Trauma Flashcards
What is the golden hour of trauma?
Period immediately following trauma in which rapid assessment, diagnosis, stabilization must occur.
What should happen in prehospital phase of trauma management?
Control of airway and external hemorrhage.
Immobilization.
Rapid transport to hospital.
What should a trauma history include?
AMPLE: Allergies Medications/Mechanism of injury PMH/Pregnant Last meal Events surrounding mechanism of injury
What are the ABCs of trauma care?
Airway (w/ cervical spine precautions) Breathing and ventilation Circulation/Control of hemorrhage Disability (neuro status) Exposure/Environment control Foley
Describe airway and C-spine management.
Assess patency.
Use jaw thrust or chin lift to open airway.
Clear foreign bodies.
Insert oral or nasal airway when necessary.
Describe breathing and ventilation management.
Inspect, auscultate, palpate chest.
Identify and treat injuries that may impair (e.g. pneumothorax, flail chest, pulmonary contusion, massive hemothorax).
All receive O2.
Describe control of hemorrhage.
Assess circulatory status (e.g. cap refill, pulse, skin color).
Place 2 large-bore IVs (always draw blood).
Use direct pressure.
Describe assessment of disability.
Rapid neuro exam.
Establish pupillary size, reactivity.
Assess level of consciousness (e.g. AVPU, GCS).
What is AVPU?
Assesses level of consciousness:
Alert, Verbal, Pain, Unresponsive.
What should you do before placing a Foley?
Examine prostate and genitalia for injury (mainly, urethral transection).
First perform retrograde urethrogram if suspected.
What are signs of urethral transection?
Blood at the meatus.
High-riding prostate.
Perineal or scrotal hematoma.
What is appropriate initial fluid therapy?
Bolus of < 2L of isotonic crystalloid solution.
Pediatrics: 20 cc/kg.
What is a crystalloid?
Na-based solution that provides transient increase in intravascular space (2/3 quickly distributes to EV and interstitial spaces).
Ex. saline, Ringer’s lactate.
What is a colloid?
Blood product-based solution that remains in intravascular space longer.
Costly, riskier (transfusion rxn, viruses), not superior in volume resuscitation.
Ex. RBCs, albumin.
What is the 3-to-1 rule?
Rough estimate of the total volume of crystalloid needed to replace blood loss.
What is a trauma series?
Radiographs of C-spine, chest, pelvis.
Usually occurs concurrently with early resuscitation.
What are the layers of the scalp?
SCALP. Skin Connective tissue Aponeurosis (galea) Loose areolar tissue Pericranium
How is a galeal laceration treated?
Single-layer, interrupted 3.0 non-absorbable sutures through the skin, subcutaneous tissue and galea.
The brain is partially compartmentalized by reflections of which dural layers?
Falx cerebri
Tentorium cerebelli
Where is CSF produced?
Choroid plexus.
What is the rate of production of CSF?
500 cc/day (150 cc circulating at any given time).
What is CPP?
CPP = cerebral perfusion pressure = MAP - ICP.
What is the Monro-Kellie hypothesis?
The sum of the volume of brain, blood and CSF within the skull must remain constant. (Thus increased ICP may result in cerebral herniation or cessation of cerebral blood flow.)
What is the Cushing reflex?
The brain’s attempt to maintain CPP. May present as hypertension and bradycardia in the setting of increased ICP.
What are indications for a head CT?
Neurologic deficit.
Persisting depression or worsening of mental status.
Moderate/severe mechanism of injury.
Depressed fracture.
Linear fracture overlying dural venous sinus or meningeal artery groove.
After discharge for head trauma, what signs and symptoms should family look out for?
Persistant or worsening headache Dizziness Vomiting Inequality of pupils Confusion
What measures are used to lower ICP?
HIVED: Hyperventilation Intubation w/ pretreatment and sedation Ventriculostomy Elevation of head Diuretics (mannitol, furosemide)
What is the anterior triangle of the neck?
Bordered by midline, posterior border of SCM, mandible.
Contains majority of vital structures of neck.
What is the posterior triangle of the neck?
Bordered by trapezius, posterior border of SCM, clavicle.
Lower zone contains subclavian vessels, brachial plexus, apices of lungs.
What are the anatomical markers for the zones of the neck?
Cricoid cartilage.
Angle of mandible.
What are possible complications of penetrating injuries to the neck?
Exsanguination.
Airway compromise (e.g. hematoma, thyroid cartilage fracture, tracheal cartilage dislocation).
CVA (e.g. transection of carotid, air embolus).
Esophageal injury.
What procedure is performed in event of laryngotracheal separation?
Tracheostomy.
What are indications for surgical exploration in neck trauma?
Expanding hematoma. Subcutaneous emphysema. Tracheal deviation. Change in voice quality. Air-bubbling through wound. Deteriorating vitals.
What exploratory techniques for neck trauma are used in lieu of surgery?
C-spine film and CXR. Arteriography. Esophagogram (water-soluble --> barium). Esophagoscopy. Bronchoscopy. CT.
What region of the spine is most vulnerable?
Cervical.
What are the vertebral regions of the spine?
Cervical (7), Thoracic (12), Lumbar (5), Sacral (5), Coccygeal (4).
At what vertebral level does the spinal cord end?
L2.
What is spinal shock?
State of flaccidity, absent reflexes, absent autonomic control (uninhibited parasympathetic) occurring after spinal injury.
Does signify permanent damage.
What is the difference between a complete and incomplete spinal cord injury?
Complete means no preservation of neurologic function distal to injury. (Note: DTRs and sacral reflexes may be preserved.)
What is sacral sparing?
Preservation of perianal sensation, voluntary sphincter contraction, or voluntary toe flexion in a spinal cord injury.