trauma Flashcards
1
Q
pneumothorax
A
collapsed lung; occurs when air leaks into pleural space
2
Q
primary blast injury
A
direct effects of pressure waves cause injury mainly to HOLLOW ORGANS
3
Q
secondary blast injury
A
results from FLYING DEBRIS striking person
4
Q
tertiary blast injury
A
results from PERSON striking another OBJECT
5
Q
the golden hour
A
first 60 seconds after the occurrence of multi-system trauma; victims chances of survival are greatest if they receive definitive care within the first hour after injury
6
Q
definitive care
A
where problems can be fixed (surgeon, OR)
7
Q
primary survey
A
identify, detect, address life-threatening situations
8
Q
trauma adults vs peds
A
child:
- smaller airway (nose + mouth)
- trachea narrow/softer/more flexible
- tongue occupies larger space
9
Q
nasopharyngeal airway appropriate when…
A
gag reflex intact and no blunt face trauma
10
Q
oropharyngeal airway appropriate when…
A
no gag reflex
11
Q
ABCDE
A
a irway/cervical spine b reathing c irculation d isability e xposure
12
Q
airway for spontaneously breathing patient
A
non-rebreather
13
Q
airway for patient requiring ventilatory assistance
A
bag-valve-mask + appropriate airway adjunct + 100% oxygen
14
Q
airway for significantly impaired consciousness
A
endotracheal tube + mechanical ventilation
15
Q
external hemorrhage
A
usually obvious, best controlled with firm, direct pressure on bleeding site with thick, dry dressing material
16
Q
internal hemorrhage
A
more hidden complication that must be suspected in injured patients or those who present in shock states
17
Q
AVPU
A
a lert
v oice, responsive to
p ain, responsive to
u nresponsive
18
Q
GCS
A
intubate!
19
Q
intraosseous access: humerus has same flow rate as
A
subclavian vessel
20
Q
central line access appropriate for trauma patient when?
A
once patient is stabilized - MUST be done under sterile technique
21
Q
appropriate PRBC for men/women 55+
A
O+
22
Q
appropriate PRBC for peds and women
A
O-
23
Q
coagulopathy
A
abnormalities of clotting
- likely due to activation of protein C pathway; exacerbated by hypothermia
- can be reversed with vitamin K or FFP, but small window of opportunity after injury
- anticoagulants (warfarin) significantly increase risk
24
Q
6 Ps of rapid sequence intubation
A
p reparation / preoxygenate
p remedicate (lidocaine to prevent gag for low ICP)
p aralysis & sedation
p assing the tube
p roof of placement
p ostintubation management
25
preferred method of intubation & why (trauma)
endotracheal tube
- good control of airway
- prevents aspiration
26
cricothyroidotomy
surgical airway when intubation via nose or mouth is not possible.
- higher than tracheostomy
27
shock types 3Ps
hypovolemic - preload
cardiogenic - pump
obstructive - pipes
28
hypovolemic shock
loss of circulating blood, plasma, other bodily fluids
29
hypovolemic shock: causes
- traumatic, thermal injury
- excessive vomiting, diarrhea
- vaginal, GI bleeding
- diuresis
30
hypovolemic shock: treatment goals
- ensure adequate oxygenation, ventilation, perfusion
| - STOP VOLUME LOSS & restore
31
five areas we bleed into
```
chest
abdomen
retroperitoneum
pelvis
long bones/soft tissue
```
32
beware hypocalcemia, how & prevention consideration?
- calcium citrate added to banked blood to prevent clotting
| - consider calcium administration after every 4th unit of PRBCs
33
permissive hypotension
administration of only enough blood volume for vital organ perfusion in order to avoid dislodging clots
- SBP ~90 adequate/permissive
- controversial
34
electrolyte imbalances in hypovolemic shock
- hyperkalemia (cell lysis)
- hypocalcemia (calcium citrate in banked blood)
- acid/base imbalance (liver converts citrate to bicarbonate)
35
deadly triad
acidosis, coagulopathy, hypothermia
36
cardiogenic shock
impaired heart muscle leads to poor pumping action, decreased cardiac output
37
cardiogenic shock: causes
- myocardial infarction
- cardiomyopathy
- severe blunt cardiac injury
38
cardiogenic shock: s/s
- dyspnea
- tachycardia
- hypotension
- rales
- altered mental status
- distended neck veins
39
cardiogenic shock: management
same as heart failure! reduce preload, afterload; support pump
40
obstructive shock
obstruction impairs blood flow in or out of the heart, which leads to decrease in cardiac output - form of cardiogenic shock
41
obstructive shock: causes
tension pneumothorax, cardiac tamponade - 2 largest causes
- pulmonary embolism
- aortic aneurysm
42
obstructive shock: clinical presentation
varies with cause --
- chest, back pain
- distended neck veins
- dyspnea
- tachycardia
- hypotension
- cyanosis
- muffled heart sounds
43
obstructive shock: management
TREAT UNDERLYING CAUSE
- chest decompression
- pericardiocentesis
- embolectomy
- surgical repair
44
distributive shock
occurs in response to reduction in the systemic vascular resistance, mainly due to vasodilation
- NO CHANGE IN VOLUME - just size of vasculature
3 types: neurogenic, septic, anaphylactic
45
neurogenic shock
a type of distributive shock
- loss of vasomotor tone r/t loss of vasomotor sympathetic regulation
- can resolve within 48 hours
46
neurogenic shock: causes
- outflow from vasomotor center inhibited
- parasympathetic response increases, causes vasodilation
- spinal cord injuries at or above T6
47
neurogenic shock: presentation
- bradycardia
- warm, dry skin
- hypotension
- poikilothermia (lose all body temp and adapt to temp of environment
48
poikilothermia
inability to maintain core body temperature independent of ambient temperature (adapt to temp of environment)
- seen in neurogenic shock
49
septic shock
type of distributive shock - loss of vascular tone r/t toxins, invading microorganisms
inflammatory response
50
septic shock: inflammatory response
```
inflammatory response causes
acute vascular, cellular response
- neutrophils migrate to injury site
- VASODILATION
- increased CAPILLARY permeability
- FIBRINOGEN CLOT develops
- MAST CELLS release vasoactive mediators
```
51
septic shock: management
fluid resuscitation, antibiotics, vasopressors, inotropic support
52
shock evaluation: perfusion status
mental status, pulses, BP, UOP
53
poor man's cardiac output
urinary output (no urine = sucky cardiac output)
54
shock evaluation: resolution of anaerobic metabolism
lactate levels!
55
normal lactate range
56
shock evaluation: lactate levels significance
- build up is an indirect measurement of oxygen debt
- - also monitors resuscitation, tissue perfusion
- excess --> metabolic acidosis
57
shock: lactate clearance how?
- all body cells except RBCs can clear
| - via volume resuscitation
58
indirect measurement of oxygen debt
lactate levels
59
one of the most commonly seen minor head injuries
concussion
60
concussion
traumatic reversible deficit with or without temporary loss of consciousness with some amnesia
- lasts minutes to hours
- CT normal
61
concussion: cause
strong, rapid acceleration - deceleration stimulus or sudden blow to skull
62
concussion: s/s
- LOC after injury
- dizziness, headache
- nausea, vomiting
- amnesia, asking same questions over and over
63
secondary impact syndrome
concussion/head injury before first concussion is resolved results in significant longterm complications, cognitive issues
64
hematoma
localized collection of blood outside blood vessels, usually in liquid form within tissue
65
ecchymosis
hematoma > 10 mm
type of purpura
not necessarily caused by trauma
66
bruise
caused by trauma, always
67
purpura
red or purple discoloration of skin that do not blanch when pressure is applied
68
petechia
1 - 2mm spot on skin caused by minor bleed; type of purpura
69
epidural hematoma
collection of blood between skull and dura
- ARTERIAL bleed under high pressure, does not tamponade --> increased ICP
- rapid onset!
70
epidural hematoma: s/s
RAPID!
- initial period of unconsciousness
- lucid interval (classic, not always present): awake then rapid decline to unconsciousness
- pupils: unilateral, fixed, dilated
- paresis, paralysis: contralateral progression to posturing
- cushing's response LATE
71
paresis
weakness of voluntary movement or partial loss of voluntary movement
72
cushing's response
late sign of epidural hematoma, physiological response to increased intracranial pressure
triad:
- systolic hypertension
- irregular breathing
- bradycardia
73
subdural hematoma
collection of VENOUS blood between dura matter and subarachnoid layer of meninges; GRADUAL onset
acute, subacute, chronic
74
subdural hematoma: acute presentation timeframe
75
subdural hematoma: subacute presentation timeframe
2 - 14 days
76
subdural hematoma: chronic presentation timeframe
> 14 days
77
subdural hematoma: acute s/s
- headache, drowsy, confusion
- STEADY decline in LOC
- unilateral pupil dilation + lack of response to light
- contralateral hemiparesis
78
hemiparesis
weakness on one side of body
79
subdural hematoma: chronic s/s
- gradual, non-specific changes
- alteration in mentation
- hemiparesis
- papilledema
- dilated pupil, sluggish to light
80
papilledema
optic disc swelling in response to ICP
81
hematoma treatment x8
- monitor neuro
- manage BP
- elevate HOB to improve venous, CSF return
- quiet environment
- sedation, analgesics, anticonvulsants
- decompression of cranial vault to decrease ICP
- prepare for emergency surgery: clot evacuation or coiling procedure
- maximize O2, ventilation
82
axial loading
direct trauma to head or feet
83
spinal cord injuries common in what age range?
15 - 35yo
84
enopthalmos
posterior displacement of eyeball due to changes in orbit (bone) or muscle
85
nasal trauma common in
children!
86
with nasal trauma, clear drainage or blood tinged drainage should be considered...
CSF
87
malocclusion
wonky shutting teeth
88
neck trauma management tends to be...
surgical evaluation and repair
89
fractures of ribs 10 - 12 associated with...
liver and spleen injuries
90
most frequently injured organ
spleen
| - may be associated with rib fracture or lower left chest trauma
91
Kehr's sign
referred pain to left shoulder from spleen injury
92
kidney injury nota bene
usually occurs with other injuries, not alone
- right kidney lower than left because liver!
- hard to detect since inside retroperitoneal space
93
grey turner's sign
bruising to flanks indicative of kidney injury
94
cullen's sign
bruising around umbilicus due to kidney injury
95
pancreas injury usually associated with
duodenal injury and blunt trauma
| - management is rarely surgical
96
colon injuries mostly due to
penetrating trauma
97
population more prone to stomach trauma
pediatrics
98
common finding in stomach/bowel injury
blood in ng/og aspirate
99
stomach/bowel injury management x2
- surgical! examine entire length because if not fixed, peritonitis
- bowel rest
100
where is the bladder in adults?
pelvis
101
where is the bladder in peds?
abdomen
102
most common bladder injury
extraperitoneal rupture, highly associated with pelvic fracture
- injury at bladder neck, contents spill into peritoneal cavity
103
bladder injury typically due to
blunt trauma
104
extraperitoneal bladder rupture
most common
highly associated with pelvic fracture
pain with urination
105
intraperitoneal bladder rupture
at top of bladder due to increased pressure from bottom
penetrating trauma
hematuria, inability to void
106
urethra classic triad
- inability to void
- blood at urinary meatus
- distended palpable bladder
107
bloody urinary meatus?
DON'T PLACE A DAMN FOLEY
108
second most common cause of death in multi-system trauma patients
pelvic fracture
109
blood loss in pelvic fractures
3L+ loss or more due to injured vessels, typically VENOUS
110
once pelvis examined and determined to be unstable...
DO NOT MANUALLY EXAMINE AGAIN
111
long bone trauma management
```
assess distal CMS
p rotection
r est
i ce
c ompress
e levate
r ehab
```
112
deadly dozen
lethal six
- airway obstruction
- tension pneumothorax
- pericardial tamponade
- open pneumothorax
- massive pneumothorax
- flail chest
hidden six
- thoracic aortic disruption
- pulmonary contusion
- tracheobronchial injuries
- blunt cardiac injury (myocardial contusion)
- diaphragmatic tear
- esophageal injury
113
one of the major causes of trauma fatalities
airway obstruction (lethal six/deadly dozen)
114
tension pneumothorax
tear in visceral pleura allows air to enter potential space, pressure increases, lung collapses
- air rushes into pleural space during inhalation, but can't come out during exhalation
- thoracic structures pushed to opposite side of chest
- obstructive shock: affects cardiac output; this is the difference between tension pneumothorax and plain pneumothorax
115
late sign of tension pneumothorax
tracheal deviation = dead
116
tension pneumothorax s/s
hyperresonance on percussion
tracheal deviation
and all the standards
117
main indication for chest decompression
tension pneumothorax
118
tension pneumothorax: management
- immediate decompression
- chest needle decomp is temporary
- chest tube placement is primary fix
119
pericardial tamponade
develops when tear in pericardial sac and an injury to one of the chambers of the heart or coronary vessels causes blood to collect in potential space
- usually due to penetrating, very rarely due to blunt
120
beck's triad
- jugular distension
- hypotension
- muffled heart sounds
121
pulses paradoxus
radial pulses disappear during inspiration, due to drop in systolic > 10 mmHg
122
pericardial tamponade: s/s
```
beck's triad
pulses paradoxus
ST segment changes
widened mediastinum
pulseless electrical activity
```
123
pulseless electrical activity (PEA)
form of cardiac arrest, s/s of pericardial tamponade
124
pericardiocentesis
- fix for pericardial tamponade
| - QUICKLY! or death due to decreased cardiac output
125
open thoracotomy
- fix for pericardial tamponade
- usually performed in CRASHING patient
- only with PENETRATING trauma
- low survivability rate
126
pericardial tamponade: fixes
- pericardiocentesis (QUICK!)
| - open thoracotomy (crashing/penetrating, low survivability)
127
open pneumothorax
sucking chest wound - occurs when opening from pleural space to outside of chest; air rushes in and increases intrapleural pressure resulting in the collapse of underlying lung tissue
128
open pneumothorax: clinical presentation
penetrating wound with bubbling appearance and sucking sound
129
massive pneumothorax
develop as result of collection of blood in pleural space (>1500mL)
- intercostal vessels most common source
- blunt or penetrating
130
massive pneumothorax: clinical presentation
shocky but FLAT jugular veins
131
shocky but FLAT jugular veins
massive pneumothorax presentation
132
chest tube thoracostomy
insertion of chest tube into pleural cavity to drain air, blood, bile, pus, or other fluids
133
flail chest
multiple rib fractures occurring in 2+ places along rib, resulting in floating segment that moves paradoxically with normal chest wall movement
- impairs oxygenation, ventilation
- classic with blunt trauma, especially steering wheel impact
134
flail chest: management
stabilize flail segment (bulky dressing, hand)
intubation, PEEP
pulmonary toilet
135
pulmonary toilet
procedures to clear mucus, secretions from airways
136
thoracic aortic disruption
results from rapid deceleration event
| - 85 to 90% immediate death, survivors typically due to clot around tear
137
most common site of thoracic aortic disruption
arch where ligamentum arteriosum holds descending aorta in place
138
thoracic aortic disruption: clinical presentation
- DEAD
- upper extremity BP asymmetry
- widened pulse pressure
- loss of distal pulses
- harsh systolic murmur
139
pulmonary contusion
contusion of lung parenchyma resulting from blunt trauma, usually rapid deceleration leading to tissue destruction, hemorrhage, edema
- inflammatory process starts - leukocytes - fibrin clots
- significant cause of ARDS in trauam
140
significant cause of ARDS in trauma
pulmonary contusion
141
pulmonary contusion: clinical presentation
hypercarbia
hemoptysis
crackles
respiratory acidosis
142
pulmonary contusion: management
can't fix, support to allow lungs to heal
| - PEEP: maximize O2 or else acidotic
143
tracheobronchial injuries
results from tear, injury to one of the larger airways in bronchial tree; usually close to carina at bifurcation
- deceleration force, compression injury
- RARE
144
blunt cardiac injury
aka myocardial contusion; blunt trauma (penetrating possible too) directly affecting heart muscle impairs pumping
- force causes hemorrhage, edema, myocyte injury
- results in cell necrosis, scar formation
- right ventricle most common injury site
145
blunt cardiac injury: management
gotta let let body heal itself
- monitor for cardiogenic shock
- NO THROMBOLYTICS
146
diaphragmatic tear: presentation
- seen on CXR
- most commonly left side because right protected by liver
- bowel sounds in chest
- chest pain referred to shoulder
147
esophageal injury: MOI
penetrating - usually. GSW 95%
| blunt - MVC 75 to 80%
148
esophageal injury: diagnosis
difficult to assess! use EGD or esphagogram
| - poor outcome if not identified/corrected!
149
esophageal injury: clinical presentation
- subq air
- mediastinal air
- unexplained fever
