Trauma Flashcards

Question

Chronic subdural

Answer 1

Older patients or alcoholics Shrunken brain = stretched veins. Tearing of bridging veins from minor trauma or an old trauma maybe weeks ago. HA then progressive dementia. Dx: CT (crescent shaped) Tx: Craniotomy This is why all patients with dementia should get a CT

Answer 2

Could just be chronic subdural hematoma

Answer 3

Hyperventilation Raise head of bed Mannitol

Answer 4

Sports injury LOC Amnesia (retrograde) CT is normal Tx: Go home but only if patient has family to keep them up. Keep them awake for 24 hrs

Answer 5

Patient who had angular trauma like a car accident where car spun a lot Presents with coma CT shows blurring of grey-white junction Tx = pray

Answer 6

Zone 1 = lowest. Below cricoid and above clavicle (most conservative) Zone 2 = middle (lots of surgery here) Zone 3 = above angle of mandible (some surgery)

Answer 7

All cases where there is: Expanding hematoma Deteriorating vitals Clear signs of esophageal or tracheal injury (coughing or spitting blood) GSW to middle neck

Answer 8

surgery always

Answer 9

Arteriography, esophagogram (water soluble then barium if negative), esophogoscopy, and bronchoscopy before surgery to decide approach

Answer 10

Arteriogram. If abnormal then surgery

Answer 11

Arteriogram and U/S Looking for expanding hematoma or active bleeding

Answer 12

Blood supply is hard to control in these regions.

Answer 13

Pain and temperature. lateral spinal cord, anterior Crosses over before ascending

Answer 14

Vibration/Position Dorsal, medial Crosses over in brainstem

Answer 15

Upper extremity more medial than lower extremity. Lateral spinal cord.

Answer 16

Patient with FND - ED, urine/fecal incont, erection that doesn't stop Dx = MRI Initial trauma doesn't do the damage. It's the edema around it. Therefore, you can really skip the MRI and just give them dexamethasone (decadron)

Answer 17

At the site of the lesion you lose LMNs - paralysis Below the site you lose UMNs - upgoing Babinsky and hyperreflexia All sensory is lost and all pain/temp is lost. Basically nothing works below the lesion

Answer 18

Ipsilateral loss of motor and sensory (vib/position) Contralateral loss of pain/temp Sharp knife trauma

Answer 19

Burst fractures of the vertebral bodies. Loss of motor function and loss of pain/temp on both sides distal to injury Preserved vibration/position sense

Answer 20

Patient is elderly with forced hyperextension of the neck (rear-end collision). There is paralysis and burning pain in upper extremities with preserved functions in lower extremities Sort of like syrinx - cape-like distribution. May expand to include ALS.

Answer 21

MRI: CT is easier to do if we only need to see bones. Some think high dose steroids right after the injury may help

Answer 22

Usually seen with penetrating thoracic trauma, but blunt can cause it too. Tachycardia, muffled heart sounds, JVD, hypotension and electrical alternans on ECG (alternating heights of R in QRS complexes) Dx with cardiac U/S as part of FAST Requires immediate decompression via needle pericardiocentesis, pericardial window or thoracotomy with manual decompression Clinically apparent tamponade may result from 60-100ml of blood

Answer 23

Usually secondary to MVAs, fall from heights, crush injury, blast injury, direct violent trauma Get a screening ECG

Answer 24

anterior and parallel to phrenic nerve (longitudinally)

Answer 25

Can be from penetrating trauma or blunt trauma that caused a rib fracture Air in pleural space Usually asymptomatic. Maybe Chest pain. Dyspnea Hyperresonance of affected side Decreased breath sounds of affected side Dx: upright CXR - absence of lung markings where the lung has collapsed. Vertical lung shadow. Tx: Tube thoracostomy in upper lung. Confirm placement with CXR

Answer 26

Air enters pleural space and cannot escape. Causes total ipsilateral lung collapse and mediastinal shift, impairing venous return and thus decreasing cardiac output resulting in shock Same signs as pneumothorax PLUS tracheal deviation away from affected side Dx should be clinical - don't wait on the CXR to start treatment Tx: immediate needle decompression followed by tube thoracostomy

Answer 27

Dyspnea Dullness to percussion Reduced breath sounds Lung compressed upward so there is an air-fluid level. Dx: CXR shows horizontal air-fluid level Tx: Thoracostomy in lower lung. We need to figure out if bleed is from peripheral or pulmonary artery. Pulm vasculature is lower pressure and stops on its own. Look at chest tube output - If 1500cc initial drainage OR 600cc in 6hrs go to surgery (thoracotomy) 25% of hemothorax cases have associated pneumothorax 75% of hemothorax cases are associated with extrathoracic injuries

Answer 28

1500cc initial drainage from chest tube 200cc/hr for 4hrs continued drainage - Thoracic great vessel injury - Esophageal injury - Patients who decompensate after initial stabilization

Answer 29

ONLY from penetrating trauma from the outside (not ribs) Breathe in: air enters Exhale: flap closes. Air gets stuck May get a tension pneumo Pt = trauma, dyspnea, tension pneumo Dx: Visual inspection Tx: Occlusive dressing taped on 3 sides to create our own valve. THEN chest tube to drain whatever air is left.

Answer 30

Blunt trauma usually Can induce ANY of the penetrating traumas CP that makes them splint - won't breathe much. Reduced breathing leads to higher risk for atelectasis and pneumonia ``` Dx = CXR Tx = pain control (avoid tons of opiates) balanced with breathing ```

Answer 31

Flail chest is an indication for looking for problems inside the chest HUGE blunt trauma - requires 2+ ribs broken in 2+ places Paradoxical movement ``` Dx = visual inspection and CXR Tx = weights/binders to align it. Maybe surgical placement of a plate ```

Answer 32

Flail chest Sternal fracture Scapular fracture Investigate for: Aortic dissection, pulmonary contusion and myocardial contusion

Answer 33

Get CXR - normal initially. All of a sudden the pt gets dyspnea and pulm edema Takes 48h from trauma for CXR to show b/l whiteout This is a non-cardiogenic pulmonary edema - a lot like ARDS Tx = avoid crystalloids. Give colloids BUT really we treat with PEEP (push fluid back into leaky capillaries)

Answer 34

Dx: prophylactic EKG and troponin Tx: Control HF and arrythmias with MONA BASH

Answer 35

High speed MVAs. Torn at ligamentum arteriosum due to inertia Patient is either DOA (total tear) or if tear is incomplete there is an adventitial hematoma Dx: CXR - This determines index of suspicion - If widened mediastinum, tearing CP radiating to back or dif BPs on exam then index is very high. THEN do CT. If index is high and CT is negative do angiogram. If index is low and CT negative stop. Tx = surgical repair. Get systolic BP as low as you can first.

Answer 36

ecchymotic area found in distribution of lower anterior abdominal wall and can be associated with perforation of bladder or bowel as well as lumbar distraction fracture (Chance Fracture)

Answer 37

Periumbilical ecchymosis is indicative of intraperitoneal hemorrhage

Answer 38

Flank ecchymosis indicative of retroperitoneal hemorrhage

Answer 39

L shoulder or neck pain secondary to splenic rupture Increases in trandelenburg position or with LUQ palpation Caused by irritation of diaphragm

Answer 40

All go to ex-lap

Answer 41

If you see: Evisceration Peritoneal signs Shock GO TO EX-LAP If you probe the wound and cannot enter peritoneum then watch/wait. If you can enter then GO TO EX-LAP

Answer 42

``` Head = 50cc Chest = 500cc Abdomen = 1500cc Pelvis = 2000cc Thighs = 1000cc each Ankles = 200cc each Arms = 100cc each Forearms = 50cc each ``` Anything below nipple and above knee then can kill you

Answer 43

We need to know if patient is bleeding or not Get FAST or CT If bleeding then Ex-Lap

Answer 44

Positive if free fluid is demonstrated in abdomen 4 views used to search for free fluid (presumed to be blood in trauma patient) that collects in dependent areas and appears as hypoechoic on US 1) Morrison's pouch (RUQ) - btw liver and kidney 2) Splenorenal recess (LUQ) - btw spleen and kidney 3) Pouch of Douglas - above rectum "bladder view" 4) Subxiphoid and parasternal views - looks for hemopericardium

Answer 45

Pros: Fast, noninvasive, 80-95% sensitive for intra-abdominal blood Cons: user dependent, low specificity for individual organ injury

Answer 46

CVP line or CP placement Intra-aortic balloon pump placement Overinflation of Swan-Ganz

Answer 47

90% die at scene another 50% die within 24h

Answer 48

Absent/low upper extremity pulses and BP Increased lower extremity pulses

Answer 49

#1 = ruptured liver - ligamentum teres tears from inertia - Tx = repair or lobectomy. Can do pringle (grab hepatoduodenal ligament and cut off hepatic artery/portal vein) Ruptured spleen - massive bleed - has a capsule so repair is pretty easy - if you can fix it save it - if not sacrifice it - remember to vaccinate against encapsulated organisms Ruptured diaphragm - BS in thorax - Kehr's sign - Get CXR - Tx = surg

Answer 50

Major MVA/Fall to break a pelvis Use hip-rocking maneuver - will always be broken in 2 places. Can move it in 2 directions at once with extreme pain Look for urethral injuries - high riding prostate, blood at meatus. Get an IV pyelogram and avoid foley. May require prophylactic protoscopy to rule out rectal injury Dx = CT (the same one we got during FAST) Tx = give them blood and track H/H Do NOT operate. Let the hip heal first.

Answer 51

Pulmonary contusion.

Answer 52

Like a sunburn Erythema, warm, tender No blisters

Answer 53

Erythema, warm, tender Blisters

Answer 54

Deeper than dermis (into fascia or muscle) Painless Surrounded by 2nd degree burns White/charred lesions

Answer 55

Alkali or acidic Alkali are worse Either on the skin - never buffer. just irrigate a ton OR swallowed - never vomit. CAN buffer here bc it's in stomach

Answer 56

Closed fire/explosion Chemicals/smoke inhaled and may burn larynx. Eventual edema can block the airway Look for soot on nostrils/mouth Dx = bronchoscopy Tx = intubation

Answer 57

Lightning strikes or touching high voltage wires Entrance and exit wounds Can cause arrhythmias Can burn muscle in contact with bone (bones conduct electricity well). This can cause rhabdo. Can act on nerves as well and generate muscle contractions that can cause posterior dislocation of shoulder Dx = check CK. If positive get creatinine Tx = IVF and mannitol

Answer 58

No matter the source Initially blood vessel is patent. THEN cut off by eschar Watch for signs of vascular compromise. ``` Dx = clinical Tx = cut the eschar at bedside (it's 3rd degree so it won't hurt) ```

Answer 59

Tells us how much fluid we need to give burn patients (%BSA involved)(kg body weight)(4cc) = fluids lost Add that number of cc's of LR to 2000cc of D5W Replace the total as: 50% in first 8hrs. 50% in next 16hrs.

Answer 60

ONLY count 2nd/3rd degree burns ``` Whole head = 9% Chest front = 9% Upper back = 9% Abdomen front = 9% Lower back = 9% Leg front = 9% x 2 Leg back = 9% x 2 Arm = 9% x 2 ``` Total = 99% Genitalia = 1%

Answer 61

Animal bite... was it a wild animal? Wild: Capture it and kill it. Look at its brain. If you see signs of rabies or you couldnt catch the animal then vaccinate (vaccine + IgG) Domestic: Observe the animal. If you see signs of rabies then vaccine + IgG If never see signs of rabies then nothing needs to be done

Answer 62

Anaphylaxis? Yes: SubQ Epi 1:1000 + H1/H2 blockers No: remove stinger

Answer 63

Signs it's venomous: slit-like eyes, cobra cowl, rattlers Patient will have skin changes, erythema and lots of PAINNN if it's venomous. ``` Dx = clinical Tx = anti-venom ```

Answer 64

Pt has bite and abdominal pain OR enzymatic evidence of pancreatitis** ``` Dx = it's pretty much too late Tx = IVF and IV Calcium to treat the pancreatitis ```

Answer 65

Attic. Old boxes. Southern USA. Starts off with small dot of erythema Progresses to necrotic ulcer with ring of erythema ``` Dx = clinical Tx = debridement over and over. Skin grafting when toxin has resolved ```

Answer 66

WORST ONE Sex act or fist fight Shady story Dx = clinical and shady story Tx = Debride, explore wound and irrigate a ton THEN give Abx (amoxicillin or augmentin)