Trauma Flashcards
What is the leading cause of death in the first 4 decades of life?
Trauma
In pts with trauma, permanent disability is ___ times greater than the mortality rate
3!
T/F There is a bimodal distribution of death in trauma patients
False, the distribution is TRIMODAL
In cases of trauma, what percentage of patients die instantly?
50% (no amount of medical care could have saved them)
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?
30%
Airway: 40%
Blood loss: 25%
In cases of trauma, what percentage of patients die w/in days to weeks following the event? What is their death usually attributed to?
20%
Multi-organ-system-failure or Sepsis
In cases of trauma, what group of patients have the greatest success in surviving? (providers should focus on these patients and saving them)
The second peak (20% Minutes-hours)
ACS CoT Criteria is comprised of what three categories?
Physiologic, Injury, and Mechanism
What are two examples of mechanism criteria?
Fall >2x height, rollover in vehicle or death in vehicle
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”
Trauma captain
How do we evaluate a patient’s airway?
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!
What type of injury should be assumed in patients with multisystem trauma?
C-spine injury
If a pt has a GCS of ____, you should intubate them
<8
What is a flail chest? Describe it. Complications?
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
What is subcutaneous emphysema?
Air in superficial soft tissues leaked from the lungs, significant underlying lung injury, likely not oxygenating well
If a tension pneumothorax is suspected, what procedure should be performed?
Needle decompression
If a pneumothorax / hemothorax is present, what should be done?
Place a chest tube
If a pt has a sucking chest wound, what should be done?
Place an occlusive dressing
What should be assumed in any hypotensive trauma patient?
Hemorrhagic shock
In order to rapidly and effectively asses hemodynamic status, where and how many pulses should be measured?
4 extremity pulses
What are 5 contraindications for placing a foley catheter (signs of pelvic injury)
- Blood at urethral meatus
- Perineal ecchymosis
- Blood in the scrotum
- High riding prostate
- Pelvic Fxs
In a trauma, what type and how many IVs should be placed?
2 large bore IVs
What causes compression/collapse of right side of the heart?
Cardiac tamponade
If you are suspicious of urethral injury, what should be performed prior to insertion of a catheter?
A retrograde urethrogram
In trauma pts brought to the trauma bay “cracking the chest” is otherwise known as what type of procedure?
ED thoracotomy
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?
Penetrating trauma to chest with low velocity weapon
How effective is an ED thoracotomy? (percentage)
~10%
During the ABCDEs, what are your two main concerns in regards to disability? (anatomically speaking)
The brain and the spine
If you find a spinal cord injury within the first 8 hours of its occurrence, what should you administer to the pt?
High dose steroids
If you suspect increased ICP, what should you do to the head of the patient’s bed?
Elevate it
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”?)
The back! (also, if considering puncture wounds, the axillae)
If there is an obvious major injury/violation of chest/abd, where should you immediately send the patient?
The OR
When a patient presents with these three sx, you should have a high suspicion for abd trauma…
Tachycardia, hypotension, and abdominal tenderness
T/F Patients with abd trauma can be asymptomatic early on
True
A ____ exam can be a useful early screening tool for abd trauma (hint: type of imaging)
FAST exam (Focused Assessment with Sonography for Trauma)
Free fluid without solid organ injury is a _____ _____ injury until proven otherwise
hollow viscous
A hollow viscous injury can involve the ___, ___, or ___ (hint: think organs)
Stomach, bowel, or mesentery
What type of injuries can result in bucket-handle tears of mesentery?
Deceleration
Small bowel and colon injuries result most often from what type of trauma?
Penetrating
Hollow viscous injury sx are a result from a combination of ___ ___ and___ ___
blood loss and peritoneal contamination
What is the most commonly injured organ in blunt trauma?
Spleen
T/F Splenic injury often needs to be managed operatively
False, splenic injury often can be managed non-operatively
Pain in what area may be indicative of splenic injury?
Left lower rib
T/F Splenic injury is often associated with other injuries
True
What is the second most common type of solid organ injury?
Liver
T/F Liver injury is often associated with other injuries
True
Is liver injury difficult to manage surgically?
Yes, it is
What imaging study visualizes solid organs and vessels well?
Abdominal CT scan
What do CT scans NOT see well? (think certain types of injury and anatomical structures)
Hollow viscous, duodenum, diaphragm, omentum
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?
There is an increase in mortality related to cancer from CT scans
What is the goal of a FAST exam?
To evaluate for free fluid
How many views does a FAST exam have? What are they? (Think chest/abd regions)
4 views: Cardiac, RUQ, LUQ, suprapubic
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
- Primary Survey
- Secondary Survey
- FAST exam
- CT Head or Pelvis
- Home/Observation/Non-Emergent OR
Is there an “I” in trauma? ;)
Trauma is best managed by a team approach
