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*Surgery > Trauma 2 > Flashcards

Trauma 2 Flashcards

1
Q

what is Cushing reflex (due to ICP)

A

bradycardia
hypertension
slow RR

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2
Q

what does a GCS of 3-8 indicate?

A

traumatic brain injury

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3
Q

what does a GCS of 9-12 indicate?

A

moderate traumatic brain injury

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4
Q

what does a GCS of 13-15 indicate

A

normal

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5
Q

what should you get in a suspected head injury

A

non-contrasted head CT

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6
Q

what artery is usually injured in a epidural hematoma

A

middle meningeal

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7
Q

what usually causes a epidural hematoma

A

blow to the head

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8
Q

is there a low or high association w/ intraparenchymal injury w/ a epidural hematoma

A

low

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9
Q

classic presentation of epidural hematoma

A

brief LOC
lucid interval
rapid neurologic decline

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10
Q

what will a epidural hematoma look like on a CT

A

lens or convex shape

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11
Q

Tearing of bridging veins between the dura mater and the surface of the brain
Usually diffuse, rotational force applications to the brain

A

Acute subdural hematoma (ASDH)

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12
Q

what will an acute subdural hematoma look like on CT?

A

crescent shaped

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13
Q

do epidural or subdural hematomas have a worse prognosis

A

subdural due to parenchymal damage

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14
Q

Occur in the elderly
Atrophy of the brain put the bridging veins under stretch allowing for injury with much less force
May present up to several months after the injury
Blood may be several cm thick

A

chronic subdural hematoma

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15
Q

tx for a chronic subdural hematoma

A

burr hole or craniotomy

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16
Q

is outcome better for chronic subdural hematoma or ASDH?

A

chronic

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17
Q

Hemorrhage mixed with brain
Site of direct blow or the point opposite (contracoup)
Presentation depends on site

A

intraparenchymal contusions

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18
Q

Immediate and transient LOC or decrease consciousness after strike to head often with amnesia
Grading systems of severity mostly in athletics

A

concussion

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19
Q

Common in those suffering a traumatic brain injury
Trauma more common cause of SAH than ruptured aneurysm
Must rule out ruptured aneurysm

A

traumatic subarachnoid hemorrhage (SAH)

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20
Q

Axons sheared at boundary between gray and white matter during rapid acceleration/deceleration
Occurs in up to 50%of with severe injury

A

Diffuse axonal injury (DAI)

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21
Q

presentation of diffuse axonal injury

A

Presentation is a mild concussive state of confusion to depressed level of consciousness

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22
Q

what will diffuse axonal injury look like on CT

A

CT – multiple small hemorrhages (<1cm) throughout the brain at the junction of the gray and white matter

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23
Q

what do you do for seizure management for head injuries

A

anticonvulsant for 7 days

phenytoin or levetiracetam

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24
Q

how to prevent secondary brain injurys

A 
elevated HOB
drain CSF fluid
sedation/ paralysis
osmotic agents and diuretics
managed respirator to avoid elevated CO2
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25
Q

what is where a patient has no motor of sensory below level of lesion

A

complete spinal cord injury

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26
Q

spare some degree of sensory and/or motor function below level of lesion

A

incomplete SCI

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27
Q

with C1-C5 lesions what is compromised

A

respiratory effort

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28
Q

Affects motor strength in the upper extremities > lower
Sensory function variable below lesion
Elderly patients with spinal stenosis and hyperextension injury

A

central cord syndrome

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29
Q

Compression of by herniated disc or bone fragment
Loss of motor function and pain and temperature sensation
But preservation of proprioception, vibration and pressure sensation below the lesion (dorsal columns)

A

anterior cord syndrome

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30
Q

Cord hemisection
Motor function and proprioception and vibration sense disrupted on side of lesion
Pain and temperature sensation diminished on contralateral side

A

Brown-Sequard Syndrome

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31
Q

Injury to sacral spinal cord

Saddle anesthesia, loss of bowel and bladder function and lower extremity weakness

A

Conus Medullaris Syndrome

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32
Q

Compression and dysfunction of the lumbosacral nerve roots

Presents similar to conus medullaris syndrome

A

Cauda-Equina Syndrome

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33
Q

with a suspected SCI what do you palpate the spine for?

A

step-offs and tenderness

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34
Q

what is a way to test for response to painful stimuli in a comatose patient

A

stick a pen into their cuticle

35
Q

what is a MRI good for

A

ligamentous injuries

36
Q

if a symptomatic patient has normal x-rays and CT what do you do next? (looks for ligamentous injuries)

A

normal flexion/ extension view

or MRI w/i 48 hours of injury

37
Q

what are dynamic flexion/extension films?

A

done under flouroscopy

38
Q

tx for spinal cord injury

A

hard cervical collar for C-spine injury
spinal precaution
high-dose methylprednisone (no longer standard of care)
stabilization and decompression

39
Q

Results from an injury to the heart or great vessels within the pericarium allowing blood to accumulate in the pericardial space (as little as 150 cc)
may interfere with cardiac filling and venous return to the heart leading to decreasing cardiac output, decreased peripheral perfusion, and shock

A

cardiac tamponade

40
Q

A large chest wall defect with pneumo thorax

A

open pneumothorax

41
Q

tx for open pneumothorax

A

Cover the defect with a 3-sided occlusive impermeable dressing – one-way valve
(coverts open to simple pneumo)
place a chest tube

42
Q

what type objects cause cardiac tamponade?

A

penetrating trauma

43
Q

what is Beck’s traid

A

hypotension, muffled heart sounds, and distended neck veins

44
Q

drop in sBP by ≥ 10 during inspiration

A

pulsus paradoxus

45
Q

when should you suspect cardiac tamponade

A

patient with a mechanism of injury consistent with this injury and a patient who is not responding to initial resuscitative efforts

46
Q

Tx for cardiac tamponade

A

volume resuscitation
surgical decompression and reapir
w/ deterioration- pericardiocentesis or ER thoracotomy

47
Q

blood in the pleural space

Absent breath sounds and dullness to percussion

A

hemothorax

48
Q

tx for hemothorax

A

chest tube

49
Q

what is a massive hemothorax

A

If > 1500 cc out immediately
> 200cc/hr x 4 hr,
or > 100cc/hr x 8 hr

50
Q

tx for massive hemothorax

A

thoracotomy

can auto-transfuse

51
Q

2 or more consecutive ribs fractured in more than one place creating a free floating segment of chest wall

A

Flail chest

52
Q

tx for flail chest

A

pain control and pulm toilet
IV fluid
may need intubation

53
Q

what is flail chest associated w/

A

pulmonary contusion

54
Q

most common site of a blunt aortic injury

A

just distal to left subclavian artery

55
Q

what injuries are associated w/ a blunt aortic injury?

A 
clavicle fx
1st rib fx
sternum fx
asymmetry of pulses in UE and LE
paraplegia
56
Q

CXR signs of blunt aortic injury

A

widened meaistinum (>8 cm)
apical cal (left side)
indistrinct aortic knob
deviation of the trachea/ NGT/ ET tobue to the right

57
Q

after a CXR for a suspected aortic injury what do you get?

A

CTA
then surgical reapir
keep BP low prior to reapir

58
Q

An extreme life-saving procedure reserved for patients who present in extremis from penetrating trauma or who rapidly deteriorate in the ED despite aggressive resuscitative measures

A

emergency thoracotomy

59
Q

what is involved in an emergency thoractomy

A

Pericardiotomy
Open cardiac message
Aortic cross-clamping in abdominal injuries (left side)
Direct compression of intrathoracic injuries

60
Q

most often penetrating abdominal injuries hit what?

A

liver then small bowel

go to OR

61
Q

where do blunt traumatic injuries occur

A

liver
spleen
retroperitoneal
(tx non operately)

62
Q

what injuries are typically managed non-operatively

A

Blunt liver/spleen/kidney

63
Q

operative tx of liver injuires

A

pack it

64
Q

tx for pancreatic injuries

A

drainage and possible resection

65
Q

what do you do when treating liver or spleen injuries non operatively

A

ICU
2 large bore IVs
Serial H&H
OR vs embolization depends on blood requirements and vital signs

66
Q

if a patient has a blunt trauma and is stable what do you do

A

CT abd and pelvis with IV contrast

67
Q

what is a FAST exam

A

RUQ, LUQ, pelvis and epigastrium (pericardium) with US- look for fluid

68
Q

what is DPL?

A

diagnostic peritoneal lavage

If blood in abdomen

69
Q

clinical eval for pelvic fracture

A

Palpation of the pelvic bony landmarks
Compression maneuvers to assess stability
Rectal/vaginal exam to assess for open fracture
Blood at urethral meatus or high riding prostate to assess for urethral injury
Retrograde urethrogram if bladder or urethral injury suspected

70
Q

how much different in the pubic rami indicate a separation

A

25 mm

71
Q

where is most blood from a pelvic fracture?

A

retroperitoneal vein

72
Q

tx for pelvic fracture

A

Wrap pelvic binder of sheet around pelvis to include the ASISs to greater trochanters (if this doesn’t work- probably arterial bleed)
if not working- angiography or embolizaiton
followed by definitive fixture

73
Q

where are pelvic hematomas found?

A

retroperitoneal (can hold 4L)

seen on CT

74
Q

tx for pelvic hematoma if found intra-op

A

pack the pelvis

75
Q

how are renal injuries treated

A

non-operatively
bleeding but stable- angio
bleeding and usntable- OR

76
Q

what should you Suspect in any male with a pelvic fracture

A

urethral injuries

77
Q

diagnosis of a urethral injury

A

retrograde urethrogram

78
Q

treatment for urethral injuries

A

primary repair w/ penetrating

delayed repair w/ blunt- suprapubic catheter

79
Q

susceptibility to ischemia w/ kidneys

A

an hour

80
Q

susceptibility to ischemia w/ muscles

A

4-6 hours

81
Q

what are hard signs of extremity vascular injury

A

Expanding or pulsatile hematoma
Limb ischemia
Bruit or thrill
Absence of distal pulse

82
Q

soft signs of extremity vascular injury

A 
h/o hemorrhage at scene – now stopped
Deficit of nerve associated with vessel
Stable, non-expanding hematoma
Proximity of wound to major blood vessel
ABI < 0.9
83
Q

best way to control external bleeding

A

firm direct pressure or packing

84
Q

further testing to do w/ soft signs of vascular injury

A

color flow doppler

arteriography

*Surgery (5 decks)

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