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Trauma - Rosen's > Trauma > Flashcards

Trauma Flashcards

1
Q

head on collision mechanism of injury associated with which potential injuries

A

facial injuries
lower extremity injuries
aortic injuries

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2
Q

rear end collision mechanism of injury associated with which potential injuries

A

hyperextension of C spine
C spine fractures
central cord syndrome

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3
Q

lateral T bone collision mechanism of injury associated with which potential injuries

A

thoracic injuries
abdominal injuries- spleen, liver
pelvic injuries
clavicle, humerus, rib fractures

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4
Q

rollover MVC mechanism of injury associated with which potential injuries

A

crush injuries
compression fractures of the spine

*significant mechanism of injury

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5
Q

MVC - ejected from vehicle mechanism of injury associated with which potential injuries

A

spinal injuries

*significant mortality

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6
Q

MVC with windshield damage (likely unrestrained) mechanism of injury associated with which potential injuries

A

closed head injuries, coup/contrecoup injuries
facial #s
skull #s
C-spine #s

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7
Q

MVC with steering wheel damage mechanism of injury associated with which potential injuries

A 
thoracic injuries
sternal and rib #s, flail chest
cardiac contusion
aortic injuries
hemothorax, pneummothorax
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8
Q

MVC with dashboard involvement or damage

A

pelvic and acetabular injuries

dislocated hip

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9
Q

MVC proper seat belt use associated wtih

A

sternal, rib #, pulmonary contusion

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10
Q

MVC use of lap belt only associated wtih

A

Chance fractures, abdominal injuries, head and facial injuries and #s

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11
Q

MVC use of shoulder belt only associated with

A

C spine injuries, and #s, “submarine” out of restraint devices, possible ejection

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12
Q

MVC with airbag deployment associated with

A

upper extremity soft tissue injuries and #s
lower extremity injuries and #s

not effect for lateral impacts, less severe head and upper torso injuries, more severe in children

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13
Q

trauma pedestrian vs. automobile at low speed mechanism of injury associated with which potential injuries

A

tibia and fibula fractures, knee injuries

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14
Q

trauma pedestrian vs. automobile at high speed mechanism of injury associated with which potential injuries

A

Waddels triad: tibia and fibula or femur #s, truncal injuries, craniofacial injuries

thrown pedestrians at risk for multi system trauma

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15
Q

bicycle vs. automobile trauma mechanism of injury associated with which potential injuries

A

closed head injuries

handlebar injuries: spleen or liver lac, additional intra-abdominal injuries, consider penetrating injuries

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16
Q

bicycle trauma - non-automobile related mechanism of injury associated with which potential injuries

A

extremity injuries

handlebar injuries

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17
Q

what height of fall has an LD50

A

36-60ft

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18
Q

fall trauma with vertical impact associated with what injrueis

A 
calcanea and lower extremity #s
pelvic #s
closed head injuries
C spine #s
renal and renal vascular injuries
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19
Q

fall trauma with horizontal impact associated with what injuries

A

craniofacial fractures
hand and wrist fractures
abdominal and thoracic visceral injuries
aortic injuries

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20
Q

what components of airway exam important in primary survey in trauma

A 
neck or maxillofacial injuries- sub Q emphysema, expanding hematoma, burns/signs of inhalation injury
GCS > 9
sufficient respirato effort
no active vomiting
no significant oropharyngeal bleeding
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21
Q

what components of breathing exam important in primary survey in trauma

A

assess for signs of injury that may compromise ability to oxygenate or ventilate
look for increased work of breathing, tachypnea, penetrating wounds, subQ emphysema, chest wall instability, flail segments, tracheal deviation and distended neck veins, equal breath sounds, O2 sat, cyanosis, tracheal deviation

identify and treat flail chest, cardiac injury, pulmonary contusion, tension pneumothorax, open or massive pneumothorax

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22
Q

what components of circulation exam important in primary survey in trauma

A

mental status, skin color and temp, heart rate, BP, capillary refill

2 large bore 14 or 16G IVs

if patient in shock – non hemorrhagic: tension pneumothorax, cardiac tamponade, cariogenic, neurogenic, septic vs. hypovolemic: hemorrhagic or fluid loss

locate hemorrhage: physical exam: external, thoracic, abdomen, pelvis, long bone

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23
Q

what history is important in secondary survey

A

AMPLE

allergies
medications
PMHX
last meal
environment and events leading up to trauma
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24
Q

treatment/workup of trauma patient with shock

A

resuscitation: 1-2L isontic funds, 1:1:1 ratio of PRBCs, platelets FFP
prevent hypothermia
TXA 1g IV bolus, followed by 1g infusion over 8 hours

direct pressure/tourniquet for localized hemorrhage
reduce/splint long bone #s
wrap pelvis, angioembolization in pelvic #
internal hemorrhagE: laparotomy or thoracotomy

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25
Q

airway considerations for blunt trauma patients

A

severe maxillofacial injuries
maintain C spine in line immobilization, consider awake intubation for C spine injuries
assess for laryngeal / tracheal injury
anticipate blood/emesis in the airway

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26
Q

airway considerations in penetrating trauma

A

watch for expanding hematoma
anticipate significant bleeding
impaired video/fiberoptic techniques

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27
Q

breathing considerations in blunt trauma

A

chest contusions
flail segment
bowel sounds in chest

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28
Q

breathing considerations in penetrating trauma

A

chest injury
significant bleeding
sucking chest wound

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29
Q

circulation considerations in blunt trauma

A

positive FAST
unstablie pelvis
long bone #
signs of retroperitoneal bleeding

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30
Q

circulation considerations in penetrating trauma

A

obvious vascular injury

external hemorrhage

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31
Q

confounding factors to consider which may be causing altered mental status other than head injury in trauma

A

hypoglycemia
hypertension meds can cause bradycardia/hypotension
use of diuretics/anticholinergics can cause hyponatremia
seizure/postictal
anticoagulants - neuroimaging needed
intoxication - drugs or alcohol

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32
Q

laboratory evaluation of the trauma patient

A

lytes, liver function, INR, UA, blood type and screen, lactate levels or base deficit

B-hCG in females

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33
Q

what test is used in massive transfusion or extensive bleeding in trauma patents to aid in early diagnosis of coagulopathies

A

TEG - thrombestrography

ROTEM - thromboelasometry

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34
Q

important examination/ diagnoses to pick up during trauma secondary survey - general

A

exam: LOC, GCS, any specific complaints

critical diagnoses: GCS < 8, focal motor deficit

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35
Q

important examination/ diagnoses to pick up during trauma secondary survey - head

A

exam: pupils, visual fields, contusions, lacerations evidence of skull fracture (hemotympanum, racoon eyes, battle sign, palpable defects)
critical diagnoses: herniation syndrome
emergent diagnoses: globe rupture, open skull fracture, CSF leak

36
Q

important examination/ diagnoses to pick up during trauma secondary survey - face

A

exam: contusions, lacerations, midface instability, malocclusion
critical diagnosis: airway obstruction due to bleeding
emergent diagnoses: facial fractures, mandibular fracture

37
Q

important examination/ diagnoses to pick up during trauma secondary survey - neck

A

exam: penetrating injury, lacs, JVD, subQ emphysema, hematoma, midline cervical tenderness
critical diagnoses: carotid injury, pericardial tamponade, tracheal/laryngeal fracture, vascular injury, cervical fracture, dislocation

38
Q

important examination/ diagnoses to pick up during trauma secondary survey - chest

A

exam: resp effort, excursion, contusions, lacerations, focal tenderness, crepitus, subQ emphysema, heart tones, breath sounds
critical diagnoses: impending respiratory failure, flail chest, cardiac tamponade, tension pneumothorax
emergent diagnoses: cardiopulmonary injury, intrathoracic injury, rib #s, pneumothorax, hemothorax

39
Q

important examination/ diagnoses to pick up during trauma secondary survey - abdomen, flank

A

exam: contusions, penetrating injury, lacerations, tenderness, peritoneal signs
critical diagnoses: intra-abdomainl hemorrhage, abdominal catastrophe
emergent diagnoses: solid, hollow viscous injury

40
Q

important examination/ diagnoses to pick up during trauma secondary survey - pelvis, GU

A

contusions, lacerations, stability, symphyseal tenderness, blood (urethral meatus, vaginal bleeding, hematuria), rectal exam
critical diagnoses: pelvic hemorrhage, unstable pelvic fracture, colorectal injury (bleeding), urethral injury

41
Q

important examination/ diagnoses to pick up during trauma secondary survey - neuro/spinal cord

A

exam: midline bony spinal tenderness, mental status, paresthesias, sensory level, motor function, including sphincter tone
critical diagnoses: spinal fracture, dislocation, epidural or subdural hematoma
emergent diagnoses: cerebral contusions, shear injury, SCI, contusion, nerve root injury

42
Q

important examination/ diagnoses to pick up during trauma secondary survey - extremities

A

exam: contusions, lacerations, deformity, focal tenderness, pulses, cap refill, eval of compartments
critical diagnoses: compartment syndrome, vascular injury, neurovascularinjury, arterial injury, hemorrhage shock
emergent diagnoses: rhabdomyolysis, fracture

43
Q

what imaging needed in patients with blunt trauma with significant chest pain, sternal tenderness, or abnormal thoracic US or CXR findings

A

CT chest

44
Q

recommended imaging in patients with penetrating chest trauma, after normal CXR and thoracic US, asymptomaticc

A

repeat CXR in 1 hour, does not need a CT

45
Q

do you need pelvic Xray on alert, hemodynamically stable stables who are asymptomatic

A

no

46
Q

who in blunt trauma gets a CT abdo

A 
abdo pain or tenderness
significant mechanism of injury
abnormal eFAST
gross hematuria
unreliable exam (altered, distracting injury, head injury)

seat belt sign associated with internal abdominal injury

47
Q

who in blunt trauma can forego abdominal CT

A

GCS 15, normal abdominal physical exam, negative eFAST, normal laboratory results

48
Q

in blunt trauma patients not getting an abdominal CT, what monitoring do they need

A

repeat FAST and Hb

49
Q

surgeon should be present in ED on trauma patient within 15 mins of arrival if any of the following criteria

A

confirmed hypotension (SBP < 90) +GSW to neck, chest, abdo, or proximal extremities OR intubated patents transferred from scene
respiratory compromised requiring emergent airway
penetrating GSW to neck, chest abdo or pelvis
GCS < 8 attributed to trauma

50
Q

define flail chest

A

three or more adjacent ribs are fractured at 2 points, allowing free segment of chest wall to move in paradoxical motion with flail moving inward on inspiration and outward with expiration

51
Q

which ribs are less likely to fracture

A

1-3 are short and protected
9-12 are longer and more mobile at anterior end
4-8 most likely to fracture

52
Q

findings suggestive of clinical diagnosis of rib fracture

A

severe point tenderness, bony crepitus, ecchymosis, muscle spasm over the rib
bimanual compression of thoracic cage remote from injury produces pain at site of fracture

53
Q

NEXUS CT rule for CT chest after blunt trauma

A

if does not meet any of this criteria, do not need CT chest

abnormal CXR
rapid deceleration mechanism (fall >20 feet or MVC > 65km/h)
distracting painful injury
chest wall tenderness
sternal tenderness
Tspine tenderness
scapular tenderness
54
Q

indicatins for operative fixation of flail chest

A

pts unable to wean from ventilator secondary to mechanics of flail chest, persistent t pain, severe chest wall instability, progressive decline in pulmonary function

55
Q

treatment of flail chest

A

pulmonary physiotherapy
effective analgesia
selective use of ETT and mechanical ventilation
close observation for respiratory compromise

56
Q

what work up needed if suspect sternal fracture

A

if minimal trauma e.g. fall to ground or punch to chest, CXR

if more significant trauma, or when CXR shows displaced # or evidence of intrathoracic injury - CT chest

57
Q

clinical manifestatiosn of pulmonary contusion

A

dyspnea, tachypnea, cyanosis, tachycardia, hypotension, and chest all bruising -rales or absent breath sounds on asucultation

58
Q

diagnosis of pulmonary contusion

A

CXR- patchy, irregular alveolar infiltrate

ABG- widening A-a gradiane tindicates decreasing pulmonary diffusion capacity of patient’s contused lung

59
Q

what is difference between pulmonary contusion and ARDS

A

contusion occurs within minutes of initial injury, isolated to segment or lobe
ARDS develops 48-72 hours later, more diffuse

60
Q

treatment of pulmonary contusion

A

IV fluids restricted to maintain intravascular volume withn strict limits and comprehensive supportive care consisting of tracheobroncial toilet, suctioning, pain relief

avoid intubation because increase morbidity
if 1 lung severely contused and causing significant hypoxemia can intubate and ventilate lungs separately

61
Q

types of pneumothorax

A

simple
communicating
tension
occult

62
Q

indications for tube thoracostomy

A

traumatic cause (expect asymptomatic, apical pneumothorax)
moderate to large size
resp Symptoms regardless of sitze
increase size of pneumothorax after conservative therapy
recurrence of pneumothorax after removal of initial chest tube
patient requires ventilator support
pt requires GA
associated hemothorax
bilateral pneumothorax regardless of siez
tension pneumothraox

63
Q

complications of tube thoracostomy

A

formation of hemothorax, pulmonary edema, bronchopleural fistula, pleural leaks, empyema, subQ emphysema, infection, intercostal artery laceration, contralateral pneumothorax, and parenchyma injury

64
Q

placement site for tube thoracostomy

A

4th or 5th intercostal space at midaxillary line

65
Q

causes of hemothorax

A

hemorrhage for injured lung parenchyma body vommon

intercostal, internal mamary arteries more often than hilarious or great vessels

66
Q

indicaitons for thoracotomy

A

initial thoracotomy drainage more than 20cc/kg of blood or more than 1500mL or 200mL/hr for 3 hours
persistent bleeding more than 7cc/kg/hr
increasing hemothorax on CXR
pt remains hypotensive despite adequate blood replacement and other sites of bleeding have been ruled out
pt decompensated after initial response to resuscitation

67
Q

clinical features suggestive of tracheobronchial injury

A

massive air leak through a chest tube, hemoptysis, or increasing subQ emphysema
Hamman’s crunch if air tracks to mediastinum
continuous bubbling into chest tube hooked to suction

68
Q

what diagnostic test used if tracheobronchial injury suspected

A

bronchoscopy

69
Q

which patients may be okay with conservation mgmt for tracheobronchial injury

A

tracheal tears less than 2cm without esophageal prolapse, mediasitnitis, or massive air leakage

70
Q

CT findings consistent with diaphragmatic injury

A

diaphragmatic discontinuity, intrathoracic herniation of abdominal contents, waist-like constriction of abdominal viscera (collar sign)

71
Q

treatment of diaphragmatic injury

A

surgery

72
Q

potential complications after blunt cardiac trauma

A

life threatening dysrhythmias, conduction abnormalities, CHF, cardiogenic shock, hemopericardiaum with tamponade, cardiac rupture, valvular rupture, intraventricular thrombi, thromboembolic phenomena, coronary artery occlusion, ventricular aneurysms and constrictive pericarditis

73
Q

what is myocardial concussion

A

commotio cordis
acute form of blunt cardiac trauma usually produced by sharp, direct blow to mid anterior chest that stuns the myocardium and results in brief dysrhythmia, hypotension and LOC
no structural heart damage

74
Q

recommended monitoring of patient after commotio cords who are not found mohave more severe traumatic cardiac injury

A

observe 6-12 hours on telemetry

when D/C, no return to play until additional outpatient cardiac testing performed if indicated

75
Q

part of heart most likely to get myocaridal contusion

A

RV - anterior position and close to sternum

76
Q

how to assess for myocaridal contusion

A

if negative 12 lead ECG + negative troponin, can rule out myocardial contusion

77
Q

treatment of suspected myocardial contusion

A 
similar to MI
saline lock IV if fluids not otherwise indicated
cardiac  monitoirng
O2 if hypoxic
analgesic agents

dysrhythmias usually transient adndont require tx; if VT or A Flutter treat as per ACLS guidelines

treat and prevent any conditions that increase myocardial irritability

lytics & asa contradincated in trauma

78
Q

disposition of pt with myocardial contusion

A

telemetry observation or in-hospital monitoring, depending in patients other injuries

markedly abnormal ECG, troponin elevation or hypotension warrant echocardiography and cardiology consult

79
Q

proposed mechanisms of myocardial rupture in trauma

A
  1. deceleration stearin stresses on fixed attached of IVC and SVC to RA
  2. upward displacement of blood and abdominal viscera from blunt abdominal injury causes sudden increase in intracardiac pressure
  3. direct compression of the heart between sternum and vertebral bodies
  4. laceration from a fractured rib or sternum
  5. complications of a myocardial contusion, necrosis, and subsequent cardiac rupture
80
Q

what determines survival in patients with cardiac rutpuree

A

if pericardium remains in tact, protected from immediate exsanguination

81
Q

auscultation revealing harsh murmur known as bruit de moulin

A

pneumopericardium - seen in rupture

82
Q

imaging in myocardial rupture

A

FAST bedside US reveals pericardial effusion

CXR may be helpful to note the presence of other intrathoracic injuries (eg. hemothorax, pneumothorax, and signs of possible aortic dissection)

83
Q

indications for ED thoracotomy

A

penetrating traumatic cardiac arrest

  - cardiac arrest at any point with initial signs of life in the field  (less than 10 mins of CPR)
    - SBP < 50 after fluid resus
    - severe shock with clinical signs of cardiac tamponade

blunt trauma
-cardiac arrest in the ED

84
Q

indications for central line

A

(1) IV access (especially if difficult peripheral access)
(2) CVP monitoring
(3) ScvO2 monitoring/sampling
(4) Infusions of irritant substances (e.g. vasoactive agents, chemotherapy or TPN administration)
(5) Renal replacement therapy, olasmapheresis and apheresis
(6) Transvenous pacing

85
Q

contraindications for central line

A

CONTRAINDICATIONS

coagulopathy
respiratory failure
raised ICP (cannot tilt head down)
-> can use femoral approach in all the situations above

obstructed vein (e.g. thrombus, or tumour)
overlying skin infection, burn or other disease process
hemorrhage from target vessel
uncooperative patient

Trauma - Rosen's (1 decks)

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