Trauma Flashcards
What is subcutaneous emphysema?
Air under the skin
Where can you get subcutaneous emphysema?
Anywhere air can get in; especially in the chest
What does DIC stand for?
Disseminated Intravascular Coagulation
What happens during DIC?
You begin bleeding from every orifice due to all of the body’s clotting factors already being used up
What types of patients can get DIC?
Any patient that has a massive insult to the body. Especially prevelant in septic patients or patients that have a massive liver trauma
What is a transected aorta?
An aorta that is sliced clear through
Where does an aorta normally transect?
The aortic arch
GSC scoring for eye opening
4 - Spontaneous
3 - Voice
2 - Pain Stimulation
1 - None
GCS scoring for Verbal
5 - Oriented Conversation 4 - Confused Conversation 3 - Inappropriate Words 2 - Incomprehensible Sounds 1 - None
GCS scoring for Motor
6 - Obeys Commands
5 - Localizes Pain
4 - Withdraws to Pain
3 - Abnormal Flexion of Arms & Extension of Legs (Decorticate Posturing)
2 - Abnormal Extension of Arms & Legs (Decerebrate Posturing)
1 - None
BSA for Burnt Head?
9%
BSA for Burnt Anterior Trunk?
18%
BSA for Burnt Chest?
9%
BSA for Burnt Abdomen?
9%
BSA for Burnt Back?
18%
BSA for Burnt Arm?
9%
BSA for Burnt Upper Arm?
4.5%
BSA for Burnt Forearm?
4.5%
BSA for Burnt Leg?
18%
BSA for Burnt Thigh?
9%
BSA for Burnt Lower Leg?
9%
BSA for Burnt Groin?
1%
BSA for Burnt Palm?
1%
What is the Parkland Formula?
4 x BSA Burnt x Weight (kg)
S/S of Hemothorax?
Hypovolemic Shock
Ventilatory Insufficiency
Lack of Tracheal Deviation
Dullness on Percussion
Diff. Diagnosis for Hemothorax?
Supportive Treatment
Rapid Transport
Fluid Resuscitation
Needle Decompression
S/S of Pneumothorax?
Diminished / Absent / Unequal Breath Sounds Chest pain on affected side Dyspnea Hypoxia Pulsus Paradoxes
Diff. Diagnosis for Pneumothorax?
Manage ABCs
O2
Inspect for Wounds
S/S of Open Pneumothorax?
Open / Bubbling / Sucking Chest Wound Tachycardia Tachypnea Restlessness Hyper Resonant Percussion Sound
Diff Diagnosis for Open Pneumothorax?
Place gloved hand over wound IMMEDIATELY
Apply Occlusive Dressing
O2
Burp wound when necessary
Key symptom differences between Hymothorax vs Pneumothorax?
Hypovolemia
Percussion
What is Pulsus Paradoxes?
A drop in blood pressure
S/S of Tension Pneumothorax?
Absence of Breath Sounds on Affected Side Chest Pain on Affected Side Dyspnea Hypoxia Pulsus Paradoxes
Narrow Pulse Pressure
V-Fib
JVD
Tracheal Deviation
Diff. Diagnosis for Tension Pneumothorax?
Manage ABCs
O2
Inspect for Wounds
Needle Decompression
S/S of Cardiac Contusion?
Respiratory Distress Hypoxia / CO2 Retention Rails, Rhonchi, Wheezes, Diminished Lung Sounds on affected side Possible Hemoptysis Beck's Triad
Blunt Chest Trauma & They start throwing PVCs, it’s probably a contusion
Diff. Diagnosis for Cardiac Contusion?
Manage ABC’s
Use caution to avoid edema when administering fluids
What is Beck’s Triad?
Hypotension w/ Narrow Pulse Pressure
JVD
Muffled Heart Sounds
What is in Upper-Left Abdominal Quadrant?
Stomach
Spleen
Bowel
What is in Lower Right Abdominal Quadrant?
Appendix
What is in Upper-Right Abdominal Quadrant?
Gallbladder
Liver
Intestines
What is Kerhr’s Sign?
Referred pain to the left shoulder from a spleen injury
Why does Kerhr’s sign happen?
Because the sensory nerve for the left shoulder runs through the spleen
Which organs are solid?
Liver
Spleen
Kidneys
Pancreas
Which organs are injured the most during blunt or penetrating trauma?
Pancreas
Which organs bleed the most from trauma?
Solid organs
Which organ should you expect to be injured in all right sided chest & abdominal trauma?
Liver
Which organ should you expect to be injured in fractures of the 7th - 9th ribs?
Liver
Which organ is commonly injured in sports injuries?
Spleen
Which organ is most commonly injured during blunt trauma?
Pancreas
Where is the pancreas located?
Retroperitoneal space
Which organs are hollow?
Large & Small Intestines
Stomach
Bladder
Gallbladder
Which organs are most commonly injured during penetrating trauma?
Large & Small Intestines
Which organs are in the retroperitoneal space?
Part of intestines
Pancreas
Gallbladder
Kidneys
Injury to which organs rarely cause abdominal pain?
Retroperitoneal organs
Which signs can injury to retroperitoneal organs cause?
Grey Turner Sign
Cullen Sign
What is grey turner sign?
Ecchymosis in Flanks
What is Cullen Sign?
Ecchymosis around the umbilicus
What is a Le Forte I Fracture?
Fracture just under the nose
What is a Le Forte II Fracture?
Fracture across bridge of nose down to corners of mouth
What is a Le Forte III Fracture?
Fracture across bridge of nose and around to temples
What is a zygomatic fracture?
Fracture of cheek bones & orbits
S/S of zygomatic fracture?
Flatten face appearance
Loss of sensation over cheek, nose, & upper lip
Paralysis of upward gaze may also be present
Treatment for open abdominal wounds?
Moist Sterile Dressing
Treatment of neck lacerations?
Occlusive Dressing
Manage ABC’s
S/S of head injuries; B/P?
B/P is elevated
S/S of increased ICP?
Hypertension Bradycardia ***Irregular Respirations ***Unequal Pupils ***Vomiting
What is Cushing’s Triad a symptom of?
That your brain is leaving your head through the Foramen Magnum
S/S of Cushing’s Triad?
***Irregular Respirations
Hypertension
Bradycardia
What is Decerebrate Posturing?
Extension of arms & legs
What is Decorticate Posturing?
Flexion of arms & extension of legs
What is Beck’s Triad a sign of?
Cardiac Tamponade
S/S of Beck’s Triad?
JVD
Muffled Heart Tones
Tachycardia
What is Kerhr’s Sign?
Referred left shoulder pain due to spleen injury
What is Herring-Breuer Reflex?
Stretch receptors in the lungs limiting the amount of breath you can take in
Treatment of Cushing’s Triad?
Keep head up
Hyperventilate 20-24 breaths per minute for a short time
Keep EtCO2 30-35
Keep MAP of 60
Treatment of Beck’s Triad?
Diesel Bolus
What is shock?
Hypoperfusion
Why does Hypovolemic Shock occur?
Not enough volume to fill the container
What is Neurogenic Shock?
An interruption in the sympathetic nervous system
The sympathetic nervous system isn’t working but the parasympathetic nervous system does
S/S of Neurogenic Shock?
Since the sympathetic nervous system doesn’t work but the parasympathetic does:
- Bradycardia (No vagus nerve)
- Hypovolemia (No vessel constriction)
- Warm, Flushed Skin (Blood vessels are big and blood is leaking out everywhere)
Treatment of Neurogenic Shock?
Fluids (Address the fluid issue first)
Atropine
Lopressors (Dopamine)
What is the biggest cause of Distributive Shock?
Sepsis
S/S of Distributive Shock?
They go from Tachycardic & Hypertensive to hypovolemic
Treatment for Distributive Shock?
Fluids (Address the fluid issue FIRST)
Levophed
What is Obstructive Shock?
Something’s blocking the blood flow
What are the two most common causes of Obstructive Shock in trauma?
Embolus (you take a steering wheel to the chest) Tension Pneumothorax (no negative pressure in the pleural cavity so the vena cava don't fill all of the way)
3 types of Distributive Shock?
Septic Shock
Neurogenic Shock
Anaphylaxis
What is Cardiogenic Shock?
Pump Failure
S/S of Cardiogenic Shock?
Low BP
Altered LOC
Treatment for Cardiogenic Shock?
Lopressor
What type of shock causes fainting?
Psychogenic (Blood vessels dilate, less O2 to brain, and you faint)
S/S of compensated shock?
B/P is Good
S/S of decompensated shock?
B/P Starts dropping
Cool, Clammy, Pale Skin
Pulses Weak & Thready
Treatment of Impaled Objects?
Stabilize unless they’re compromising airway or CPR
Treatment of profuse bleeding?
Direct pressure
Maybe tourniquet
Causes of Laryngeal Fractures?
Direct Throat Trauma
S/S of Laryngeal Fractures?
Swelling, Bruising
Difficulty Speaking
Hoarse Voice
Stridor, Crepitus
Treatment of Laryngeal Fractures?
Manage ABC’s
DO NOT intubate unless they decompensate!
S/S of Ruptured Diaphragm?
Lung Sounds in Apices but Bowel sounds in bases of lungs
Short of Breath
Treatment of Ruptured Diaphragm?
Transport Upright
Maybe put OG tube down to deflate bowel
S/S of Pulmonary Embolism after a trauma?
Abrupt shortness of breath Sharp Chest Pain Dusky & Cyanotic from nipple line up Bloody Sputum Low B/P
Cause of Anaerobic Metabolism?
Hypoperfusion (body starts breaking down glycogen)
Treatment of Anaerobic Metabolism?
Fluids
O2
Appearance of 1st Degree Burns?
Redness
Blisters
Appearance of 2nd Degree Burns?
Redness
Weeping Blisters
Appearance of 3rd Degree Burns?
Charred Skin
What are baroreceptors?
Sensors in aortic arch & carotid sinuses that detect blood pressure
Where are baroreceptors located?
Aortic Arch
Carotid Sinuses
What do baroreceptors do to the sympathetic nervous system?
Stimulate it
S/S of flail segments?
Paradoxical movement
Severe Rib Pain
Treatment of flail segments?
Pain Management
What are flail segments?
2 or more areas that fracture on the same rib
Treatment for Pregnant Trauma Patients?
Left Lateral Recumbent Position
Why do we put pregnant trauma patients in the left lateral recumbent position?
Keeps baby off inferior vena cava & improves return blood flow
What are the potential life-threatening complications of long bone fractures?
Fat Embolism
Blood Loss
When does anterior cord syndrome occur?
When bone fragments from a blowout fracture sever the anterior chord of the spinal cord
S/S of Anterior Cord Syndrome?
Motor Function, Temperature, & Pain Sense loss from that fracture down
Proprioception is in tact
What is central cord syndrome?
Severing of the central spinal cord
When does central cord syndrome usually occur?
Cervical Spine Injuries
S/S of Central Cord Syndrome?
Extremity Weakness & Burning
Rectal Tone In Tact (Sacral Sparing)
What is Sacral Sparing?
An in tact rectal tone
S/S of Brown-Sequard Syndrome?
One side of the body has a loss of proprioception
Pain & Temperature loss on the opposite side
3 layers of brain (from outside in)?
Dura Matter
Arachnoid
Pia Matter
Where is a subdural hematoma located?
Below the dura matter
S/S of subdural hematoma?
Not many. Usually found on cat scan
May have headache
S/S of Epidural Hematoma?
Initially knocked out, regains consciousness, and goes out again
Nausea
Vomiting
Headach
Where is an epidural hematoma located?
Above the dura matter
S/S of subarachnoid bleed?
Thunderclap headache
What is a cerebral contusion?
Bruise on the brain
S/S of a cerebral contusion?
Repetitive questioning
Nausea
Vomiting
Which has the most potential for severe damage, velocity or mass?
Velocity
Differentiate Decorticate & Decerebrate Posturing
DeCORticate Posturing = (CORE) Arms flexed
Decerebrate Posturing = Arms extended
Which is worse, Decorticate Posturing or Decerebrate Posturing?
Decerebrate Posturing
Potential causes of Rhabdomyolysis?
Compartment Syndrome
S/S of Rhabdomyolysis?
Peaked T Waves Nausea Vomiting Confusion Weakness
Treatment of Rhabdomyolysis?
FLUIDS, FLUIDS, FLUIDS
Bi-Carb & Calcium
Hospital will also give Insulin
B/P goal for IV Fluids in Trauma?
90+ Systolic
Treatment / Care of Amputated Body Parts?
Wrap in Plastic & Place on Ice (not directly on ice tho)
3 Temperature Ranges for stages of Hypothermia
Mild = 89 - 95 Moderate = 82 - 89 Severe = 82 Minus
S/S of Mild Hypothermia
Awake, Lethargic Shivering Numb Extremities Pale Cool to Touch
S/S of Moderate Hypothermia
Decreased LOC No Shivering Bradycardic Bradypneic Incontenant of Urine
S/S of Severe Hypothermia
Unconscious
Rigid Muscles
Weak, Thready Pulse
EtCO2 Goals in ICP cases
35 or less
Over 35 increases vasodialation & edema in brain
Causes of Left Shoulder Pain
Kehr’s Sign
S/S of Retinal Detachment
EMERGENCY!!!
PAINFUL Black Curtain Effect Flashes of Light Blurred Vision Loose Peripheral Vision
S/S of Central Retinal Artery Occlusion
PAINLESS
Sudden loss of vision
S/S of Retinal Detachment vs Central Retinal Artery Occlusion
Retinal Detachment = Painful, gradual loss of vision
Central Retinal Artery Occlusion = Painless, sudden loss of vision
