Trauma 2 Flashcards

(84 cards)

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
what is where a patient has no motor of sensory below level of lesion
complete spinal cord injury
26
spare some degree of sensory and/or motor function below level of lesion
incomplete SCI
27
with C1-C5 lesions what is compromised
respiratory effort
28
Affects motor strength in the upper extremities > lower Sensory function variable below lesion Elderly patients with spinal stenosis and hyperextension injury
central cord syndrome
29
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)
anterior cord syndrome
30
Cord hemisection Motor function and proprioception and vibration sense disrupted on side of lesion Pain and temperature sensation diminished on contralateral side
Brown-Sequard Syndrome
31
Injury to sacral spinal cord | Saddle anesthesia, loss of bowel and bladder function and lower extremity weakness
Conus Medullaris Syndrome
32
Compression and dysfunction of the lumbosacral nerve roots | Presents similar to conus medullaris syndrome
Cauda-Equina Syndrome
33
with a suspected SCI what do you palpate the spine for?
step-offs and tenderness
34
what is a way to test for response to painful stimuli in a comatose patient
stick a pen into their cuticle
35
what is a MRI good for
ligamentous injuries
36
if a symptomatic patient has normal x-rays and CT what do you do next? (looks for ligamentous injuries)
normal flexion/ extension view | or MRI w/i 48 hours of injury
37
what are dynamic flexion/extension films?
done under flouroscopy
38
tx for spinal cord injury
hard cervical collar for C-spine injury spinal precaution high-dose methylprednisone (no longer standard of care) stabilization and decompression
39
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
cardiac tamponade
40
A large chest wall defect with pneumo thorax
open pneumothorax
41
tx for open pneumothorax
Cover the defect with a 3-sided occlusive impermeable dressing – one-way valve (coverts open to simple pneumo) place a chest tube
42
what type objects cause cardiac tamponade?
penetrating trauma
43
what is Beck's traid
hypotension, muffled heart sounds, and distended neck veins
44
drop in sBP by ≥ 10 during inspiration
pulsus paradoxus
45
when should you suspect cardiac tamponade
patient with a mechanism of injury consistent with this injury and a patient who is not responding to initial resuscitative efforts
46
Tx for cardiac tamponade
volume resuscitation surgical decompression and reapir w/ deterioration- pericardiocentesis or ER thoracotomy
47
blood in the pleural space | Absent breath sounds and dullness to percussion
hemothorax
48
tx for hemothorax
chest tube
49
what is a massive hemothorax
If > 1500 cc out immediately > 200cc/hr x 4 hr, or > 100cc/hr x 8 hr
50
tx for massive hemothorax
thoracotomy | can auto-transfuse
51
2 or more consecutive ribs fractured in more than one place creating a free floating segment of chest wall
Flail chest
52
tx for flail chest
pain control and pulm toilet IV fluid may need intubation
53
what is flail chest associated w/
pulmonary contusion
54
most common site of a blunt aortic injury
just distal to left subclavian artery
55
what injuries are associated w/ a blunt aortic injury?
``` clavicle fx 1st rib fx sternum fx asymmetry of pulses in UE and LE paraplegia ```
56
CXR signs of blunt aortic injury
widened meaistinum (>8 cm) apical cal (left side) indistrinct aortic knob deviation of the trachea/ NGT/ ET tobue to the right
57
after a CXR for a suspected aortic injury what do you get?
CTA then surgical reapir keep BP low prior to reapir
58
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
emergency thoracotomy
59
what is involved in an emergency thoractomy
Pericardiotomy Open cardiac message Aortic cross-clamping in abdominal injuries (left side) Direct compression of intrathoracic injuries
60
most often penetrating abdominal injuries hit what?
liver then small bowel | go to OR
61
where do blunt traumatic injuries occur
liver spleen retroperitoneal (tx non operately)
62
what injuries are typically managed non-operatively
Blunt liver/spleen/kidney
63
operative tx of liver injuires
pack it
64
tx for pancreatic injuries
drainage and possible resection
65
what do you do when treating liver or spleen injuries non operatively
ICU 2 large bore IVs Serial H&H OR vs embolization depends on blood requirements and vital signs
66
if a patient has a blunt trauma and is stable what do you do
CT abd and pelvis with IV contrast
67
what is a FAST exam
RUQ, LUQ, pelvis and epigastrium (pericardium) with US- look for fluid
68
what is DPL?
diagnostic peritoneal lavage | If blood in abdomen
69
clinical eval for pelvic fracture
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
how much different in the pubic rami indicate a separation
25 mm
71
where is most blood from a pelvic fracture?
retroperitoneal vein
72
tx for pelvic fracture
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
where are pelvic hematomas found?
retroperitoneal (can hold 4L) | seen on CT
74
tx for pelvic hematoma if found intra-op
pack the pelvis
75
how are renal injuries treated
non-operatively bleeding but stable- angio bleeding and usntable- OR
76
what should you Suspect in any male with a pelvic fracture
urethral injuries
77
diagnosis of a urethral injury
retrograde urethrogram
78
treatment for urethral injuries
primary repair w/ penetrating | delayed repair w/ blunt- suprapubic catheter
79
susceptibility to ischemia w/ kidneys
an hour
80
susceptibility to ischemia w/ muscles
4-6 hours
81
what are hard signs of extremity vascular injury
Expanding or pulsatile hematoma Limb ischemia Bruit or thrill Absence of distal pulse
82
soft signs of extremity vascular injury
``` 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
best way to control external bleeding
firm direct pressure or packing
84
further testing to do w/ soft signs of vascular injury
color flow doppler | arteriography