Trauma Flashcards
What stage of peak death does ATLS prevent?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
B. Stage II
Stage 2. This occurs within minutes to several hours following injury. This is when the “golden hour” of care after injury occurs, characterized by need for rapid assessment and resuscitation. Causes of death include: subdural and epidural hematomas, hemopneumothorax, splenic rupture, liver lacerations, pelvic fractures, and other injuries causing significant blood loss.
Stage 1 is initial trauma event. Deaths during this peak are usually due to apnea from severe brain injury or high spinal cord injury, rupture of the heart/aorta/other large vessels. Very few patients survive these injuries.
Stage 3 is days to weeks after injury. Death usually occurs secondary to sepsis and multi-organ system failure.
There is no stage 4 or fourth peak.
A patient presents to the trauma bay. You complete your initial assessment and find that the patient opens their eyes to painful stimuli, withdraws from this stimulus, and is making incomprehensible word sounds. What is their GCS score?
A. 6
B. 7
C. 8
D. 9
C. 8
Eye - 2 for pain
Verbal - 2 for incomprehensible
Motor - 4 for withdraws from stimulus
Eye
1 - No response
2 - Responds to pain
3 - Responds to speech
4 - Spontaneous response
Verbal
1 - No response
2 - Incomprehensible sounds
3 - Inappropriate words
4 - Confused
5 - Oriented to time, place, and person
Motor
1 - No response
2 - Abnormal extension (Decerebrate)
3 - Abnormal flexion (Decorticate)
4 - Flexion withdrawal from pain
5 - Moves to localize pain
6 - Obeys commands
Best response - 15
Comatose patient - 8
Totally unresponsive - 3
What is the best measurement of perfusion in a trauma patient?
A. Urine output
B. Blood pressure
C. Capillary refill
D. Mean arterial pressure
A. Urine output
Blood pressure is a late indicator of tissue perfusion
Which of the following is not part of the Cushing reflex triad?
A. Hypertension
B. Irregular breathing
C. Bradycardia
D. Confusion
D. Confusion
The Cushing reflex (also called Cushing’s triad) is a physiological response to increased intracranial pressure (ICP), often seen in the trauma setting when there is significant brain injury, such as traumatic brain injury (TBI), intracranial hemorrhage, or cerebral edema.
The reflex involves three key clinical signs:
- Hypertension
The body attempts to maintain cerebral perfusion pressure (CPP) by increasing systemic blood pressure to overcome the elevated ICP.
CPP = Mean Arterial Pressure (MAP) - ICP. If ICP rises, MAP must also rise to sustain perfusion to the brain. - Bradycardia
As blood pressure rises, baroreceptors in the carotid sinus and aortic arch stimulate the parasympathetic nervous system, causing a reflexive slowing of the heart rate. - Irregular Respirations
Increased ICP compresses the brainstem, disrupting normal respiratory patterns. Breathing may become irregular, slow, or stop entirely (e.g., Cheyne-Stokes respirations, ataxic breathing).
For a two stage repair of a third degree burn, how long do you wait after debridement for stage 2 recon? A. 24-48 hrs
B. 96 hrs
C. 1 week
D. 2 weeks
A. 24-48 Hours
If early excision and grafting is the treatment of choice, it may be a one- or two-stage technique. With the one-stage technique, the operation consists of excision of the burn to viable tissue and the placement of a graft. In the two-stage technique, the first operation is for the excision of the burn to viable tissue and coverage with a biologic dressing. The wound is reevaluated and grafted 24 to 72 hours later
Injury to the bony orbit will most likely result in which kind of visual changes?
A. Monocular diplopia
B. Bitemporal hemianopia
C. Binocular diplopia
D. Monocular hemianopia
C. Binocular diplopia
Most orbital trauma patients suffer from binocular diplopia (i.e double vision with both eyes open). This is usually caused by extraocular muscle dysfunction secondary to edema, entrapment, or globe malposition.
In monocular diplopia, the patient has double vision when the unaffected eye is closed. Injury to the globe, such as lens dislocation or retinal detachment, has probably occurred.
Bitemporal hemianopsia occurs when there is loss of peripheral vision in the outer (temporal) half of both visual fields. It is typically caused by damage to the optic chiasm, where the optic nerves from the nasal (inner) half of each retina cross over. This damage is typically caused by pituitary tumors, aneurysms, stroke, trauma, and multiple sclerosis.
Unilateral hemianopia occurs when a person experiences vision loss in half of one eye. It is classically caused by
stroke (most common cause), Brain tumor, Head injury, Optic nerve damage, and Ischemia.
What structure separates the inferior orbital middle and lateral fat pads?
A. inferior oblique muscle
B. arcuate expansion of the capsulopalpebral fascia
C. orbital septum
D. infraorbital artery
B. arcuate expansion of the capsulopalpebral fascia
The inferior oblique muscle separates the middle and medial fat pads. The middle and lateral fat pads are separated by the arcuate expansion of the inferior oblique muscle.
What structure surrounds the lacrimal sac?
The lacrimal sac lies between the anterior and posterior branches of the medial canthal tendon. It is lateral to the nasal and middle fat pads of the upper lid
What valve prevents retrograde flow of mucus from the nasal cavity into the lacrimal duct system?
A. Valve of Hasner
B. Valve of Rosenmüller and Huschke
C. Valve of Krause
D. Valve of Taillefer
A. Valve of Hasner
Valve of Hasner: Also known as the plica lacrimalis, this valve is located at the end of the nasolacrimal duct and prevents mucus or air from entering the sac when blowing the nose
Valve of Bochdalek and Foltz: Located in the lacrimal puncta
Valve of Rosenmüller and Huschke: Control the ostium of canaliculi to the lacrimal sac
Valve of Krause: Guards the path where the lacrimal sac enters the nasolacrimal duct
Valve of Taillefer: Located in the central lacrimal duct
What is the most important suture to consider in pediatric nasal fractures?
A. Nasofrontal
B. Septovomerine
C. Nasomaxillary
D. Ethmoidal
B. Septovomerine
The septal component is the most important and requires accurate reduction and alignment if secondary deformities are to be avoided.
A patient presents with traumatic telecanthus after an MVC resulting in her face striking the steering wheel. The patient was a restrained passenger. Which of the following likely characterizes her naso-orbito-ethmoidal fracture?
A. Markowitz I
B. Markowitz II
C. Markowitz III
D. Markowitz IV
C. Markowitz III
NOE Type I: simple fracture and medial canthal tendon remains attached.
NOE Type II: comminuted fracture, but the medial canthal tendon remains attached.
NOE Type III: comminuted fracture with detachment of the medial canthal tendon. Patients will have traumatic telecanthus.
There is no NOE Type IV
Which suture is the most important to fixate in a ZMC fracture?
A. ZM
B. ZF
C. ZS
D. ZT
A. Zygomaticomaxillary
Which suture is used to ensure correct reduction of the zygomatic bone after fracture?
A. ZM
B. ZF
C. ZS
D. ZT
C. Zygomaticosphenoid
What is the best way to prevent injury to the temporal branch of the facial nerve when raising a bicoronal flap?
A. The dissection should stay between the temporoparietal fascia and superficial layer of the deep temporal fascia.
B. The dissection should stay between the superficial layer of the deep temporal fascia and the temporalis fascia
C. The dissection should stay between the temporalis fascia and the temporalis muscle
D. The dissection should stay between the subcutaneous tissue and the superficial musculoaponeurotic system
A. The dissection should stay between the temporoparietal fascia and the superficial layer of the deep temporal fascia
CN VII runs just beneath or within the temporoparietal fascia/SMAS
The temporoparietal fascia is continuous with the galeal aponeurosis, SMAS, and platysma.
The deep temporal fascia is continuous with the parotidomasseteric fascia and superficial layer of the deep cervical fascia.
Galea –> Temporoparietal fascia –> Superificial musculoaponeurotic system –> Platysma/superficial cervical fascia
Pericranium –> Temporalis fascia (superficial and deep separate around the zygomatic arch) –> Parotidomasseteric fascia –> superficial layer of the deep cervical fascia
Which type of shock is not associated with increased systemic vascular resistance?
A. Hypovolemic
B. Distributive
C. Cardiogenic
D. Obstructive
B. Distributive
Distributive shock, which includes septic shock, anaphylactic shock, and neurogenic shock, is characterized by decreased systemic vascular resistance (SVR) due to widespread vasodilation. This is in contrast to other types of shock, such as hypovolemic, cardiogenic, and obstructive shock, which are typically associated with increased SVR as a compensatory mechanism to maintain blood pressure and perfusion
