Trauma Flashcards by Mary Slome

Ellis II dental fracture involves:

Enamel and dentin;

Immediate f/u required to prevent abscess

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Ellis III dental fracture involves:

Pulp and blood;

Immediate f/u required to prevent abscess

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Trauma with inability to look up;

what’s broken?

Inferior orbital wall with entrapment

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What is the O’Riain wrinkle test?

Test the nerve to see if a finger wrinkles in warm water

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The most sensitive bedside test for nerve injury in a finger after trauma is:

Two-point discrimination

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Where should you place a needle for needle decompression?

2nd intercostal space, midclavicular line, over the superior edge of the rib (to avoid the inferior running neuromuscular bundle)

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What size needle should be used for needle decompression?

14 to 20 gauge

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Traumatic proptosis with impaired extraocular movements;

dx?

Retrobulbar hematoma

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Orbital blowout fracture causes entrapment of what muscle?

Inferior rectus

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A ruptured globe presents with what symptom?

Enophthalmous, from vitreous humor leaking out of the eye

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Anesthesia of infraorbital region;
Diplopia with upward gaze;
Epistaxis;
Infraorbital subcutaneous emphysema;
dx?

Orbital blowout fracture

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Trauma to the eye with fluid level/meniscus in the anterior chamber;
dx?

Hyphema (collection of blood)

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What is keratitis?

Corneal inflammation

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Growth visible on the sclera which crosses the limbus into the cornea;
dx?

Pterygium

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Central cord syndrome results from what kind of injury?

Hyperextension

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Central cord syndrome occurs typically in what age group?

The elderly, with pre-existing degenerative joint disease

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What is central cord syndrome?

The ligamentum flavum buckles into the cord, resulting in a contusion of the cord’s central portion

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Sensation of the dorsal aspect of the foot and dirsiflexion of the foot;
What nerve?

L5;

Herniation of the L4-5 disc

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Where is Zone 1 for penetrating neck injury?

Clavicles (Sternal notch) to cricoid cartilage

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Where is Zone 2 for penetrating neck injury?

Cricoid cartilage to the angles of the mandibles

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Where is Zone 3 for penetrating neck injury?

Above the angles of the mandible

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What is the protocol for a Zone 1 penetrating trauma, regardless of whether a patient looks stable on physical exam?

Angiography
Esophogram
Admit for obs

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T/F: A patient with a liver laceration who is hemodynamically stable can be managed conservatively.

True

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Test of choice for diagnosing solid organ injury

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After a trauma, a Foley yields gross hematuria. What is the best step to evaluate for urologic injury?

CT abdomen/pelvis with IV and transurethral contrast

ED thoractomy is not inducated for what kind of trauma?

Blunt; | low success rate

What kind of trauma has the best success rate for ED thoracotomy?

Penetrating

Best patient for ED thoracotomy has what?

Unconscious Pulseless Detectable BP (Penetrating chest wound)

Distal radius fx involves injury to what nerve?

Median nerve --> decreased sensation over thenar eminence

After a trauma, if the affected leg is internally rotated, what is the most likely injury?

Dislocation of hip

After a trauma, if the affected leg is externally rotated and abducted, what is the likely fx?

Femoral neck fx

Artery involved in knee dislocation

Popliteal

If Doppler does not detect pulses in the foot after knee dislocation, what is the appropriate management?

Immediate reduction in ED under conscious sedation without xray

In human bite wounds, what bacteria should be considered and treated for?

Eikenella corrodens (and staph and strep)

How should human bites be dressed?

Do not suture--let heal by secondary intention to reduce infection risk

Management for occult PTX?

100% O2

When is Heliox used?

Reactive airway disease with resistance to flow

Patients with anterior cord syndromes, such as central cord syndrome, have what kinds of symptoms?

Sensory

Paralysis and loss of pain and temperature bilaterally below the lesion; dx?

Brown-Sequard syndrome

Aortic injuries usually leak where?

Left hemithorax

Patients with high voltage injury commonly present with:

Burns | Deep burns occur in less than 5% of lightening injuries

Four types of burns/skin changes associated with high voltage electrical injury:

Linear burns; Punctate burns; Feathering; Thermal burns

A burn to 1 hand is what % SA?

2-3%

Fracture of the distal radius paired with a dislocation of the distal radioulnar joint, dx?

Galeazzi fracture more common in men FOOSH injury

Displaced ulnar fracture with radial head dislocation, dx?

Monteggia Fracture

Distal radius fracture with dorsal and radial displacement of distal segment, dx?

Colles fracture

Fracture of the anterior and posterior arches of C1 after hyperextension injury, dx?

Jefferson fracture

What vertebral fracture is commonly associated with duodenal injuries?

Chance fracture

Abdominal distention, nausea, and bilious vomiting, delayed presentation after trauma, dx?

Gastric outlet obstruction from expanding duodenal hematoma

Most common location for posterior nosebleed

Posterior epistaxis arises most commonly from the posterolateral branches of the sphenopalatine artery but may also arise from the carotid artery

Most common location for anterior nosebleed

Kisselbach's plexus

Mgmt of nosebleed

Conservative measures should occur first, so patients should blow their nose to remove blood and clots. Spray the patient’s nares with oxymetazoline and hold the alae tightly against the septum. After 10 to 15 minutes, an attempt to identify the source of bleeding should occur with rhinoscopy. If a bleeding source is identified, then cautery can occur. Anterior packing can also be used whether a source is identified or not or if cautery fails. Caution should be used when using cautery, and one should not cauterize the bilateral sides of the septum, as this can lead to necrosis and perforation. Pretreat with a topical anesthetic and topical vasoconstrictor prior to inserting a nasal pack to aid in the cessation of bleeding but also for patient comfort. If bleeding occurs out of the contralateral nare, then packing of the contralateral nare may also be required. The next step if bleeding persists is to place a posterior packing, with hospital admission required in most cases and the packing removed in 48–72 hours.

stable avulsion fracture of C6 or C7 and occurs secondary to abrupt flexion of the neck with contraction of the lower neck muscles, dx?

Clay shoveler fx

extreme hyperextension and occurs when the posterior spinal processes are fractured and protrude into the spinal canal, dx?

Hangman's fracture/pars interarticularis fx

hyperextension of the anterior longitudinal ligament, causing avulsion of the anterior and inferior aspect of the body, or flexion causing a fragment to form from compression of the anterior vertebrae, dx?

Teardrop fx | *unstable*

Name three stable cervical spine fractures.

Clay shoveler fracture, unilateral facet dislocation, and a type I odontoid fracture

unstable fracture that occurs secondary to a compressive force such as falling on the head or objects from above landing on the head, dx?

Jefferson fx | unstable

What artery is at risk of injury with a supracondylar fracture?

Brachial artery

Most common injuries in the UEs associated with compartment syndrome

Supracondylar fractures in children and distal radius fractures in adults are the most common injuries associated with compartment syndrome in the upper extremity

the cortex on one side of the bone is disrupted while the periosteum remains intact on the opposite side, dx

Greenstick fx | risk for re-fx

Which LeFort fracture classification involves the orbital walls, ethmoid bone, and nasal ridge?

LeFort III (craniofacial dissociation)

Base Deficits in Hemorrhage - ATLS

Class I 0 to -2 Class II -2 to -6 Class III -6 to -10 Class IV -10 or greater

First cause of death after MSK injury worldwide

Tetanus

ATLS - In burn mgmt, titrate fluids to

Urine output