediastinum, tracheal deviation (to oppo side)

hypotension and neck veins happen with tamponade too, use POCUS

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68
Q

chest tube size and settings

A

historically, 22-24F for pneumo and 32F for hemo, however just use 24F for both. can use seldinger and smaller if only pneumo, ie use 14F

set to water seal and 20 cm H2O of suction.

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69
Q

open pneumo (aka sucking chest wound) mgmt

A

three sided occlusive dressing
if chest tube required, dont put it through wound

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70
Q

what injuries implied with pneumomediastinum

A

larnygeal, tracheal, major bronchi, pharynx or esophagus (NEED TO R/O eso, scope or xr with oral contrast)

71
Q

exam findings pneumomedistiunm

A

subQ emphysema in neck, Hammans crunch (crunch during systole)

72
Q

4 causes of lung opacification in trauma

A

massive hemo
diaphragmatic rupture with herniation
lung collapse
pulm contusion

73
Q

where do hemothorax bleed from, how many also have pneumo

A

lung parnechyma, intercostals, less commonly great vessls/hilar vessesls
25%

74
Q

massive hemothorax criteria: (indicated need for thoracotomy)

A

initial output >1500 mL (or 20 mL/kg kids)), or subsequent output of 200 mL/hr (3 ml/kg/hr in kids), or persistent hypotension

75
Q

how visible are rib # on cxr

A

about 50%

76
Q

peds vs adult chest trauma

A

peds less likely to break ribs, more likely to injure inner structures

77
Q

initial concerns/associate dinjuries in rib #

A

pneumo/hemo
brachial plexus,
liver/spleen lac

78
Q

rib # mgmt

A

pain mgmt, pulm hygiene, admit if 3 or more, admit ICU if 6 or more and >65 yoa

79
Q

define flail chest

A

2 or more breaks in 3 or more adjacent ribs causing paradoxical movement of chest

80
Q

flail chest mgmt

A

same as rib # +, CPAP if stable, early ventilation if needed

81
Q

3 reasons for hypoxemia in flail chest

A

pain, hypoexapansion and pulm contusion

82
Q

sternal fracture best seen on?

A

lateral cxr

83
Q

does isolated sternal fracture predict blunt cardiac injury? do they need cardiac monitoring? should you do initial ECG and troponin?

A

NO, Not if ecg & trop normal, YES

84
Q

findings of pulmonary contusion

A

hemoptysis 50%, opacity on cxr, dyspnea, tachypnea, tachycardia, chest wall bruising usually present

85
Q

cxr findings and timeline of pulm contusion

A

pathcy infiltrates within minutes to hours.

86
Q

mgmt of pulm contusion

A

intubate for failure of oxygenation or ventilation, admit for monitoring/pulmonary hygiene, no abx or steroids prophylactically.

87
Q

2 complications of pulm contusion

A

ARDS, pma

88
Q

test for blunt myocardial injury

A

normal ECG and trop rule it out.

89
Q

beck triad for tamponade

A

muffled HS, hypotension, distended neck veins

90
Q

what is pulsus parodoxus

A

<10 in SBP with inspiration (sign of tamponade)

91
Q

walk through pericardiocentesis

A

go

92
Q

where do most blunt aortic injuries occur

A

aortic isthmus (between Lt subclav and ligamentum arteriosum)

93
Q

cxr findings of traumatic aortic injury

A

widened mediastinum
loss of aortic knob
eso/trach deviation
widened paraspinous interface
widened right paratracheal stripe
left apical cap
left hemothorax
depression of lt mainstem bronchus

94
Q

mgmt of traumatic aortic injury

A

operative repair, labetalol to keep SBP <120, control pain, no valasalva

95
Q

should you probe a penetrating chest wound or remove fb?

A

no, can dislodge clot and cause massive hemm

96
Q
A
97
Q

3 types of blunt abdo trauma

A

diaphragmatic, hollow viscus, solid organ

98
Q

which diaphragm is usually injured in blunt injury

A

left (not protected by liver)

99
Q

imaging in diaphragmatic injury

A

they all suck, unless there is herniation (doesnt always happen).. gold standard d is laparoscopy or thorascopy

100
Q

mgmt of diaphragmatic hernia

A

NG decompression of the stomach (URGENTLY in ED), then OR

101
Q

blunt hollow viscus injury often associated with what L spine fracture

A

Chance fracture

102
Q

presentation of hollow viscus injury

A

tend to present with delayed peritoneal signs… if abdo wall contusion, seatbelt sign, serial exams.. ie period of obs is appropriate if normal CT, but concerning mechanism

103
Q

three blunt abdo injuries that are difficult to diagnose on CT

A

diaphragm, pancreas (a solid organ) and bowel (unless full thickness perf, which presents like free air)

104
Q

most commonly injured organ in abdo trauma

A

spleen, then liver

105
Q

most commonly injured organs in abdo stabbings

A

liver then small bowel

106
Q

most commonly injured organs in abdo GSW

A

small bowel, then colon, then liver

107
Q

indications for surgery in blunt trauma

A

+ FAST and hypotension
evisceration of abdo contents
peritonitis
free air
diaphragm or aortic injury
rena injury with urine outside gerota fascia
persistent blood from NGT, rectum or vagina

108
Q

indications for surgery in penetrating trauma

A

injury with hypotension
peritonitis
evisceration of abdo contents
+ FAST and hypotension
any GSW that has violated peritoneum
foreign body in abdomen
suspected diaphragm injury
blood from rectum, NGT or vagina

109
Q

what GA is uterues/bladder no longer in pelvis, what GA is abruption a concern

A

12 wks
16 wks

110
Q

what is normal FHR

A

120-160

111
Q

vital sign changes in pregnancy

A

baseline HR inc by 10-15
baseline BP dec in first or second trim
RR inc later in pregnancy

112
Q

why does Lt lat decubitus work in preg

A

decompresses IVC

113
Q

GA that confers possible viability

A

24 weeks (dome of uterus above umbilicus)

114
Q

indications for perimortem c-section

A

maternal arrest with no ROSC in 4 minutes and GA >24 weeks

if performed <5 min = excellent outcomes, 5-10 mins good, > 15 mins poor

115
Q

indications for emergent c-section

A

GA >24 weeks, signs of fetal distress, uterine rupture, placental abruption, preterm labour with signs of malpresentaton and mom can tolerate it.

116
Q

changes to blood gas in later pregnancy

A

baseline bicarb 21
baseline pco2 30 (pco2 40 is hypoventilation)

117
Q

3 broad categories of pelvic fractures

A

major ring, acetabular, avulsion/single bone

118
Q

mechanism of acetabular # (one for young and one for old)

A

young= high energy MVC - knee into dashboard
old= fall

*mgmt depends on pt and fracture factors

119
Q

mgmt of most avulsion fracture

A

non-op

120
Q

most common complication of major pelvic ring #s

A

retroperitoneal bleeding fom injury to low pressure veins

121
Q

what is destot sign

A

hematoma over inguinal ligament or scrotum, indicates major pelvic ring #s

122
Q

3 types of major pelvic ring #s and their classification system, (mechanically unstable)

A

Young-Burges system.
lateral comprssion, anteroposterior compression (open book), vertical shear

123
Q

mgmt of unstable pelvis

A

binder placed at GTs

124
Q

important consideration in major pelvic fracture

A

look for open fracture with rectal perineal and vaginal exam.

125
Q

lateral compression fracture: incidence, mechanism, findings

A

50%, T bone MVC or pedstruck, transverse pubis rami with sacroiliac fracture

126
Q

anteroposterior fracture (open book): incidence, mechanism, findings

A

25%, head on MVC, pubic symphysis and SI joint disruption

127
Q

vertical shear: incidence, mechanism, findings

A

5%, fall/jump from height, fracture fragments/symphysis displaced vertically.

most associated with severe hemm

128
Q

biggest complication if hip dislocation if not reduced quickly

A

AVN of fem head

129
Q

types of hip dislocation and what is most common, then think through reductin techniqques

A

posterior (80-90%), anterior and central

130
Q

Mechanisms of urethrwl injury

A

Straddle injury, direct blow, instrumentation, penile fracture

131
Q

signs of urethral injury and test to order

A

blood at meatus, inability to void, high riding prostate, perineal hematoma, vaginal bleeding,

need to get RUG before placing foley

132
Q

3 grades of bladder injury and mgmt

A

contusion –> nothing
extraperitoneal rupture –> foley for 10-14 days
intraperitoneal rupture -> operative

133
Q

test for ?bladder rupture

A

retrograde cystogram –> often need RUG first

134
Q

signs, test and mgmt of ureteric injuries

A

flank pain/hematuria, CT IVP or regular CT with contrast, most need operative mgmt

135
Q

imaging test in ?testicular injury

A

doppler u/s

136
Q

how to repair simple lacerations to penis?

A

4-0 absorbable, if fracture (laceration of tunica albuginea)–> need uro

137
Q

3 causes of pain out of proportion to exam

A

nec fasc, compartment syndrome, mesenteric ischemia

138
Q

causes of compartment syndrome

A

circumferential cast or burns, swelling within compartment (hematoma, fracture, crush, injection, ischemia/reperfusion injury

139
Q

what is first structure affected by compartment syndrome

A

nerves, leads to loss of 2-point discrimination

140
Q

normal compartment pressure

A

0-10, greater than 20 is concerning, >30 is diagnostic

141
Q

5 p’s of compartment syndrome

and two earlier findings

A

pain, pain, pain, pain, pain

pain with passive extension, loss of 2 point discrimination

142
Q

Hard signs of arterial injury (90% chance of injury, straight to OR)

A

pulsatile bleeding, audible bruit, rapidly expanding hematoma, obvious arterial occlusion, decreased temperature

143
Q

soft signs of arterial injury (get CTA)

A

history of arterial bleeding, proximity to major artery, diminished pulses, peripheral nerve injury, small non-pulsatile hematoma, ABI <0.9)

144
Q

in penetrating extremity injury always perform bilateral _______?

A

ABI

145
Q

how to perform ABI

A

doppler SBP below injury / doppler SBP uninjured limb

146
Q

what to do with amputated extremities

A

wash with sterile saline, wrap in saline soaked gauze, put in ziplock bag and then on ice .

147
Q

4 zones of fingertip amputation

A

1: bone and nail bed intact
2. exposed bone
3. entire nail bed gone
4. amp near DIP jt

148
Q

high pressure injection injuries, mgmt?

injuries are often grease or paint

A

surgical debridement, in ther meantime give abx, tetanus, elevate and splint limb, often look benign at outset.

149
Q

parkland formula

A

4 mL* TBSA * weight = fluid over 1st 24hrs and then give half in first 8 hours

use 3mL in kids

use in kids with >10% TBAS and adults with >20% TBSA,

**titrate to UO of 0.5-1 mL/kg/hr

150
Q

rule of 9’s and palm rule

A

palm (including fingers) = 1% TBSA

9 for face/head, 9 for each arm, 18 for each leg, 18 each for front and back of torso, 1 for perineum

151
Q

superficial burns: depth, findings prognosis

A

-epidermal layer only
-red painful, tender, non blistering ie sunburn
-heals without scarring in 1 wk

152
Q

superficial partial thickness: depth, findings prognosis

A

-epidermis and superficial dermis, blood vessels, sweats glands, hair follicles ok
-red, painful, blistering, BLANCHING,
-heals with minimal scarring in 2-3 weeks

153
Q

deep partial thickness: depth, findings prognosis

A

-epidermis and superficial dermis but deeper
-red to pale white/yellow, less painful, NO BLANCHING,
-3-8 weeks with scarring and some contracture

154
Q

full thickness: depth, findings prognosis

A

-epidermis and all dermis
-white/black/charred, painless, leathery
-require surgical grafting, unless <1 cm

155
Q

with burn patient always think about??

A

CO and cyanide

156
Q

burn centre criteria

A

-partial thickness >10% TBSA
- burns involving face, hands, feet, genitals or major joints
- full thickness burns
-electrical burns, including lightning
-chemical burns
-Inhalation injury.
- pt with preexisting condition that could complicate mgmt
-pt with burns and concomitant trauma, where burn injury is more serious
burned children in place w/o specialized peds burn care
-burned pts who will need special social, emotional or long term rehab.

157
Q

burn dressing/debridement

A

polysporin or Silvadene cream (antimicrobial cream) then mepilex Ag or non stick like adaptic/bactigras

can de-roof blisters and debride dead skin, initial debridement just soak a 4X4 gauze pad in sterile water and scrub burn.

158
Q

subdermal: depth, findings prognosis

A

-muscles, bones
-looks horrible
-life and limb threatening.

159
Q

in nasal trauma alwasy look for?

A

septal hematoma

160
Q

describe septal hematoma drain

A

-anesthetize the septum with topical our atomised anesthetic -
-make elliptical incision over the hematoma
-evacuate the clot with pressure or suction
-place a small Penrose drain and pack the nares as an anterior epistaxis bilaterally
-follow up E NT in 48 hours

161
Q

dx of nasal fracture

A

clinical! no need for xrays or CT, CT only if concern for other facial fracture

162
Q

nasal fracture mgmt

A

if alignment is acceptable, no septal hematoma, no epistaxis and pt can breathe through both nares, do nothing, no f/u
-if alignment terrible, try and reduce (lidocaine soaked pledgets to bilat nares is often enough) or refer to see ENT within 5-7 days

163
Q

what are orbital blowout fractures and how do they happen

A

orbital floor fracture, from direct blunt force to globe (fist, ball etc)

164
Q

what are medial orbital fracture

A

fracture through the lamina papyracea into the ethmoid sinus

165
Q

complications of orbital fracture

A

extraocular nerve entrapement, most often inf rectus, leads to DIPLOPIA and abn EOM

166
Q

orbital # mgmt

A

prophylactic abx to cover sinus pathogens (controversial), if diplopia, muscle entrapement urgent referral to ophtho, ENT, plastics for f/u within 24 hrs. other non-urgent referral.

167
Q

test for mandibular fracture

A

tongue blade test: bite on tongue blade and if can break it once twisted by dr, 95% neg predictive value,

168
Q

mgmt of mandible fracture:

A

if open ( ie blood in mouth) give abx and urgent referral
-if closed, non-displaced fractured with analgesia, soft diet and ENT/plastics/OMS f/u in 1-2 days

169
Q

mechanisms of mandible fracture

A

forced occlusion (breaks condyle), lateral blow (breaks body or angle). most are multifocal but 40% unifocal (bc of U shape)

170
Q

what causes mandible dislocation and where does it dislocate?

A

excessive mout openening, anterior and superior

171
Q

what 3 bones make up the tripod

A

zygomatic, maxillary, orbital
aka zygomatico-maxillary-orbital complex

172
Q

classification for midface fractures? name and explain

A

Lefort 1: break through maxilla (bilat or unilat) just above roots of teeth, dental arch is mobile

Lefort 2: bilat through maxill and through inferior orbit and nasal bridge, dental arch and nose move together

lefort 3: rare, maxilla, orbit, nasal bridge, zygoma, often has CSF leak, whole face moves.

173
Q

where do you pull to test for lefort fracture

A

pull anteriorly on central incisors

174
Q

Signs of life? (Context of thoracotomy indication)

A

CCFP EM (20 decks)

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