trauma Flashcards
All patients with blunt trauma require cervical spine immobilization
Yes
most common indication for intubation
altered mental status
What is the indication of emergent tracheostomy
laryngotracheal separation or laryngeal fractures
Treatment of flail chest with underlying pulmonary contusion
require presumptive intubation and mechanical ventilation
treatment of tension pneumothorax
CTT
treatment of open pneumothorax
closure of pneumothorax and CTT
What is the direction of insertion of a CTT
directed superiorly and posteriorly
36F Chest tube
where is the incision of a CTT
4th - 5th ICS MAL
pressure of carotid pulse
60 mmHG
pressure of femoral pulse
70 mmHg
pressure of radial pulse
80 mmHg
Definition of massive hemothorax
- > 1500 ml blood loss
2. 1/3 of blood volume in pediatrics
what is the incision on emergency department thoracotomy
left anterolateral thoracotomy
Indication of emergency department thoracotomy
- witnessed penetrating trauma with < 15 mins of prehospital CPR
- witnessed blunt trauma with < 5 mins of prehospital cpr
Persistent severe post injury hypotension BP <60 mmHg
- cardiac tamponade
- hemorrhage
- air embolism
Layers of the body passed by CTT
- skin
- suuperficial fascia
- serratus anterior
- external intercostal
- internal intercostal
- innermost intercostals
- endothoracic fascia
- parietal pleura
What is the most common cause of cardiogenic shock in a trauma patient
tension pneumothorax
Areas in the body in performing physical exam that needs special attention
- axilla
- back
- perineum
The big three radiographs in BLUNT trauma
- lateral cervical spine
- chest
- pelvic
Radiograph for truncal gunshot wound
- anteroposterior and lateral chest and abdomen
Target INR and PTT of trauma patients
INR < 1.5
PTT < 45 seconds
What are the zones of the neck?
zone 1 - up to the level of cricoid
zone 2 - cricoid up to the angle of mandible
zone 3 - above the mandible
What is the 5 plain radiograph views of the cervical spine
- lateral
- anteroposterior
- transoral odontoid
- bilateral oblique views
Treatment of penetrating neck injury that is asymptomatic
zone I -CT scan neck and chest, CTA esophagogram, bronchoscopy zone II a.transcervical GSW - like zone 1 b. all others - observe zone III -observe
Treatment of penetrating neck injury that is symptomatic, stable
zone I
-CT scan neck and chest, CTA esophagogram, bronchoscopy
zone II
a. operative exploration
zone III
-angiography - Interventional radiography embolization
Treatment of GSW/Stab wound in the abdomen of stable patient
A. GSW
- Anterior abdomen - explore lap
- RUQ, tangential, back or flank - CT scan
B. Stab wound
- back, flank - CT scan
- AASW + LWE - DPL, CT or Serial Exam
Positive Result of DPL
- WBC > 500 ml
- Amylase > 19
- ALP > 2
- Bilirubin >0.01
- RBC
a. AASW > 100,000
b. Thoraco abdominal >10,000
if between 1,000 - 10,000 do laparoscopy or thoracoscopy
Areas of FAST
- subxiphoid
- morison’s pouch/ hepatorenal recess
- LUQ/ perisplenic
- pelvis
> 250 ml blood
What age is cricothyroidotoy is contraindicated
< 8 years old can cause subglottic stenosis
What is the immediate management of air embolism
Trendelenberg position to trap air in the left ventricle
What is the blood loss of a rib fracture
100 to 200 ml
What is the blood loss of a pelvic fracture
> 1000 ml
What is the blood loss of a tibial fracture
300 to 500 ml
What is the blood loss of a femur fracture
800 to 1000 ml
