Trauma

Question 1

Resuscitation Blood Plan

Answer 1

Resuscitate blood 1:1:1 ratio RBC, plasma and platelet

Always rule out other traumas (e.g. bleeding spleen), cervical spine injury with shock

Can be neurological (hypotension with bradycardia)

Question 2

What other scans to look for if you see hemorrhage on CT?

Answer 2

Bone window for fracture
CTA for vascular injury

Question 3

Source of hypotension

Answer 3

Bleeding (thoracic, abdomen, long bone, laceration)

Obstructive (pneumothorax, tamponade)

Cardiac

Neurologic (hypotension with bradycardia)

Question 4

Indications for Surgery for Epidural hematoma

Answer 4

> 30cc
1.5cm thickness
0.5cm shift
Exam

Question 5

Indications for Surgery for Subdural hematoma

Answer 5

> 1cm
0.5cm shift
OR
GCS drop of 2 or more
ICP>20
Pupillary changes

Question 6

Indication for Surgery for ICH

Answer 6

> 50cc
OR
20cc with
- >0.5cm shift
- GCS 6-8
- Refractory ICP
- Cysternal compression

Question 7

Indications for Surgery for Posterior fossa hemorrhage

Answer 7

Mass effect (cisternal compression, obstructive)
Neurologic dysfunction

Question 8

Indications for Surgery for Open depressed skull fracture

Answer 8

Thickness of skull
Hematoma
Infection
Deformity
Frontal sinus

Question 9

Trauma guidelines in ICU

Answer 9

ICP management
Early feed (5 days)
Early tracheostomy
No iodine mouth wash
Antibiotics for EVD
Phenytoin for 7 days

NO STEROIDS

Question 10

MRC CRASH trial 2004

Answer 10

10K patients 48h of Methylpred or placebo - higher death in steroid group

Question 11

RESCUE-ICP Results

Answer 11

37% of medical group eventually had surgery

ICP better controlled in surgical group
16% surgical vs 9% medical adverse events
15 vs 21 days surgical/medical hospital stay