Trauma Flashcards
An airway should be placed in a patient with a GCS under?
8
Subcutaneous emphysema of the neck is indicative of?
Major trauma to the tracheobronchiol tree
When securing an airway in a patient with subcutaneous emphysema in the neck, what must be done?
The airway must be secured via fiber optic bronchoscope
What is the most common cause of shock?
Hypovolemic hemorrhagic
If peripheral IV’s cannot be placed, what’s the best alternative option?
Adults: percutaneous femoral vein catheter or saphenous vein cut downs
Child <6: intraosseus cannulation of the proximal tibia
In a patient with symptoms of shock as well as: flushed and warm skin, low CVP, and circulatory collapse..what is the diagnosis and possible causes?
Vasomotor shock
Anaphylaxis, spinal cord transection, high spinal anesthetic
Any patient with head trauma that lost consciousness, requires?
CT scan
A patient presenting with head trauma that has raccoon eyes, rhinorrhea, otorrhea, or bruising behind the ears should be evaluated for?
Fracture at the skull base or upper cervical spine via CT scan
An acute epidural hematoma has what classifications:
- Lucid interval
- Fixed, dilated pupil
- CL hemiparesis with decerebrate posturing
- CT with lens shapes hematoma
How does the treatment between epidural and subdural hematoma treatment differ?
Epidural hematoma patients should have an emergent craniotomy
Subdural hematoma will require an emergent craniotomy if there is midline shift. If not shift, than elevate head, hyperventilate, give mannitol or furosemide.
Gradual neurological deterioration over weeks in the elderly is likely due to?
Chronic subdural hematoma from venous sinus tearing
How should GSW’s to the neck be handled?
Upper: angiogram
Middle: surgery
Lower: angiogram, bronchoscopy, and EGD
A patient with a knife wound to the right spine has distal right sided paralysis and loss of propioception. He also has distal left sided loss of pain sensation. What’s the likely cause of these symptoms?
Hemisection of the spinal cord (brown sequard)
Spinal cord damage should be determined with what imaging modality?
MRI
A patient who suffered a fall from 8 feet presents with Distal BL loss of motor function, pain, and temperature. What is the underlying cause of his symptoms?
Anterior cord syndrome due to burst fractures of the vertebral bodies
An elderly male is in an automobile collision and has forced hyperextension of the neck. He is complaining of an inability to move his upper extremities and burning pain in his lower extremities. What is this patient suffering from?
Central cord syndrome
An elderly patient with rib fractures should be treated with?
Local nerve block and epidural catheter
If the chest tube in a patient with a hemothorax collects 1500 mL of blood upon insertion, what is the concern?
Systemic vessel bleed
A patient with flail chest is at a high risk for this complication? How is this prevented?
Fluid overload
Treat with fluid restriction and diuretics
A trauma patient is in the ED following a high speed MVC where the patient crashed into a wall. He has multiple rib fractures and a Sternal fracture. He appears stable, but chest xray shows widened mediastinum. What’s your major concern?
Aortic rupture of the distal arch. Get spiral CT and do surgery
What are the two biggest causes of an air embolism?
- A patient on a respirator
2. Air in the subclavian vein during catheter insertion
A patient with a Petechial rash on the neck, tachycardia, fever, and low platelets following a fracture of the femur likely has?
Fat embolism
Where are possible locations of bleeding in patients who develop shock secondary to blunt trauma?
Abdomen (most common), thighs, and pelvis
What determines how you proceed with a patient who you suspect has intrabdominal bleeding?
Whether they are hemodynamically stable
Stable: CT
Unstable: FAST and OR
A patient with a splenectomy will need post-operative immunization against?
Pneumococcus, Hib, meningococcus (5 days here, 2 weeks usually)
If anticipated immunize prior to surgery
How do you treat DIC intraoperatively?
With platelet packs and FFP. If hypothermia and acidosis than stop surgery.
What is the best plan of action for a pelvic fracture with bleeding?
Pelvic fixation with IR angiographic embolization of internal iliac arteries
What is the best plan of action in a male with meatal blood, scrotal hematoma, and high riding pro state following a pelvic fracture?
Retrograde urethrogram
What studies must be done in patients with pelvic fractures and suspected bladder injuries?
Retrograde cystogram and post-void X-rays
In a patient with an extremity injury to the arteries, nerves and bones, what gets repaired first?
Stabilize bone, do vascular repair, leave nerve for last
Crush injuries if the extremities need treatment with?
Fluids, osmotic diuretics and urine alkalinization (for muscle damage and ensuing renal failure)
Circumferential burns of the extremities require?
Escharotomies
What are the fluid requirements for an adult patient who has a burn >20% of the body?
1000 mL/h of RL and adjust to urinary output of 1-2 mL/kg/h
What would be the fluid needs for a baby who suffered a wound >20% of the body?
20 mL/kg/h
What is the antidote for black widow spider bites?
IV calcium gluconate
A patient in hypovolemic shock will develop this acid base abnormality?
Lactic acidosis
What acid base abnormality is associated with the highest mortality?
Higher base deficit
