trauma

Question 1

GCS

Answer 1

eye 4verbal 5motor 6best 15coma 8no resp 3

Question 2

pulses + BP correlation

Answer 2

Radial (BP 80mmHg)Femoral (BP 70mmHg)Carotid (BP 60mmHg)

Question 3

tachycardia + blood loss

Answer 3

(130’s-140’s) – 750-1000cc blood loss

Question 4

hypotension + blood loss

Answer 4

500-2000cc blood loss

Question 5

basilar skull fracture key signs

Answer 5

raccoon eyes (periorbital ecchymosis) - anterior fossabattle sign - middle fossa

Question 6

battle sign

Answer 6

ecchymosis over mastoid process indicative of basilar skull fracture

Question 7

indicative of spinal trauma

Answer 7

step offloss of rectal tone

Question 8

when does LOC assessment occur in trauma survey?

Answer 8

secondaryAVPU, AOx#, GCS

Question 9

Le Fort (and grades)

Answer 9

facial fracturesLe Fort I: maxillary rim & usually inferior nasal apertureLe Fort II: mid maxilla & inferior orbital rim & across bridge of noseLe Fort III: craniofacial dissociation & zygomatic arch

Question 10

• grey turner sign *

Answer 10

bruising around flank & abdomen (injury to spleen)

Question 11

• Cullen’s Sign *

Answer 11

blue discoloration around umbilicus (hemoperitoneum)

Question 12

coopernail’s sign

Answer 12

ecchymosis of scrotum or labia

Question 13

spinal shock

Answer 13

hypotension from vasodilation & venous poolingall phenomena surrounding physiologic/anatomic transection of spinal cord resulting in temp loss/depression of all/most spinal reflex activity below level of injury

Question 14

Basilar Skull Fracture: anterior fossa

Answer 14

Raccoon eyes & rhinorrhea

Question 15

Basilar Skull Fracture: middle fossa

Answer 15

Battle sign & CSF – tympanic memb.

Question 16

concussion vs contusion

Answer 16

concussion: diffuse brain inj assoc w gen or widespread neuro dysfxn- temporary LOC- retro/anterograde amnesiacontusion: bruising of brain @ site of impact or distal (contracoup)- prolonged LOC- monitor closely for edema, ↑in ICP, & possible herniation

Question 17

epidural hematoma

Answer 17

bleeding btw inner table & dura mater- freq occurs w/ linear skull fracture- art bleed – middle meningeal art, assoc w temporal/parietal injury- rapid det w LOC & herniation

Question 18

subdural hematoma

Answer 18

bleed btw dura mater & arachnoid meninges- most common hematoma- assoc w other injuries (contusions)- sx r/t area of injury, degree ↑ICP

Question 19

intracerebral hematoma

Answer 19

bleeding into brain parenchyma from direct injury or shearing of small vesselsMechanism of injury: trauma, GSWPoor prog d/t associated injuries (↑ mortality)

Question 20

supratentorial (uncal) herniation

Answer 20

shifting of lateral temporal lobe (uncas) → tentorial notch = compression of lateral midbrain, third cranial nerve, & posterior cerebral artery

Question 21

early sign of hypoxia

Answer 21

change in LOC(could also be d/t ↑ ICP so assess neuro & resp)

Question 22

change in LOC: THINK

Answer 22

assess neuro & resp consider ↑ ICP or hypoxia

Question 23

aortic dissection/aortic arch tear s/s

Answer 23

U&L pulse differences, widened mediastinum CXRhemodynamic instability, expanding hematomaarteriogram = direct data about injury to aorta

Question 24

1 diagnostic test for abdominal trauma assessment

Answer 24

bedside US

Question 25

abdominal deceleration + direct forces, see?

Answer 25

retroperitoneal hematomas

Question 26

blunt trauma to abdomen?

Answer 26

often hidden, likely fatal

Question 27

see hematoma in flank area, suspect

Answer 27

renal injury

Question 28

liver vs splenic laceration grades

Answer 28

liver: 6, may take 48-72 hours to presentspleen: 5, most common organ for abd blunt trauma, delayed hemmorhage

Question 29

liver lac presents in

Answer 29

48 - 72 hours

Question 30

most common organ for abd blunt trauma

Answer 30

spleen! may have elayed hemmorhage

Question 31

rib fx 8-10 think

Answer 31

SPLENIC INJURY!

Question 32

overwhelming post-splenectomy infections (OPSI)

Answer 32

pneumococcal d/t loss of immune fxn- tx: Polyvalent Pneumococcal Vaccine w/in 72 hours

Question 33

biggest infection risk w splenectomy

Answer 33

pneumococcal

Question 34

pancreatic trauma presents in

Answer 34

evidence of injury may not be seen for 12 -24 hours bc masked by other injuries

Question 35

pancreatic trauma s/s

Answer 35

• epigastric pain radiating to back* tenderness to deep palp * hyperglycemia↑ amylase & lipaseN&V, ileus

Question 36

• epigastric pain rad to back* tender to deep palp * hyperglycemiaTHINK

Answer 36

pancreatic trauma

Question 37

abdominal compartment syndrome

Answer 37

↑in intra-abd pressure gt 20mmHgresult of expanding abd contents:- bleeding → abd cavity- bowel edema from activation inflammatory mediators & reperfusion injury- fluid resuscitation (crystalloids)

Question 38

abd perfusion pressure equation + goal

Answer 38

APP = MAP - IAPgoal: gt 60 mmHg

Question 39

bladder pressure requiring emergency celiotomy

Answer 39

greater than 25 r/t abdominal compartment syndrome

Question 40

reperfusion injury

Answer 40

sudden release of anaerobic toxins causing CV instability, usually r/t abdominal compartment syndrome fluid resuscitation

Question 41

chest film finding with diaphragm rupture

Answer 41

unilateral ↑ of diaphragm

Question 42

diaphragm rupture

Answer 42

50% pts also have pelvic fractureoften mistaken as ptxsuspect if: seat belt marks lower that expected on abdCXR: unilateral ↑ of diaphragm

Question 43

why is AC more dangerous than DC

Answer 43

produces tetany

Question 44

Zone of coagulation

Answer 44

area where tissue is not viable

Question 45

Zone of stasis

Answer 45

surrounding zone of coag where ↓ perfusion & edema develop w/in 24-48hrs

Question 46

Zone of hyperemia

Answer 46

surrounding zone of stasis, inflammatory response w ↑blood flow