TRAUMA

Question 1

Clinical signs of shock

Answer 1

Low blood press (

Question 2

Volume replacement steps in shock

Answer 2

Lactated ringers (no sugar)
Blood (packed red cells)

Want urinary output to be 0.5 - 2.0 mL/kg/h

Question 3

Causes of shock

Answer 3

Hypovolemic (bleeding, burns, diarrhea, etc…) - low CVP

Pericardial tamponade - high CVP

Tension pneumothorax - high CVP

Question 4

Skull fracture:

Signs
Imaging
Management

Answer 4

Signs:
Raccoon eyes
Rhinorrhea/Otorrhea
Ecchymosis behind ear

Imaging: CT scan

Management: DO NOT do nasal endotracheal intubation

Question 5

What does every patient who has been unconscious get

Answer 5

CT scan - look for intracranial hematomas

Question 6

How to control for intracranial pressure

Answer 6

Elevate head
Hyperventilate (PCO2 35)
Avoid fluid overload
Give medication (mannitol or furosemide)

Question 7

Can hypovolemic shock happen from intracranial bleeding?

Answer 7

No - not enough space to produce the amount of blood loss… Look for another source

Question 8

Brown Sequard hemisection

Answer 8

Clean cut injury (knife)
IPSILATERAL to injury: paralysis, loss of proprioception
CONTRALATERAL to injury: loss of pain and temperature

Question 9

Anterior cord syndrome

Answer 9

Burst fractures of vertebral bodies

Loss of MOTOR, PAIN, TEMP bilaterally
Vibration and proprioception preserved (dorsal columns not affected)

Question 10

Central cord syndrome

Answer 10

Elderly in rear end collision (forced hyperextension of the neck)

Paralysis and burning in upper extremities

Lower extremities not usually affected

Question 11

Why can a rib fracture be deadly in elderly

Answer 11

PAIN > HYPOVENTILATION > ATELECTASIS > PNEUMONIA

Treat with local nerve block and epidural catheter

Question 12

First aid for sucking chest wound

Answer 12

Occlusive dressing that allows air out but not in

Taped on 3 sides

Question 13

White out of the lungs

Answer 13

Pulmonary contusion

Treat with fluid restriction and diuretics

Question 14

Traumatic rupture of aorta

Answer 14

Severe deceleration injury
Junction of arch and descending aorta
Think of this with fracture of hard to break chest bones (1st rib, scapula, sternum)
Dx with spiral CT scan (CT angio)

Question 15

Internal bleeding

Answer 15

Hides in:
Thighs
Pelvis
Abdomen

Diagnose with CT scan

Question 16

What does the patient who needs a CT scan need to be

Answer 16

Hemodynamically stable

Question 17

Combined injuries of arteries, nerves and bone - what sequence should they be fixed?

Answer 17

Bone then arteries then nerves

Question 18

Complications and treatment of crush injuries

Answer 18

Hyperkalemia, Myoglobinemia, Myoglobinuria, Renal failure

Tx with vigorous fluids, osmotic diuretics, alkalization of urine

Question 19

Chemical burns

Answer 19

Alkaline (Drano) worse than acidic (battery acid)

Treat both with intense irrigation - don’t play chemist

Question 20

High voltage electrical burns

Answer 20

Always deeper and worse than they appear to be

Can have late development of cataracts and demyelinization syndrome

Question 21

Fluid infusion in adults

Answer 21

This is if you’ve burned your 20% of body surface

Start with 1,000mL/h of Ringer lactate without sugar

Adjust to desired urinary output - 1-2mL/kg/h while avoiding CVP over 15mmHg

Question 22

Rabies prophylaxis

Answer 22

Immunoglobulin + vaccine

Tx with this in unprovoked dog bites or bites from wild animals

Question 23

Snake bites - what are the signs of envenomation?

Answer 23

Severe local pain
Swelling
Discoloration developing within 30 minutes of the bite

First aid: splint extremity during transportation

Question 24

Black widow spider bites vs brown recluse

Answer 24

BLACK WIDOW
Nausea, vomiting, muscle cramps
Antidote - IV calcium gluconate

BROWN RECLUSE
Necrotic center and surrounding halo of erythema
Treat with dapsone