Trauma

Question 1

What is the classic triade of High Rise Syndrome?

Answer 1

• Epistaxis
• Hard palate fracture
• pneumothorax

Question 2

Explain terminal velocity and how it is determined. What is the terminal velocity of an average 5kg cat?

Answer 2

• velocity of a falling body increases i.e., accelerates speed of fall that is pulled by gravity and determined by size and body surface area
• larger SA increases drag force which opposes velocity of the fall
• eventually velocity will reach point where gravitational forche equals drag force –> body stops accelerating = terminal velocity

5kg cat 60 mph - reached after 5 stories

Question 3

What is the equation for the force with which the body hits the ground?

Answer 3

F = ma

F force
m mass of the body
a acceleration

Question 4

How does a cat’s body position and therefore injury distributions change if falling from the second versus 6th floor?

Answer 4

2nd floor - likely landing on its limbs - most injuries to limbs

6th floow - high enoug to reach terminal velocity where vestibular system is no longer stimulated and cat will land flat, horizontal with injuries to thorax and abdomen

Question 5

What are the most common abdominal injuries reported with high rise syndrome?

Answer 5

• hemoabdomen
• traumatic pancreatitis
• pancreatic rupture
• uroabdomen

Question 6

How could you diagnose traumatic pancreatitis/pancreatic rupture on abdominal effusion?

Answer 6

intraabdominal lipase activity 22:1 compared to paired serum

Question 7

In feline high rise syndrome which limb of the pancreas does usually rupture?

Answer 7

left pancreatic limb

Question 8

What are the types of Trauma with the highest mortality rates in cats and dogs?

Answer 8

dogs
1. HBC
2. ballistic injury
3. injured inside vehicle
4. nonpenetrating bite wound
5. choking/pulling injury

cats
1. HBC
2. ejected from vehicle
3. nonpenetrating bite wound
4. ballistic injury
5. choking/pulling

Question 9

What are the most common types of traumas in dogs versus cats?

Answer 9

dogs - penetrating

cats - blunt

Question 10

Do dogs or cats have higher average ATT scores on presentation after trauma?

Answer 10

Cats (2 versus 1 in dogs)

Question 11

How commonly do dogs and cats require surgery after trauma?

Answer 11

common

dogs 44%
cats 33%

Question 12

How does the mortality rate from trauma compare between dogs and cats?

Answer 12

dogs have a higher survival to discahrge percentage (93%) versus cats (83%)

notes
* natural death the same but cats more commonly euthanized
* dogs were more commonly euthanized for financial reasons than cats (19% versus 16%)

Question 13

What is the most common type of trauma in both dogs and cats?

Answer 13

bite wounds

Question 14

What is included in the VetCOT score and how does it perform compared to the ATT score?

Answer 14

VetCOT score:
* Presence of spinal trauma
* Presence of head trauma
* Lactate
* iCa

compared to ATT:
* same AUROC (0.87)
* same disciminatory performance
* better callibration with VetCOT score - ATT overpredicts mortality at low scores

Answer 15

• vascular tone
• myocardial contraction
• coagulation
• neuronal signaling and conduction
• hormonal release/enzymatic function

Question 16

what is the most common trauma type in toy versus giant breed dogs?

Answer 16

toy - blunt trauma (fall or HBC)
giant - penetrating

Question 17

How does the survival from trauma compare between giant and toy breed dogs?

Answer 17

better survival percentage overall for toybreeds but patient size did not impact survival in a logistic regression model

Question 18

How do ATT scores and mGCS compare between blunt and penetrating trauma in dogs?

Answer 18

highest ATT score if combination of both

blunt trauma with more cases with a lower mGCS score compared to penetrating

Question 19

How does the occurence of abdominal free fluid, absence of glide sign, of pleural effusion compare between blunt and penetrating trauma in dogs?

Answer 19

all 3 most common in blunt trauma

Question 20

What is the most commonly fractured bone in feline trauma patients?

Answer 20

mandibular fractures

Question 21

How do mortality and ATT scores compare between sexes of dogs undergoing trauma?

Answer 21

neutered males/females better survival and lower ATT score compared to intact males/females

no difference between male and female

BUT: neutered males/females had less severe trauma

Question 22

In Sepuya et al. how did WBCT compare to tranditional radiographs?

Answer 22

21 dogs

• 12 injuries missed on traditional xrays - including life-concerning e.g., bulla, pneumothorax, etc.
• only one on WBCT (distal metacarpal fx)
• traditional xrays misdiagnosed a DH and a ruptured urinary bladder which WBCT could rule out
• most dogs needed sedation only (76%) for WBCT (24% anesthesia)

Question 23

For feline bite wounds, what has been shown to be associated with mortality

Answer 23

• higher ATT
• lower mGCS
• older age
• higher body weight