Trauma Flashcards
AMPLE history for trauma
Allergies, meds, pregnancy/PMH, last meal, events surrounding mechanism of injury
ABCDEF of trauma
Airway, breathing, circulation, disability, exposure/environmental control, Foley
What procedure is used if unable to intubate airway?
Cricothyroidotomy
What size is considered a large bore IV?
14 or 16 gauge
When should OGT (oral gastric tube) be placed rather than NGT?
When fx of cribriform is suspected
What is the “3 to 1” rule?
Rough estimate for how many liters of crystalloid are needed to replace one liter of lost fluid
Four types of hemorrhagic shock
How should type IV hemorrhagic shock be treated?
2 L saline followed by uncrossed (O negative) blood immediately. Death is imminent.
What is FAST?
Focused abdominal sonogram for trauma. Looks at RUQ, LUQ, pelvis, and cardiac views. Most common area for blood to pool is the hepato-renal space (pouch of Morison).
What are the five layers of the scalp?
Mneomonic is SCALP:
Skin, connective tissue, aponeurosis (galea), loose areaolar tissue, pericranium
Do you give abx ppx in simple scalp lacerations?
no
What CN runs along the edge of the tentorium cerebelli?
CN 3
Equation for cerebral perfusion pressure (CPP)
CPP = MAP - ICP
What is Cushing reflex?
HTN and bradycardia in s/o increased ICP. The brain’s effort to maintain CPP.
Glasgow coma scale
What is severe vs. moderate vs. mild head injury according to the GCS?
Severe: 8 or less
Moderate: 9-13
Mild: 14-15
Basilar skull fracture features
- Sign of very signficant mechanism of injury
- May have raccoon eyes, retruauricular ecchymoses (Battle’s sign), otorrhea, rhinorrhea, hemotympanum, CN palsies
What is the ring test for CSF rhinorrhea?
Take a sample of blood from the epistaxis and place on filter paper. If CSF present, a large transparent ring will be seen encircling a clot of blood.
Epidural hematoma
lens-shaped (convex) bleed; tearing of middle meningeal artery common. Classically have “lucid interval” and then go down hard
Subdural hematoma
Concave bleed; better prognosis in elderly due to brain atrophy. Can be acute, subacute, or chronic.
Management of severe head trauma
- ABC’s, intubation
- Maintain adequate BP with fluids
- Decrease ICP
- Mannitol (osmotic diuretic to draw fluid out of brain)- can’t use in hypotensive pt
- Hyperventilation
- Elevate head of bed
- Consider seizure ppx with phenytoin. Tx seizures with lorazepam or diazepam and phenytoin
- Ventriculostomy (burr hole) used to measure ICP
- Drain hematoma if present
Anterior and posterior triangles of neck
Three zones of the neck
How should you manage the airway of someone with laryngo-tracheal separation?
Tracheostomy
What type of injury can cause an anterior cord syndrome?
flexion injury
What area of spine is most commonly injured?
C spine
Thoracolumbar junction also fairly vulnerable
Indications for C-spine x-rays?
- Tenderness along C-spine
- Neuro deficit or altered sensorium
- Good mechanism of injury
- Distracting injury present
What type of injury might cause central cord syndrome?
Hyperextension e.g. whiplash
Atlanto-occipital dislocation
Results from severe traumatic flexion. Survival to hospital setting is rare.
Jefferson fracture
C1 (atlas) burst fracture
- Most common C1 fracture
- Happens with axial loading, e.g. patient falls right on head, or something falls right on the patient’s head
C1 rotatory subluxation
Most commonly in children, or adults with RA. Patients present with head rotated- don’t force it back into place!
Hangman’s fracture
Fracture of both C2 pedicles, usu due to hyperextension. Unstable fx but not usu spinal cord injury because spinal cord so wide at C2.
Burst fx of C3-7
Axial loading mechanism -> compression of vertebral body with protrusion of anterior portion of vertebral body anteriorly, and protrusion of posterior portion of vertebral body posteriorly
Can cause anterior cord syndrome
Simple wedge fracture
Flexion injury causing compression of anterior portion of vertebral body. Usually stable unless there is ligamentous damage.
Flexion teardrop fracture
Flexion injury caused fx of anteroinferior portion of vertebral body, ends up looking lik teardrop-shaped fragment. Unstable fx assoc with neurologic damage.
Extension tear drop fx
Same idea, but the mechanism is extension causing avulsion rather than compression. In contrast to flexion teardrop fx, this one is stable. But, hard to tell apart from the other one so treat both tthe same initially.
Clay shoveler’s fracture
Caused by either flexion or direct blow -> avulsion of tip of the spinous process, usually C7, C6, or T1
Unilateral facet dislocation
Flexion-rotation injury. Usually stable
Bilateral facet dislocation
Flexion injury. Extremely unstable, high incidence of spinal cord injury.
Subluxation of C-spine
Occurs with disruption of the ligamentous structure without bony involvement
Thoracic spine fractures
- Not very common due to stability from rib cage
- When they do occur, they are devastating because spinal cord is narrow here AND it is a watershed region for blood supply
Artery of Adamkiewicz
Greater radicular artery of Adamkiewicz. Enters spinal canal at L1; provides blood as high as T4. Arises from left intercostal artery and provides blood via the anterior spinal artery to the lower 2/3 of spinal cord.
What are the most common sites for fx in the thoracolumbar junction/lumbar spine region?
L1 > L2 > T1
Distraction or seat belt injury, aka Chance fracture
Horizontal fx through the vertebral body, spinous processes, laminae, pedicles, and tearing of the posterior spinous ligament. Caused by accel-decel injury as in a person in seat belt in MVA.
Sacral spine fractures
Pretty uncommon. If damage to sacral nerve occurs -> bowel/bladder/sexual dysfunction. Loss of sensory/motor function of LE
Coccygeal spine fracture
Fracture of coccyx evidence as “step-off” on rectal exam. Must r/o rectal bleeding 2/2 recal tear. Tx is symptomatic, doughnut pillow.
