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Emergency Medicine > Trauma > Flashcards

Trauma Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is the leading cause of death in the first 4 decades of life?

A

Trauma

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2
Q

In pts with trauma, permanent disability is ___ times greater than the mortality rate

A

3!

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3
Q

T/F There is a bimodal distribution of death in trauma patients

A

False, the distribution is TRIMODAL

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4
Q

In cases of trauma, what percentage of patients die instantly?

A

50% (no amount of medical care could have saved them)

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5
Q

In cases of trauma, what percentage of patients die wi/in minutes to hours following the event? Of that percentage, what percentage of those deaths is due to airway? Blood loss?

A

30%
Airway: 40%
Blood loss: 25%

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6
Q

In cases of trauma, what percentage of patients die w/in days to weeks following the event? What is their death usually attributed to?

A

20%

Multi-organ-system-failure or Sepsis

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7
Q

In cases of trauma, what group of patients have the greatest success in surviving? (providers should focus on these patients and saving them)

A

The second peak (20% Minutes-hours)

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8
Q

ACS CoT Criteria is comprised of what three categories?

A

Physiologic, Injury, and Mechanism

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9
Q

What are two examples of mechanism criteria?

A

Fall >2x height, rollover in vehicle or death in vehicle

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10
Q

What is the title of the person in the trauma room who provides no patient care but who is in charge of the “big picture”

A

Trauma captain

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11
Q

How do we evaluate a patient’s airway?

A

Ask them their name!
We now know their airway is patent as they are phonating, not drowning in blood/substance as they can speak, and also enough air to brain to cognate listen for hoarseness or gurgling with speech!

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12
Q

What type of injury should be assumed in patients with multisystem trauma?

A

C-spine injury

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13
Q

If a pt has a GCS of ____, you should intubate them

A

<8

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14
Q

What is a flail chest? Describe it. Complications?

A

Section of ribs broken in 2 or more locations, breath in = suck in, breath out = push out –> not normal! Obvi.
CO2 becomes trapped in that area and there is thus poor oxygenation

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15
Q

What is subcutaneous emphysema?

A

Air in superficial soft tissues leaked from the lungs, significant underlying lung injury, likely not oxygenating well

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16
Q

If a tension pneumothorax is suspected, what procedure should be performed?

A

Needle decompression

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17
Q

If a pneumothorax / hemothorax is present, what should be done?

A

Place a chest tube

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18
Q

If a pt has a sucking chest wound, what should be done?

A

Place an occlusive dressing

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19
Q

What should be assumed in any hypotensive trauma patient?

A

Hemorrhagic shock

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20
Q

In order to rapidly and effectively asses hemodynamic status, where and how many pulses should be measured?

A

4 extremity pulses

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21
Q

What are 5 contraindications for placing a foley catheter (signs of pelvic injury)

A
  1. Blood at urethral meatus
  2. Perineal ecchymosis
  3. Blood in the scrotum
  4. High riding prostate
  5. Pelvic Fxs
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22
Q

In a trauma, what type and how many IVs should be placed?

A

2 large bore IVs

23
Q

What causes compression/collapse of right side of the heart?

A

Cardiac tamponade

24
Q

If you are suspicious of urethral injury, what should be performed prior to insertion of a catheter?

A

A retrograde urethrogram

25
Q

In trauma pts brought to the trauma bay “cracking the chest” is otherwise known as what type of procedure?

A

ED thoracotomy

26
Q

What pt is the “ideal pt” for an ED thoracotomy, in regards to the type of trauma they experience and with what type of weapon?

A

Penetrating trauma to chest with low velocity weapon

27
Q

How effective is an ED thoracotomy? (percentage)

A

~10%

28
Q

During the ABCDEs, what are your two main concerns in regards to disability? (anatomically speaking)

A

The brain and the spine

29
Q

If you find a spinal cord injury within the first 8 hours of its occurrence, what should you administer to the pt?

A

High dose steroids

30
Q

If you suspect increased ICP, what should you do to the head of the patient’s bed?

A

Elevate it

31
Q

When evaluating any trauma pt, what is one location on their body that you should always inspect? (think: where do puncture wounds like to “hide”?)

A

The back! (also, if considering puncture wounds, the axillae)

32
Q

If there is an obvious major injury/violation of chest/abd, where should you immediately send the patient?

A

The OR

33
Q

When a patient presents with these three sx, you should have a high suspicion for abd trauma…

A

Tachycardia, hypotension, and abdominal tenderness

34
Q

T/F Patients with abd trauma can be asymptomatic early on

A

True

35
Q

A ____ exam can be a useful early screening tool for abd trauma (hint: type of imaging)

A

FAST exam (Focused Assessment with Sonography for Trauma)

36
Q

Free fluid without solid organ injury is a _____ _____ injury until proven otherwise

A

hollow viscous

37
Q

A hollow viscous injury can involve the ___, ___, or ___ (hint: think organs)

A

Stomach, bowel, or mesentery

38
Q

What type of injuries can result in bucket-handle tears of mesentery?

A

Deceleration

39
Q

Small bowel and colon injuries result most often from what type of trauma?

A

Penetrating

40
Q

Hollow viscous injury sx are a result from a combination of ___ ___ and___ ___

A

blood loss and peritoneal contamination

41
Q

What is the most commonly injured organ in blunt trauma?

A

Spleen

42
Q

T/F Splenic injury often needs to be managed operatively

A

False, splenic injury often can be managed non-operatively

43
Q

Pain in what area may be indicative of splenic injury?

A

Left lower rib

44
Q

T/F Splenic injury is often associated with other injuries

A

True

45
Q

What is the second most common type of solid organ injury?

A

Liver

46
Q

T/F Liver injury is often associated with other injuries

A

True

47
Q

Is liver injury difficult to manage surgically?

A

Yes, it is

48
Q

What imaging study visualizes solid organs and vessels well?

A

Abdominal CT scan

49
Q

What do CT scans NOT see well? (think certain types of injury and anatomical structures)

A

Hollow viscous, duodenum, diaphragm, omentum

50
Q

Even though some recent surgery literature advocates whole body scans on all trauma, why do you still want to be wary with ordering CT scans for pts?

A

There is an increase in mortality related to cancer from CT scans

51
Q

What is the goal of a FAST exam?

A

To evaluate for free fluid

52
Q

How many views does a FAST exam have? What are they? (Think chest/abd regions)

A

4 views: Cardiac, RUQ, LUQ, suprapubic

53
Q

List the following in the order in which they should be performed on a trauma pt:

  • Secondary Survey
  • Home/Observation/Non-Emergent OR
  • FAST
  • CT head or pelvis
  • Primary Survey
A
  1. Primary Survey
  2. Secondary Survey
  3. FAST exam
  4. CT Head or Pelvis
  5. Home/Observation/Non-Emergent OR
54
Q

Is there an “I” in trauma? ;)

A

Trauma is best managed by a team approach

Emergency Medicine (20 decks)

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