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Emergency Medicine > Trauma 2 > Flashcards

Trauma 2 Flashcards

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1
Q

Severity of initial injuries and outcomes in trauma are determined by two principal and non-modifiable factors:

A
  1. MOI

2. patient-related physciological factors (age, comorbidities)

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2
Q

Types of trauma

A
  1. Blunt (MCV, falls, sports accidents, assaults)** most common
  2. penetrating (stab wounds, gunshot wound)
  3. blast (blunt + penetrating + thermal)
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3
Q

Collisions that occur with blunt trauma

A

machine, body, organ

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4
Q

rapid deceleration can cause

A

Shearing force → stretching and tearing of structures at points of attachment

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5
Q

describe what happens with rapid deceleration of the body

A

Rapid deceleration of the body → continued downward or forward motion of internal structures → shear and tearing along the attachment of the organs and blood supply

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6
Q

compression trauma can cause

A
  1. Crushing of tissues by a direct blow or against an object

2. Compression of a closed space → rupture

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7
Q

__ is the greatest determinate of amount of force

A

speed

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8
Q

Hallmarks of high-energy mechanism

A
  1. Death in vehicle
  2. Significant intrusion
  3. Prolonged extrication
  4. Ejection
  5. Deformed steering wheel
  6. Stared windshield
  7. Rollover
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9
Q

Direction of impact (type of collision)

A
  1. Frontal impact (Head-on)*-> most common
  2. Lateral impact (T-boned)**–> highest morbidity and mortality
  3. Rear impact
  4. Rotational (corner)*
  5. Rollover
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10
Q

describe the factors in injury pattern with front impact collisions (head on)

A
  1. Up and over pathway
  2. Down and under pathway
  3. Dashboard damage/intrusion
  4. Airbag deployment
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11
Q

describe the factors in injury pattern with lateral impact collisions (t bone)

A
  1. Main force on side of impact

2. Amount of intrusion

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12
Q

describe the factors in injury pattern with rotational or corner impact collisions

A
  1. Similar injuries as those in frontal and lateral impact
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13
Q

describe the factors in injury pattern with rollover collisions

A
  1. Greater chance of ejection

2. Non-secure objects become projectiles

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14
Q

describe the factors in injury pattern with rear impact collisions

A
  1. Head rest placement
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15
Q

What are potential associated injuries with head on collision

A
  1. Facial injuries
  2. Lower extremity injuries
  3. Aortic injuries
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16
Q

What are potential associated injuries with windshield damange

A
  1. Closed head injuries, coup and countercoup injuries
  2. Facial fractures
  3. Skull fractures
    4, Cervical spine fractures**
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17
Q

What are potential associated injuries with steering wheel damage

A

Thoracic injuries

  • Sternal and rib fractures, flail chest
  • Cardiac contusion*
  • Aortic injuries
  • Hemo/pneumothoraces
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18
Q

What are potential associated injuries with dashboard involvement/damage

A
  1. Pelvic and acetabular injuries

2. Dislocated hip (posterior dislocation)

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19
Q

Potential associated injuries with rear-end collision

A
  1. Hyperextension* injuries of cervical spine
  2. Cervical spine fractures
  3. Central cord syndrome
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20
Q

Potential associated injuries with lateral (T bone) collisions

A
  1. Thoracic injuries
  2. Abdominal injuries: spleen, liver
  3. Pelvic injuries
  4. Clavicle, humerus, rib fxs
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21
Q

Potential associated injuries with rollovers

A
  1. crush injuries*

2. compression fx of spine

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22
Q

Potential associated injuries with lab belt only

A

Chance fractures, abdominal injuries*, head and facial injuries/fractures

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23
Q

Major determinants of potential for fall injury:

A
  1. height of fall
  2. impact of surface
  3. landing position (feet first is most common, horizontal impact has highest mortality)
  4. age over 40
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24
Q

Potential associated injuries for falls with vertical impacts

A
  1. Calcaneal and LE fractures
  2. Pelvic fractures
  3. Renal and renal vascular injuries
    - feet first
  4. Closed head injuries
  5. Cervical spine fractures
    - head first
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25
Q

Potential associated injuries for falls with horizontal impacts

A
  1. Craniofacial fractures
  2. Hand and wrist fractures
  3. Abdominal and thoracic visceral injuries
  4. Aortic injuries
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26
Q

Potential associated injuries for falls from standing

A

Hip, rib, spine, long bone fx’s

Closed head injuries

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27
Q

Factors determining the severity of injury in GSW

A
  1. bullet trajectory and path
  2. velocity (H, M, L)
  3. bullet caliber (mass) and bullet design (military vs hunting)
  4. number of bullet wounds
28
Q

For stab wounds to the chest below the 4th ICS suspect __

A

intraabdominal injury

29
Q

Who are more susceptible to serious injury from low-energy mechanisms

A

elderly

*Falls are #1 common cause of fatal and nonfatal injury
-Commonly have a medical cause resulting in fall
Ie. syncope, UTI

30
Q

Complications from injuries in elderly

A
  1. Longer hospital stay, more complications
  2. Blunted response to pain and hypovolemia
  3. Hypotension and tachycardia thresholds are: 110 mmHg SBP and HR over 90 BPM
  4. Bleed due to higher likelihood of comorbiditis (anticoag use, MMP)
31
Q

Take away points for trauma in elderlys

A
  1. check meds (BB, anticoagulants)
  2. normal VS can be misleading
  3. higher suspicion for injury
  4. lower threshold for diagnostic testing and admission
32
Q

Why are pediatrics more likely to have organ damage w/ blunt abdominal trauma and more head trauma with falls

A
  1. less muscular abdomen

2. have bigger, softer heads

33
Q

a pediatrics pliable skeleton may lead to what types of trauma injuries

A
  1. May suffer major internal injuries without fracture
  2. Laxity of ligaments and less calcified bones → spine injuries without bony abnormalities
    3 compliant chest well–> pulmonary contusions
34
Q

How do you estimate hypotension in children 1-10y/o

A

SBP less than 70 (2 x age) mmhg

*hypotension is a late and ominous finding

35
Q

What neuro scale do you used for a child under 4

A

APVU over GCS

36
Q

What is included in the trauma lab panel?

A
  1. CBC
  2. BMP
  3. LFTs
  4. lipase
  5. venous lactate
  6. ABGs
  7. CK in crush injuries
  8. Coags (aPTT, PT/INR, TEG)
  9. type and screen or crossmatch
  10. urinalysis
  11. Tox screen, EtOH
  12. pregnancy screen w/ B-hCG
37
Q

10-20% patients with head injury also have a ___ injury

A

cervical spine

  • Loss of consciousness is not the best predictor of intracranial pathology
  • Not all patients with a severe head injury with have external signs of head trauma
38
Q

high risk MOI of head injuries

A
  1. falls over 10ft
  2. auto vs ped
  3. MCV w/ ejection
  4. road cycling, skier/SB crash
  5. fall from standing w/ head trauma and LOC in pt on coumadin or dual antiplatlet tx
39
Q

Skull fx are almost always associated with

A
  1. Intracranial trauma (contusion, ICH)

2. basilar skull fx–> r/o cerebrovascular injury

40
Q

Must rule out c-spine injury in elderly __ and ___ (most commonly missed injury)

A

falls with head-trauma

41
Q

High risk factors for cervical injuries

A
  1. axial loading injury
  2. fall over 1 meter
  3. High speed MVC/rollover/ejection
  4. Age over 65
  5. Paresthesia’s
  6. ATV, MC or bike collision
42
Q

Most common MOI of of cervical spine injuries

A
  1. hyperflexion (most common)
  2. hyperextension (ie. whiplash)
  3. vertical compression injury (Burst fxs)
  4. flexion-rotation injury (verterbal artery injury)
43
Q

C spine transverse process fx are often associated with

A

vertebral artery injury

44
Q

Fractures of C4 and above are commonly associated with

A

paralysis of muscles of respiration (diaphragm innervated by C3-5)– worry about respiratory compromise

45
Q

fractures of the middle C spine are often associated with

A

dysfunction of the UE more so than LE (central cord syndrome)

46
Q

Imaging of cervical spine injuries

A
  1. Plain film
  2. CT– most sen. and spec. for spine injuries
  3. MRI– most sen. and spec. for ligamentous and spinal cord injuries
  4. CTA neck– evaluation of blunt cerebrovascular injury (BCVI) or seat belt sign
47
Q

Who with C spine injuries get imaging?

A

*use NEXUS criteria for low probability of injury and Canadian criteria for detecting clinically important C-spine injury

high risk– get imaging
no low RFs– get imaging
Yes low RFs– ROM test

48
Q

What is a Jefferson fracture

A

burst fracture of C1 from axial loading

*Both anterior and posterior arches break and transverse ligament is

(OMO lateral masses are wide)

49
Q

What are odontoid fractures

A

Dens/C2 fractures from flexion, extension, and rotational injuries

50
Q

What are Hangman’s fractures

A

bilateral pedicle fractures of C2 from Hyperextension + axial load

*Most common cervical spine fx

51
Q

Most common cervical spine fracture

A

Hangman’s fracture (C2)

52
Q

T5 fractures and above are at risk for

A

neurogenic shock

53
Q

Symptoms of SCI

A
  1. Pain, focal sensory or motor deficit
  2. Weakness, paresthesia’s
  3. Urinary incontinence or retention
54
Q

PE of SCI

A
  1. Focal neurological deficit
    - Bilateral → cord injury
    - Unilateral → peripheral nerve injury
    - UE > LE → central cord
  2. Decreased or absent rectal sphincter tone, diminished perineal sensation → cord injury
  3. Abnormal muscle tone (spasticity, flaccid) → incomplete or partial cord injury
55
Q

SCI to what vertebra results in:

quadriplegia/tetraplegia and paraplegia

A

C4- quad/tetra below the neck

C6- parial paralysis of hands and arms and lower body

T6- para below chest

L1- para below waist

56
Q

Management of suspected or known spine injury

A
  1. Immobilize c-spine, head of bed less than 30%, best rest, spine precautions
    * Must stay flat until cleaned with imaging
57
Q

Describe the disposition/mangement of SCI and spine injuries

A
  1. CT evidence of injury or neurologic deficit on exam →Consult Trauma and Spine/Ortho
  2. Admit to ICU if unstable fracture
  3. If spinal cord injury present → maintain normotensive BP**
  4. +/- Foley
  5. Serial neuro exams
  6. Bowel protocol for T/L spine injuries
58
Q

What findings are commonly associated with

  1. pneumothorax/ hemothorax
  2. pulmonary contusion
  3. cardiac injuries
  4. diaphragmatic injuries
  5. pneumomediastinum
A
  1. pneumothorax/ hemothorax: rib fx
  2. pulmonary contusion: multiple rib fx
  3. cardiac injuries: sternal fx
  4. diaphragmatic injuries: usually on left, overpressure injuires and penetrating trauma is most common
  5. pneumomediastinum: esphageal injury, tracheal injury, ruptured piriform sinus
59
Q

What patients need to be admitted for thoracic trauma?

A
  1. multiple rib fx (age over 65 w/ 3 or more rib fx–> admit to ICU)
  2. pneumothorax, hemothorax, pulmonary contusions
  3. pneumomediastinum
60
Q

What type of abdominopelvic trauma MOI is associated with deform hollow organ and transiently increase intraluminal pressure; laceration of solid organ

A

compression force

61
Q

What type of abdominopelvic trauma MOI is associated with vessel injuries, solid organs

A

deceleration force

62
Q

What type of abdominopelvic trauma MOI is associated with diaphragmatic rupture, bladder/bowel rupture

A

over pressure force

63
Q

Describe the injury patterns of abdominopelvic solid organ injuries:

  1. liver lac or hematoma:
  2. spleen lac or hematoma:
  3. kidney lac or hematoma:
A
  1. liver lac or hematoma: lower R rib fx
  2. spleen lac or hematoma: lower L rib fx (MOST COMMON INTRAABDOMINAL SOLID ORGAN INJURED)
  3. kidney lac or hematoma: lower posterior rib fx, T/L spine fx
64
Q

Describe the injury patterns of abdominopelvic hollow viscus injuries:

  1. bowel injury
  2. bladder injury
  3. urethral injury
A

Bowel injury → usually from penetrating injury
Bladder injury → associated w pelvic fx
Urethral injury → associated w kidney and/or bladder injury

65
Q

What patients with abdominopelvic trauma need to go to the OR or IR?

A
  1. hemodynamically unstable
    • FAST
  3. solid organ injury with active extravasation
  4. bowel or mesenteric injury
  5. vascular injury

Emergency Medicine (22 decks)

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