Trauma Flashcards

1
Q

what are the ABCDEs of the primary survey?

A

Airway
Breathing
Circulation
Disability
Exposure and environment

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2
Q

GCS less than […] is indication for intubation

A

9

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3
Q

if endotracheal intubation fails, what is the next step?

A

cricothyroidotomy

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4
Q

if the patient is unable to breathe, establish airway with […] control

A

c-spine

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5
Q

if patient is […], their airway is controlled

A

talking

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6
Q

when assessing Airway, you should have a low threshold for […]

A

intubation

(basically if the patient is not talking –> intubate)

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7
Q

where is a chest tube place?

A

4th or 5th intercostal space mid-axillary

go above the rib, VAN is below

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8
Q

When assessing Circulation, what labs should you get?

A

CBC, CMP, type and cross

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9
Q

GCS 3 means the patient is…

A

probably dead

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10
Q

correcting Circulation with fluids should be achieved by establishing […]

A

2 large bore peripheral IVs

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11
Q

immediate treatment of cardiac tamponade

A

IVF bolus and pericardiocentesis

(later– surgical exploration)

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12
Q

what are the three categories of GCS?

A

eye, motor, verbal

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13
Q

Spontaneous eye opening with blinking at baseline is GCS […]

A

4

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14
Q

eye opening to verbal command, speech, or shout is GCS […]

A

3

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15
Q

eye opening to pain is GCS […]

A

2

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16
Q

no eye opening is GCS […]

A

1

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17
Q

oriented verbal response is GCS […]

A

5

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18
Q

confused conversation, but able to answer questions is GCS […]

A

4

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19
Q

inappropriate responses but discernible words is GCS […]

A

3

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20
Q

incomprehensible speech is GCS […]

A

2

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21
Q

no speech/verbal response is GCS […]

A

1

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22
Q

obeys commands for movements is GCS […]

A

6

23
Q

purposeful movement to painful stimulus is GCS […]

A

5

24
Q

withdraws from pain is GCS […]

A

4

25
Q

abnormal flexion, decorticate posturing is GCS […]

A

3

26
Q

extensor response, decerebrate posturing is GCS […]

A

2

27
Q

no motor response is GCS […]

A

1

28
Q

a blown pupil reflects ipsilateral compression of CN […]

A

III

29
Q

what is Beck’s triad and what does it indicate?

A

hypotension, distant heart sounds, JVD

cardiac tamponade

30
Q

what areas are assessed via FAST?

A

pericardium
splenorenal
pouch of Douglas
Morrison’s pouch
lungs

31
Q

can fast assess the retroperitoneum?

A

no

32
Q

next step for a patient with positive FAST that stabilizes with fluid?

A

CT: chest, abdomen, pelvis
with contrast

33
Q

next step for a patient with positive FAST that does NOT stabilize with fluid?

A

ex-lap

have cell saver on hand

34
Q

what is the goal SBP for fluid resuscitation?

A

90-100

(overloading can cause tamponade)

35
Q

if the patient continues to decline after ABCDEs…what should you do?

A

repeat ABCDEs

(i.e. if BP keeps falling, it is likely to be ABCDE issue)

36
Q

if the chest tube drains more than […] at time of insertion –> OR

A

400 ml

37
Q

if the chest tube drains more than […] ml/hour over 4 hours –> OR

A

200

38
Q

mnemonic for secondary survey:

A

Allergies
Meds
Past illness
Last meal
Events/environment

39
Q

you’ve taken a hemodynamically unstable patient back for ex-lap:
1. what incision do you make?
2. how do you begin the case?

A
  1. midline xiphoid to pubic symphysis
  2. pack all four quadrants, take down packing 1 at a time to assess for source of bleed
40
Q

what is the seatbelt sign?

A

bruising around waist/chest/clavicle for seatbelt

41
Q

if you need to do a needle decompression for tension pneumo, where would you insert the needle?

A

2nd intercostal space, midclavicular line

42
Q

if SBP > […] and HR is normalized, you can get a CT

A

90

43
Q

what is Massive Transfusion Protocol?

A

1:1:1

RBCs
Platelets
FFP

44
Q

if a patient has midfacial fractures and you want to decompress the stomach, what should you use?

A

OG tube

45
Q

[…] fracture can cause NG to coil in intracranial space

A

cribriform plate

46
Q

what triad of PE findings indicates urethral injury?

A

high riding prostate
Ecchymotic scrotum
Blood at meatus

47
Q

Splenectomy and embolectomy patients require […] prophylaxis

A

vaccine

S pneumo., N. meningitidis, H. flu

48
Q

What labs/imaging can be considered during secondary survey?

A

cervical and lateral spine imaging
AP CXR
AP pelvis
Type and Cross
CBC
CMP
UA, drug screen
ABGs
EKG
lactate
troponin

49
Q

place pressure on the […] and […] to evaluate for pelvic fracture

A

iliac crests and greater trochanters

50
Q

you have a patient with pelvic fracture. you do a DRE and feel bony prominence. What will this patient require?

A

diverting ileostomy

51
Q

Patient is hemodynamically stable. On CT you note fluid in the around the spleen…what is the best next step?

A

consult IR for embolization

52
Q

when evaluating for Disability, you note your patient has an open femur fracture with pulsatile bleeding and is hemodynamically unstable. What is your next best step?

A

reduce fracture

53
Q

when is the tertiary survey completed?

A

24-48 hrs later once the patient is stabilized and able to interact for H&P