Trauma Flashcards
Three clinical signs of shock?
- Low BP
- Fast, feeble pulse
- Low urinary output (under .5 mL/kg/hr)
Ways to secure an airway in the presence of the cervical spine injury (In order of preference)?
- Orotracheal intubation
- Nasotracheal intubation over fiber-optic bronchoscope
- Cricothyroidotomy if over 12
In trauma setting, shock is caused by? (CVP?)
- Hypovolemic-hemorrhagic (low)
- Pericardial tamponade (high)
- Tension pneumothorax (high)
Unlike other causes of shock, no respiratory distress in?
Severe respiratory distress in?
Pericardial tapenade
Tension pneumothorax
2 alternative ways to treat shock?
- If trauma center nearby – first stop bleeding, then replace volume
- Otherwise first replace volume,
How to replace volume in trauma patient?
- 2 L ringers lactate
- Packed red cells until urinary output reaches .5-2 mL/kg/hr
- Do not exceed CVP of 15
Preferred route of fluid resuscitation? Other methods? Other methods on child under six?
2 16-gauge peripheral IV lines
Percutaneous femoral vein catheter or saphenous vein cut-downs
Intraosseous cannulation of proximal tibia
Pericardial tamponade – diagnosed by? If diagnosis is uncertain? Treatment options?
Clinical diagnosis – if unclear choose sonogram, not CXR
Pericardiocentesis, pericardial window, or open thoracotomy
Tension pneumothorax – diagnosis? Management?
Clinical – do not order CXR or wait for blood gases
- Needle into pleural space
- Follow with chest tube
Causes of shock in nontraumatic setting?
- Hypovolemic – bleeding, burns, peritonitis, pancreatitis, message diarrhea
- Intrinsic cardiogenic shock – MI, myocarditis
- Vasomotor (neurogenic) shock – anaphylaxis, high spinal cord transection, high spinal anesthetic
Penetrating head trauma – management?
Surgical intervention
Linear skull fractures – management?
- Is closed (no overlying wound), leave alone
- If open, wound closure
- If depressed or comminuted, OR
Patient with head trauma who becomes unconscious – management?
- CT scan to look for intracranial hematomas
- If negative and neurologically intact, can go home if family is willing to wake him up frequently over next 24 hours to make sure they don’t go into a coma
Fracture affecting base of skull – signs/symptoms? Management?
- Raccoon eyes
- Rhinorrhea
- Otorrhea or Bruising behind ear
- CT scan of cervical spine for integrity or especially if unconscious (to rule out intracranial bleeding)
- Expectant management (no antibiotics)
Causes of neurologic damage from trauma? Corresponding treatments?
- Initial blow – no treatment
- Hematoma that displaces midline structures – surgery
- Increased ICP – medical measures
Epidural hematoma – natural history? Imaging shows? Management?
- Trauma
- Unconsciousness
- Lucid interval (completely asymptomatic)
- Gradual lapsing into coma
- Fixed dilated pupil (mostly ipsilateral) with contralateral hemiparesis
CT scan shows biconvex, Lens-shaped hematoma
Craniotomy produces cure
Acute subdural hematoma (versus epidural hematoma)? Imaging shows? Management?
bigger trauma and no lucid interval
CT scan shows semi-lunar, crescent shaped hematoma
- Craniotomy if midline structures are deviated (but prognosis is bad)
- If no deviation, prevent increased ICP
Medical management for patient with risk of increased ICP?
- Elevate head
- Hyperventilate to PCO2 of 35, if signs of herniation
- Mannitol or furosemide to avoid overload (but do not decrease the systemic arterial pressure)
- Hypothermia/Sedation to decrease oxygen demand
Diffuse axonal injury – suggested by? Management?
CT scan shows:
- diffuse blurring of gray-white matter interface
- Multiple small punctate hemorrhages
No surgery without hematoma – just prevent increased ICP
Chronic subdural hematoma – typical patient? Mechanism? Diagnosis? Management?
Very old or severe alcoholics
- Shrunken brain moved around by minor trauma, tearing penis sinuses
- Mental function deteriorates as hematoma forms
CT scan
Surgical evacuation provides cure
Can intracranial bleeding lead to hypovolemic shock?
No,not enough space
