Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CSP > Trauma > Flashcards

Trauma Flashcards

1
Q

How should airway be assessed in the primary survey?

A

Airway

Check for airway compromise
􀂃 Ask pt. a question
􀂃 Stridor
􀂃 Orofacial injury or burns
􀂃 Visualise airway and use suction if necessary

Manoeuvres to open airway
􀂃 Jaw thrust

Adjuncts if compromise / potential compromised
􀂃 NPA: gag reflex present
􀂃 OPA: no gag reflex (stop tongue swallowing)

Emergency Airways
􀂃 Needle cricothyroidotomy or surgical cric

Definitive Airways (no risk of aspiration)
􀂃 Endotracheal tube
􀂃 Tracheostomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How should C-spine be managed in primary survey?

A

􀁸 Maintain in-line cervical support to keep neck stable

􀁸 Place pt. in hard-collar and sandbags c¯ tape

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How should breathing be assessed in primary survey?

A 
􀁸 SpO2
􀁸 Inspection of chest
􀁸 Position of trachea
􀁸 RR and chest expansion
􀁸 Breath sounds, vocal resonance
􀁸 Percussion
􀁸 ABG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the signs of tension pneumothorax?

A 
􀂃 Respiratory distress
􀂃 􀄹JVP and 􀄻BP
􀂃 Tracheal deviation + displaced apex
􀂃 􀄻 air entry and 􀄻 VR
􀂃 Hyperresonant percussion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is tension pneumothorax managed?

A

immediate decompression
􀂃 Insert large-bore venflon into 2nd ICS, midclavicular
line.
􀂃 Insert ICD later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How are open sucking chest wounds managed?

A

Convert to closed wounds by covering with damp

occlusive dressing stuck down on 3 sides.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What should be done under circulation in primary survey?

A

􀁸 Two-large bore cannulae (14/16G) in each ACF

􀁸 FBC, U+E, x-match (6U), clotting, VBG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is circulation assessed in the primary survey?

A

􀁸 Inspection: pale, sweaty, active bleeding
􀁸 Vascular status: BP, HR, JVP, heart sounds, cardiac
mon
􀁸 End-organ: consciousness, UO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how is disability assessed in the primary survey?

A

􀁸 Assess consciousness using AVPU or GCS

􀁸 Pupil responses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is exposure assessed in the primary survey?

A

􀁸 Completely undress pt.

􀁸 Perform log-role and PR
Feel for high riding prostate (urethral rupture)
Look for bleeding

􀁸 Prevent hypothermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What should be covered under the history of the secondary survey?

A

AMPLE

􀁸 Allergies
􀁸 Medication
􀁸 PMH
􀁸 Last ate / drunk
􀁸 Events
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What investigations should form part of the secondary survey?

A

􀁸 Trauma series
C-spine: lat + peg
CXR
Pelvis

􀁸 FAST scan (Focussed Assessment c¯ Sonography in
Trauma)

􀁸 CT: when pt. is stable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How should c-spine radiographs be assessed?

A

Views
􀂃 Lateral
􀂃 AP
􀂃 Open-mouth Peg view

Adequacy
􀂃 Must see C7-T1 junction
􀂃 May need swimmer’s view c¯ abducted arm

Alignment: 4 lines
􀂃 Ant. vertebral bodies
􀂃 Ant. vertebral canal
􀂃 Post. vertebral canal
􀂃 Tips of spinous processes

Bones: shapes of bodies, laminae, processes

Cartilage: IV discs should be equal height

Soft tissue
􀂃 Width of soft tissue shadow anterior to upper
vertebrae should be 50% of vertebral width.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the indication for clinical clearance of the c-spine?

A 
Indication: NEXUS Criteria
􀂃 Fully alert and orientated
􀂃 No head injury
􀂃 No drugs or alcohol
􀂃 No neck pain
􀂃 No abnormal neurology
􀂃 No distracting injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is the c-spine clinically cleared?

A

􀂃 Examine for bruising or deformity
􀂃 Palpate for deformity and tenderness
􀂃 Ensure pain-free active movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the indication for radiological clearance of the c-spine?

A

􀂃 Pt. doesn’t meet criteria for clinical clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the modalities for radiological clearance of the c-spine?

A

􀂃 Radiograph initially
- Clear if normal radiograph and clinical exam
􀂃 CT C-spine if abnormal radiograph or clinical exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is neurogenic shock?

A

Disruption of sympathetic nervous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the causes of neurogenic shock?

A

􀁸 Spinal anaesthesia
􀁸 Hypoglycaemia
􀁸 Cord injury above T5
􀁸 Closed head injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does neurogenic shock present?

A

􀁸 Hypotension
􀁸 Bradycardia
􀁸 Warm extremities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is neurogenic shock managed?

A

􀁸 Vasopressors: vasopressin and norad

􀁸 Atropine: reverse the bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is spinal shock?

A

􀁸 Acute spinal cord transection
􀁸 Loss of all voluntary and reflex activity below the level
of injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How does spinal shock present?

A

􀁸 Hypotonic paralysis
􀁸 Areflexia
􀁸 Loss of sensation
􀁸 Bladder retention

24
Q

What are the differentials in life-threatening chest injuries?

A 
ATOMIC
􀁸 Airway obstruction
􀁸 Tension Pneumothorax
􀁸 Open pneumothorax (sucking)
􀁸 Massive haemothorax
􀁸 Intercostal disruption and pulmonary contusion
􀁸 Cardiac Tamponade
25
Q

What is a massive haemothorax and what usually causes it?

A

􀁸 Accumulation of >1.5L of blood in chest cavity

􀁸 Usually caused by disruption of hilar vessels

26
Q

How does massive haemothorax present?

A 
􀁸 Signs of chest wall trauma
􀁸 􀄻BP
􀁸 􀄻 expansion
􀁸 􀄻 breath sounds and 􀄻VR
􀁸 Stony dull percussion
27
Q

How is massive haemothorax managed?

A

􀁸 X-match 6u
􀁸 Large-bore chest drain c¯ hep saline for autotransfusion
􀁸 Thoracotomy if >1.5L or >200ml/h

28
Q

How does flail chest present?

A

􀁸 Ant. or lat. # of >=2 adjacent ribs in >=2 places

􀁸 Flail segment moves paradoxically c¯ respiration

􀁸 decreased Oxygenation
Underlying pulmonary contusion
decreased Ventilation of affected segment

29
Q

What investigations should be carried out in flail chest?

A

􀁸 CXR / CT chest: pulmonary contusion (white)

􀁸 Serial ABGs: decreased PaO2:FiO2 ratio

30
Q

how is flail chest managed?

A

􀁸 O2
􀁸 Good analgesia: PCA, epidural
􀁸 Persistent respiratory failure: PPV

31
Q

What is cardiac tamponade and what usually causes it?

A

􀁸 Disruption of myocardium or great vessels leading to blood in the
pericardium leading to decreased filling and contraction leading to shock
􀁸 Usually results from penetrating trauma

32
Q

how does cardiac tamponade present?

A

􀁸 Beck’s Triad
increased JVP / distended neck veins
decreased BP
Muffled heart sounds

􀁸 Pulsus paradoxus: SBP fall of >10mmHg on inspiration

􀁸 Kussmaul’s sign: increased JVP on inspiration

􀁸 Intensely restless pt.

33
Q

how is cardiac tamponade investigated?

A

􀁸 US: FAST or transthoracic echo
􀁸 CXR: enlarged pericardium
􀁸 increased CVP >12mmHg
􀁸 ECG: low voltage QRS ± electrical alternans

34
Q

how is cardiac tamponade managed?

A

􀁸 Pericardiocentesis: spinal needle in R subxiphoid space
aiming at 45 degrees towards the R tip of left scapula
􀁸 Thoracotomy may be needed

35
Q

Which ribs are usually # and which suggest high energy trauma?

A

􀁸 Usually 5th-9th ribs

􀁸 # of upper 4 ribs = high energy trauma

36
Q

What are the complications of rib #

A

􀂃 Pneumothorax

􀂃 Lacerate thoracic or abdominal viscera

37
Q

how are rib # managed?

A

good analgesiaa

􀂃 NSAIDs + opioids
􀂃 Intrapleural analgesia
􀂃 Intercostal block

38
Q

How are sternal # usually obtained? What is the risk?

A

Usually MVA driver vs. steering wheel

risk of mediastinal injury

39
Q

How are sternal # managed?

A

􀂃 Analgesia, admit, observe
􀂃 Cardiac monitor
􀂃 Troponin: rule out myocardial contusion

40
Q

How is pulmonary contusion usually caused?

A

Usually due to rapid deceleration injury or shock waves

41
Q

how does pulmonary contusion usually present?

A

dyspnoea, haemoptysis, respiratory failure

42
Q

How is pulmonary contusion investigated?

A

􀂃 CXR: opacification

􀂃 Serial ABGs: decreased PaO2:FiO2 ratio

43
Q

How is pulmonary contusion managed?

A

O2, ventilate if necessary

44
Q

What is the cause of myocardial contusion?

A

direct blunt trauma over precordium

45
Q

how is myocardial contusion managed?

A

bed rest, cardiac monitoring, Rx arrhythmias

46
Q

how is myocardial contusion investigated?

A

􀂃 ECG: abnormal, arrhythmias

􀂃 increased troponin

47
Q

how is contained aortic disruption caused

A

Rapid deceleration injury (80% immediately fatal)

48
Q

how does contained aortic disruption present

A

initially stable but become hypotensive

49
Q

how is contained aortic disruption investigated

A

􀂃 CXR: wide mediastinum, deviation of NGT

􀂃 CT

50
Q

how is contained aortic disruption managed?

A

cardiothoracic consult

51
Q

What should raise suspicion of diaphramatic injury?

A

Consider in penetrating injuries below 5th rib or high

energy compression.

52
Q

What investigations should be done in diaphramatic injury?

A

CXR (visceral herniation), CT

53
Q

What should raise suspicion of oesophageal disruption?

A

􀁸 Usually penetrating trauma

􀁸 causing mediastinitis

54
Q

What investigations should be done in oesophgeal disruption?

A

􀂃 CXR: pneumomediastinum, surgical emphysema

􀂃 CT

55
Q

How does tracheobronchial disruption present?

A

􀂃 Persistent pneumothorax

􀂃 Pneumomediastinum

56
Q

How is tracheobronchial disruption managed?

A

thoracotomy

CSP (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions