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aaa EM Exam > Trauma > Flashcards

Trauma Flashcards

1
Q

A method to eval airway

A

1- have pt speak- patency and to evaluate for voice change and stridor
2- evidence of pooling secretions or cyanosis

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2
Q

GCS for intubation

A

GCS of 8 or less requires intubation

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3
Q

Important note for intubation

A

ALWAYS MAINTAIN C-SPINE IMMOBILIZATION

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4
Q

A patent airway DOES NOT mean adequate ventilation! Ventilation requires:

A

lung fxn
chest wall
diaphragm

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5
Q

Percussion with hyper-resonance

A

pneumothorax

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6
Q

Percussion with dullness

A

hemothorax

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7
Q

subcutaneous emphysema might indicate

A

airway injury

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8
Q

JVD in trauma may indicate

A

tension pneumothorax or cardiac tamponade

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9
Q

Tension Pneumothorax presents as

A

worsening of a simple pneumothorax

formation of a 1-way valve at the point of a rupture in the lung

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10
Q

Hypotension in a Tension Pneumothorax is due to

A

↑ intrathoracic pressure ↓ preload
Loss of left heart blood flow due to loss of pulmonary vasculature to affected lung
Compression of mediastinum

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11
Q

Tension pneumothorax is a CLINICAL diagnosis and _______ are not appropriate in this setting.

A

Xrays

If tension pneumothorax is suspected, immediate needle decompression is undertaken

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12
Q

Tension Pneumothorax needle decompression treatment details

A
  • 4-16 gauge long angiocath
  • midclavicular line, 2nd intercostal space
  • over the rib to avoid neurovasculature
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13
Q

Massive Hemothorax definition

A

A systemic or pulmonary vessel disruption leads to:

> 1500 mL blood loss initially
400 cc per hour for 2 hours

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14
Q

Consider a massive hemothorax with?

A

pts in shock w/ no breath sounds and/or percussion dullness.

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15
Q

massive hemothorax treatment

A

placing a large (36 f) chest tube

possibly a trip to the OR for hemorrhage control.

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16
Q

If a radial pulse is palpable, it suggests a systolic blood pressure of at least?

A

80 mm Hg

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17
Q

if femoral or carotid are palpable, these suggest a systolic blood pressure of at least?

A

60 mm Hg

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18
Q

ATLS Classifications of hemorrhagic shock considers?

A

HR
BP
Blood loss

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19
Q

ATLS Class of hemorrhagic shock that requires blood products

A

Class 3 and Class 4 (blood loss 30%, >40%)

20
Q

Reasons in shock–> dont mount a tachycardic response

A
  • Neurogenic shock
  • Beta blockade/ Calcium channel blockade
  • Elderly
  • Children/ young adults
  • Conditioned athletes
21
Q

Assess mental status via the AVPU scale

A

Alert.
Voice
Pain
Unresponsive

22
Q

_________ will present as a “blown pupil.” .

A

Uncal herniation

Paralysis of parasympathetic fibers of CN III

23
Q

Lowest GCS score

A

3

24
Q

Adjuncts to the Primary Survey

A 
Standard Trauma X-rays
FAST Exam (Focused Assessment Sonography in Trauma)
25
Q

FAST Exam four views

A

subxiphoid cardiac
spleno-renal
hepato-renal
bladder views

26
Q

Any blood detected during the FAST exam may represent

A

peritoneal penetration

*negative FAST does not exclude injury

27
Q

Primary Survey address

A
  • A: Airway Maintenance with CERVICAL SPINE protection
  • B: Breathing and Ventilation
  • C: Circulation with hemorrhage control / shock assessment
  • D: Disability: Neurological
  • E: Exposure/Environmental

The 2o Survey not started until all aspects of the 1o survey addressed + vitals addressed

28
Q

Secondary Survey history

A

Start with the AMPLE history:

Allergies
Medications
Past illnesses
*Last meal
Events / Environment / Mechanism of injury
29
Q

Secondary Survey physical

A

head to toe directed assessment

30
Q

Motor/ Strength Grading

A

0: Total paralysis
1: Palpable/visible contraction
2: FROM w/gravity eliminated
3: FROM against gravity
4: FROM, less than normal strength
5: Normal strength

31
Q

A __________ is most important lab in trauma patient

A

Type and Crossmatch

32
Q

Type O blood rules

A
  • Type O Negative- women

- Males may receive O Positive blood

33
Q

Type-specific blood processing time/ details

A

ABO and Rh only tested

10 minute processing

34
Q

Standard Trauma X-rays

A

AP chest + AP pelvis cxr as adjuncts to the 1o survey

C-Spine X Rays: lateral view (detects 80% fractures), AP, open mouth “Odontoid” view, and obliques

35
Q

EKG is especially important for?

A

fall, drowning, syncope or single car MVA

36
Q

_________ imaging if concern for urethral injury.

A

Retrograde-urethrogram

37
Q

Diagnositic Peritoneal Lavage

A
  • 98% sensitive for bleeding /detect bowel injury (often missed on CT)
  • replaced by US
  • performed when intra-abdominal bleeding
38
Q

Diagnositic Peritoneal Lavage is considered positive if it returns

A 
Gross blood (10 ml)
> 100,000 RBCs/mm3
> 500 WBCs/mm3
\+ Gram stain
Food fibers
Bacteria, bile, feces
39
Q

To clear the cervical spine/ remove collar, they must have the following:

A
  • Alert, not intoxicated
  • Absence of neck pain
  • Absence of midline neck tenderness
  • Absence of distracting injury
  • Absence of sensory /motor complaint
40
Q

A tracheobronchial tree disruption will present on physical as….

A
  • subcutaneous emphysema.

- may notice that after placing a chest tube, the lung refuses to inflate

41
Q

A pulmonary contusion may initially present as

A
  • mild hypoxia
  • IV fluids–> pulmonary edema and hypoxia worsens
  • Rx by proper O2 and ventilation + maintaining normovolemia.
42
Q

blunt cardiac injury

A

difficult to ddx.
only sign may be an abnormal ECG
-Echocardiography may show a hypokinetic heart.
-Rx= medicating dysrhythmias that affect hemodynamics

43
Q

immediately fatal, but those who survive may show a widened mediastinum on CXR.

A

traumatic aortic disruption caused by rapid acceleration/ deceleration causing a tear

44
Q

Cullen’s sign / Grey-Turner’s sign are both associated with __________

A

-retroperitoneal hemorrhage

Cullen’s sign =periumbilical bruising
Grey-Turner’s sign = flank bruising

45
Q

compartment syndrome presentation

A

5 P’s:

  • Pallor
  • Pain
  • Paresthesia
  • Poikilothermic
  • Pulseless (late finding).
46
Q

Injuries prone to developing compartment syndrome include

A
  • forearm / tibial injuries
  • tight dressings with swelling
  • prolonged external pressure
  • crush injuries
  • circumferential burns.

aaa EM Exam (27 decks)

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