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z Su15 HEHI 2 > trauma > Flashcards

trauma Flashcards

1
Q

pneumothorax

A

collapsed lung; occurs when air leaks into pleural space

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2
Q

primary blast injury

A

direct effects of pressure waves cause injury mainly to HOLLOW ORGANS

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3
Q

secondary blast injury

A

results from FLYING DEBRIS striking person

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4
Q

tertiary blast injury

A

results from PERSON striking another OBJECT

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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

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6
Q

definitive care

A

where problems can be fixed (surgeon, OR)

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7
Q

primary survey

A

identify, detect, address life-threatening situations

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8
Q

trauma adults vs peds

A

child:
- smaller airway (nose + mouth)
- trachea narrow/softer/more flexible
- tongue occupies larger space

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9
Q

nasopharyngeal airway appropriate when…

A

gag reflex intact and no blunt face trauma

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10
Q

oropharyngeal airway appropriate when…

A

no gag reflex

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11
Q

ABCDE

A 
a irway/cervical spine
b reathing
c irculation
d isability
e xposure
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12
Q

airway for spontaneously breathing patient

A

non-rebreather

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13
Q

airway for patient requiring ventilatory assistance

A

bag-valve-mask + appropriate airway adjunct + 100% oxygen

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14
Q

airway for significantly impaired consciousness

A

endotracheal tube + mechanical ventilation

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15
Q

external hemorrhage

A

usually obvious, best controlled with firm, direct pressure on bleeding site with thick, dry dressing material

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16
Q

internal hemorrhage

A

more hidden complication that must be suspected in injured patients or those who present in shock states

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17
Q

AVPU

A

a lert
v oice, responsive to
p ain, responsive to
u nresponsive

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18
Q

GCS

A

intubate!

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19
Q

intraosseous access: humerus has same flow rate as

A

subclavian vessel

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20
Q

central line access appropriate for trauma patient when?

A

once patient is stabilized - MUST be done under sterile technique

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21
Q

appropriate PRBC for men/women 55+

A

O+

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22
Q

appropriate PRBC for peds and women

A

O-

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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
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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

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25
Q

preferred method of intubation & why (trauma)

A

endotracheal tube

  • good control of airway
  • prevents aspiration
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26
Q

cricothyroidotomy

A

surgical airway when intubation via nose or mouth is not possible.
- higher than tracheostomy

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27
Q

shock types 3Ps

A

hypovolemic - preload
cardiogenic - pump
obstructive - pipes

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28
Q

hypovolemic shock

A

loss of circulating blood, plasma, other bodily fluids

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29
Q

hypovolemic shock: causes

A
  • traumatic, thermal injury
  • excessive vomiting, diarrhea
  • vaginal, GI bleeding
  • diuresis
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30
Q

hypovolemic shock: treatment goals

A
  • ensure adequate oxygenation, ventilation, perfusion

- STOP VOLUME LOSS & restore

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31
Q

five areas we bleed into

A 
chest
abdomen
retroperitoneum
pelvis
long bones/soft tissue
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32
Q

beware hypocalcemia, how & prevention consideration?

A
  • calcium citrate added to banked blood to prevent clotting

- consider calcium administration after every 4th unit of PRBCs

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33
Q

permissive hypotension

A

administration of only enough blood volume for vital organ perfusion in order to avoid dislodging clots

  • SBP ~90 adequate/permissive
  • controversial
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34
Q

electrolyte imbalances in hypovolemic shock

A
  • hyperkalemia (cell lysis)
  • hypocalcemia (calcium citrate in banked blood)
  • acid/base imbalance (liver converts citrate to bicarbonate)
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35
Q

deadly triad

A

acidosis, coagulopathy, hypothermia

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36
Q

cardiogenic shock

A

impaired heart muscle leads to poor pumping action, decreased cardiac output

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37
Q

cardiogenic shock: causes

A
  • myocardial infarction
  • cardiomyopathy
  • severe blunt cardiac injury
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38
Q

cardiogenic shock: s/s

A
  • dyspnea
  • tachycardia
  • hypotension
  • rales
  • altered mental status
  • distended neck veins
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39
Q

cardiogenic shock: management

A

same as heart failure! reduce preload, afterload; support pump

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40
Q

obstructive shock

A

obstruction impairs blood flow in or out of the heart, which leads to decrease in cardiac output - form of cardiogenic shock

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41
Q

obstructive shock: causes

A

tension pneumothorax, cardiac tamponade - 2 largest causes

  • pulmonary embolism
  • aortic aneurysm
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42
Q

obstructive shock: clinical presentation

A

varies with cause –

  • chest, back pain
  • distended neck veins
  • dyspnea
  • tachycardia
  • hypotension
  • cyanosis
  • muffled heart sounds
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43
Q

obstructive shock: management

A

TREAT UNDERLYING CAUSE

  • chest decompression
  • pericardiocentesis
  • embolectomy
  • surgical repair
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44
Q

distributive shock

A

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

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45
Q

neurogenic shock

A

a type of distributive shock

  • loss of vasomotor tone r/t loss of vasomotor sympathetic regulation
  • can resolve within 48 hours
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46
Q

neurogenic shock: causes

A
  • outflow from vasomotor center inhibited
  • parasympathetic response increases, causes vasodilation
  • spinal cord injuries at or above T6
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47
Q

neurogenic shock: presentation

A
  • bradycardia
  • warm, dry skin
  • hypotension
  • poikilothermia (lose all body temp and adapt to temp of environment
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48
Q

poikilothermia

A

inability to maintain core body temperature independent of ambient temperature (adapt to temp of environment)
- seen in neurogenic shock

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49
Q

septic shock

A

type of distributive shock - loss of vascular tone r/t toxins, invading microorganisms

inflammatory response

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50
Q

septic shock: inflammatory response

A 
inflammatory response causes 
acute vascular, cellular response
- neutrophils migrate to injury site
- VASODILATION
- increased CAPILLARY permeability
- FIBRINOGEN CLOT develops
- MAST CELLS release vasoactive mediators
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51
Q

septic shock: management

A

fluid resuscitation, antibiotics, vasopressors, inotropic support

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52
Q

shock evaluation: perfusion status

A

mental status, pulses, BP, UOP

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53
Q

poor man’s cardiac output

A

urinary output (no urine = sucky cardiac output)

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54
Q

shock evaluation: resolution of anaerobic metabolism

A

lactate levels!

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55
Q

normal lactate range

A
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56
Q

shock evaluation: lactate levels significance

A
  • build up is an indirect measurement of oxygen debt
    • also monitors resuscitation, tissue perfusion
  • excess –> metabolic acidosis
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57
Q

shock: lactate clearance how?

A
  • all body cells except RBCs can clear

- via volume resuscitation

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58
Q

indirect measurement of oxygen debt

A

lactate levels

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59
Q

one of the most commonly seen minor head injuries

A

concussion

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60
Q

concussion

A

traumatic reversible deficit with or without temporary loss of consciousness with some amnesia

  • lasts minutes to hours
  • CT normal
61
Q

concussion: cause

A

strong, rapid acceleration - deceleration stimulus or sudden blow to skull

62
Q

concussion: s/s

A
  • LOC after injury
  • dizziness, headache
  • nausea, vomiting
  • amnesia, asking same questions over and over
63
Q

secondary impact syndrome

A

concussion/head injury before first concussion is resolved results in significant longterm complications, cognitive issues

64
Q

hematoma

A

localized collection of blood outside blood vessels, usually in liquid form within tissue

65
Q

ecchymosis

A

hematoma > 10 mm
type of purpura
not necessarily caused by trauma

66
Q

bruise

A

caused by trauma, always

67
Q

purpura

A

red or purple discoloration of skin that do not blanch when pressure is applied

68
Q

petechia

A

1 - 2mm spot on skin caused by minor bleed; type of purpura

69
Q

epidural hematoma

A

collection of blood between skull and dura

  • ARTERIAL bleed under high pressure, does not tamponade –> increased ICP
  • rapid onset!
70
Q

epidural hematoma: s/s

A

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
Q

paresis

A

weakness of voluntary movement or partial loss of voluntary movement

72
Q

cushing’s response

A

late sign of epidural hematoma, physiological response to increased intracranial pressure

triad:
- systolic hypertension
- irregular breathing
- bradycardia

73
Q

subdural hematoma

A

collection of VENOUS blood between dura matter and subarachnoid layer of meninges; GRADUAL onset

acute, subacute, chronic

74
Q

subdural hematoma: acute presentation timeframe

A
75
Q

subdural hematoma: subacute presentation timeframe

A

2 - 14 days

76
Q

subdural hematoma: chronic presentation timeframe

A

> 14 days

77
Q

subdural hematoma: acute s/s

A
  • headache, drowsy, confusion
  • STEADY decline in LOC
  • unilateral pupil dilation + lack of response to light
  • contralateral hemiparesis
78
Q

hemiparesis

A

weakness on one side of body

79
Q

subdural hematoma: chronic s/s

A
  • gradual, non-specific changes
  • alteration in mentation
  • hemiparesis
  • papilledema
  • dilated pupil, sluggish to light
80
Q

papilledema

A

optic disc swelling in response to ICP

81
Q

hematoma treatment x8

A
  • 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
Q

axial loading

A

direct trauma to head or feet

83
Q

spinal cord injuries common in what age range?

A

15 - 35yo

84
Q

enopthalmos

A

posterior displacement of eyeball due to changes in orbit (bone) or muscle

85
Q

nasal trauma common in

A

children!

86
Q

with nasal trauma, clear drainage or blood tinged drainage should be considered…

A

CSF

87
Q

malocclusion

A

wonky shutting teeth

88
Q

neck trauma management tends to be…

A

surgical evaluation and repair

89
Q

fractures of ribs 10 - 12 associated with…

A

liver and spleen injuries

90
Q

most frequently injured organ

A

spleen

- may be associated with rib fracture or lower left chest trauma

91
Q

Kehr’s sign

A

referred pain to left shoulder from spleen injury

92
Q

kidney injury nota bene

A

usually occurs with other injuries, not alone

  • right kidney lower than left because liver!
  • hard to detect since inside retroperitoneal space
93
Q

grey turner’s sign

A

bruising to flanks indicative of kidney injury

94
Q

cullen’s sign

A

bruising around umbilicus due to kidney injury

95
Q

pancreas injury usually associated with

A

duodenal injury and blunt trauma

- management is rarely surgical

96
Q

colon injuries mostly due to

A

penetrating trauma

97
Q

population more prone to stomach trauma

A

pediatrics

98
Q

common finding in stomach/bowel injury

A

blood in ng/og aspirate

99
Q

stomach/bowel injury management x2

A
  • surgical! examine entire length because if not fixed, peritonitis
  • bowel rest
100
Q

where is the bladder in adults?

A

pelvis

101
Q

where is the bladder in peds?

A

abdomen

102
Q

most common bladder injury

A

extraperitoneal rupture, highly associated with pelvic fracture
- injury at bladder neck, contents spill into peritoneal cavity

103
Q

bladder injury typically due to

A

blunt trauma

104
Q

extraperitoneal bladder rupture

A

most common
highly associated with pelvic fracture
pain with urination

105
Q

intraperitoneal bladder rupture

A

at top of bladder due to increased pressure from bottom
penetrating trauma
hematuria, inability to void

106
Q

urethra classic triad

A
  • inability to void
  • blood at urinary meatus
  • distended palpable bladder
107
Q

bloody urinary meatus?

A

DON’T PLACE A DAMN FOLEY

108
Q

second most common cause of death in multi-system trauma patients

A

pelvic fracture

109
Q

blood loss in pelvic fractures

A

3L+ loss or more due to injured vessels, typically VENOUS

110
Q

once pelvis examined and determined to be unstable…

A

DO NOT MANUALLY EXAMINE AGAIN

111
Q

long bone trauma management

A 
assess distal CMS
p rotection
r est
i ce
c ompress
e levate
r ehab
112
Q

deadly dozen

A

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
Q

one of the major causes of trauma fatalities

A

airway obstruction (lethal six/deadly dozen)

114
Q

tension pneumothorax

A

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
Q

late sign of tension pneumothorax

A

tracheal deviation = dead

116
Q

tension pneumothorax s/s

A

hyperresonance on percussion
tracheal deviation

and all the standards

117
Q

main indication for chest decompression

A

tension pneumothorax

118
Q

tension pneumothorax: management

A
  • immediate decompression
  • chest needle decomp is temporary
  • chest tube placement is primary fix
119
Q

pericardial tamponade

A

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
Q

beck’s triad

A
  • jugular distension
  • hypotension
  • muffled heart sounds
121
Q

pulses paradoxus

A

radial pulses disappear during inspiration, due to drop in systolic > 10 mmHg

122
Q

pericardial tamponade: s/s

A 
beck's triad
pulses paradoxus
ST segment changes
widened mediastinum
pulseless electrical activity
123
Q

pulseless electrical activity (PEA)

A

form of cardiac arrest, s/s of pericardial tamponade

124
Q

pericardiocentesis

A
  • fix for pericardial tamponade

- QUICKLY! or death due to decreased cardiac output

125
Q

open thoracotomy

A
  • fix for pericardial tamponade
  • usually performed in CRASHING patient
  • only with PENETRATING trauma
  • low survivability rate
126
Q

pericardial tamponade: fixes

A
  • pericardiocentesis (QUICK!)

- open thoracotomy (crashing/penetrating, low survivability)

127
Q

open pneumothorax

A

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
Q

open pneumothorax: clinical presentation

A

penetrating wound with bubbling appearance and sucking sound

129
Q

massive pneumothorax

A

develop as result of collection of blood in pleural space (>1500mL)

  • intercostal vessels most common source
  • blunt or penetrating
130
Q

massive pneumothorax: clinical presentation

A

shocky but FLAT jugular veins

131
Q

shocky but FLAT jugular veins

A

massive pneumothorax presentation

132
Q

chest tube thoracostomy

A

insertion of chest tube into pleural cavity to drain air, blood, bile, pus, or other fluids

133
Q

flail chest

A

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
Q

flail chest: management

A

stabilize flail segment (bulky dressing, hand)
intubation, PEEP
pulmonary toilet

135
Q

pulmonary toilet

A

procedures to clear mucus, secretions from airways

136
Q

thoracic aortic disruption

A

results from rapid deceleration event

- 85 to 90% immediate death, survivors typically due to clot around tear

137
Q

most common site of thoracic aortic disruption

A

arch where ligamentum arteriosum holds descending aorta in place

138
Q

thoracic aortic disruption: clinical presentation

A
  • DEAD
  • upper extremity BP asymmetry
  • widened pulse pressure
  • loss of distal pulses
  • harsh systolic murmur
139
Q

pulmonary contusion

A

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
Q

significant cause of ARDS in trauma

A

pulmonary contusion

141
Q

pulmonary contusion: clinical presentation

A

hypercarbia
hemoptysis
crackles
respiratory acidosis

142
Q

pulmonary contusion: management

A

can’t fix, support to allow lungs to heal

- PEEP: maximize O2 or else acidotic

143
Q

tracheobronchial injuries

A

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
Q

blunt cardiac injury

A

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
Q

blunt cardiac injury: management

A

gotta let let body heal itself

  • monitor for cardiogenic shock
  • NO THROMBOLYTICS
146
Q

diaphragmatic tear: presentation

A
  • seen on CXR
  • most commonly left side because right protected by liver
  • bowel sounds in chest
  • chest pain referred to shoulder
147
Q

esophageal injury: MOI

A

penetrating - usually. GSW 95%

blunt - MVC 75 to 80%

148
Q

esophageal injury: diagnosis

A

difficult to assess! use EGD or esphagogram

- poor outcome if not identified/corrected!

149
Q

esophageal injury: clinical presentation

A
  • subq air
  • mediastinal air
  • unexplained fever

z Su15 HEHI 2 (4 decks)

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