Trauma Flashcards
What is triphasic dz?
1) sec to min - death d/t major or severe injuries
2) min to hrs - death d/t treatable but life threatening injuries
3) days to wk - death d/t multiple organ system failure/infxn
What is the fatal triad?
hypothermia
coagulopathy
acidosis
What is the primary survey?
ABCDE
What is secondary survey?
a finger in every orfice
procedures
head to to exam
What is tertiary survey?
f/u w/in 24hrs
What do you use FAST?
unstable pt in ED
What are initial xrays?
Cpsine
CXR
pelvi
When to use CT scans?
CTA of chest and other vascular injuries
What to watch out for in head injuries?
one ep of systolic BP less than 70
What is GCS for intubation?
8
What to look for w/ scalp injuries?
basilar skull fx - battle sign, hemotympanum, raccoon eyes
What is cushing reflex? What does this indicate? vs cushing triad?
slow HR but high BP
thalamic injury
triad: slow HR, high BP, widening pulses - incr diff between systolic and diastolic
How to tx ICP?
HYPERtonic saline mannitol HYPERventilation chemical parlysis - to reduce cerebral O2 demand surgical procedures
What must be r/o in eye trauma?
ruptured globe
orbital fracutre
EOM entrapment
What is retrobulbar hematoma? Tx?
complication of eye and eyelid surgery (orbital compartment sx)
tx: lateral canthotomy
What to consider for face trauma?
unstable midface = LeFort fx
mandible fx
When can you r/o C spine fx?
NEXUS rules:
- no midline tenderness
- no neurologic deficits
- no intoxicants
- no distracting injury
- normal mental status
What is chance fracture?
complete anterior-posterior spinal fx
What is associated with chance fracture?
mesenteric or bowel injury
Wht are vascular neck injuries?
external hemorrhage
rapidly expanding hematoma
bruit
palpable thrill
Young adult w/ sudden CVA sx? Tx?
carotid artery dissection
tx: anticoag to prevent embolic stroke
Cx of aortic disruption? Tx?
rapid deceleration - occurs at the ligamentum arteriosum
tx: surgery asap
Aortic disruption - imaging?
widening mediastinum
apical capping
tracheal displacement
Open pneumothorax vs tension pneumothorax?
open: no air movement
tension: one way valve injury
What are late signs of tension pneumothorax?
JVD and tracheal deviation
How to tx open vs tension pneumo?
open: cover hole w/ 3 sides
tension: needle decompression
Pt has PEA, what to think of?
pericardial tamponade
What to think of w/ splenectomy or grade III laceration?
immunization against:
h flu
menigococcus
pneumoccus
How is the liver injured in trauma?
cracks then BREAKS - NO rupture
Pt is hypotensive, low urine output, firm abdomen, and high bladder pressure (30)? Tx?
abdominal compartment sx
laparotomy
What labs to run if pt fell from ht?
ENTIRE spine + bilateral calcanei
How to tx open fx?
abx
triple abx if gross or farm injury
How to tx clavicle fx?
surgery
Where can adult blood vol be lost? half of the blood vol?
whole blood vol: pelvic fx
half blood vol: femur
How to tx pelvic fx?
close the book
Blood at meatus, high riding prostate, perineal ecchymosis? What to check for first?
urethral injury
1) retrograde urethrogram
2) urinary catheter
What ABI needs further check up?
less than 0.9
Pt has petechial rash, confusion, hypoxia, bilateral pulm infiltrates, microfat in urine?
fat emobli from extremity injury
What are trauma complications? Sx? Tx?
compartment sx P-allor P-ulslessnes - late finding P-arathesis P-aralysis P-ain out of proportion tx: fasciotomy
In what areas can pts bleed to death?
C-hest A-bdomen R-Retroperitoneum T-high S-treet/S-cene
What emboli to worry about in extremity injury?
fat emboli
What are the fluid types?
cyrstalloid
colloid
blood/products
What is the ratio for fluids?
1:1:1
How to tx ped trauma re: fluids?
1) 10-20ml/kg bolus x 2
2) blood products
How to tx pregnant pt in trauma?
treat the mother = save the fetus
-prop the mom up to get off the vena cava
What are the stages of shock?
early
late
irreversible
What haps in early shock?
normotesnive
tachycardi
tachypnea
What haps in late shock?
hypotensive
tahcy cardi
tahcypnea
What is irreversible shock?
ypotensive
HR drops
RR drops
What are the types of shock?
distributive
obstructive
cardiogenic
What is distributive shock?
septic
neurogenic
anaphylactic
adrenal
What are obstructive shock?
PE
tamponade
constrictive pericaditis
What is the equation for BP?
CO x SVR
-CO depends on preload, afterload, an dcontractility
Low SVR sx?
distributive shock
pink, warm bounding pulses
High SVR sx?
low CO = pale, cool, thready puslses
Sx for hypovolemic shock?
dec CO, Cardiovenous pressure
incr SVR
Sx for cadiogenic shock?
Dec CO, LV stroke vol
incr SVR
Sx for neurogenic shock?
paralysis of sympathetic shock = dec SVR, bradycardia, hypotension
pink/warm
How to tx neurogenic shock?
vasopressors
O2
What are the stages of septic shock?
1) SIRS
2) sepsis - infxn
3) severe sepsis - organ failure
4) shock - hypotension
How to tx septic shock?
iv
abx
vasopressor
transfusions
