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Clinical Disciplines-ER > Trauma > Flashcards

Trauma Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Vital signs for trauma activation

A
  1. RR <8 or >20 per minute
  2. SBP <100mmHg
  3. Pulse <50 or >100
  4. GCS <13
  5. O2 sat <90%
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2
Q

Cushings reflex

A
  • Indicated increased ICP:
    1. HTN
    2. Bradycardia
    3. Depressed respiratory
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3
Q

What is aniscoria > 1mm associated with?

A

Intracranial lesion

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4
Q

What is the MCC TBI?

A

MVC

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5
Q

What is the best way to treat increased ICP?

A

Mannitol

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6
Q

Why do you want to avoid prophylactic hyperventilation to PaCO2 <35?

A

Increases ischemia

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7
Q

What does Phenytoin help with?

A

early seizures

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8
Q

Define concussion

A

Transient LOC occurring immediately following non-penetrating blunt head trauma

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9
Q

Basilar skull fracture sx’s

A
  1. Battle sign
  2. Raccoon eyes
  3. Hemotympanum
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10
Q

What does a positive halo sign indicate?

A

CSF leak after a basilar skull fracture

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11
Q

Whats the MCC of an epidural hematoma?

A

Skull fracture that tears the middle meningeal artery

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12
Q

Epidural hematoma clinical manifestation

A

Brief LOC–>Lucid interval–>Coma

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13
Q

CT findings in an epidural hematoma

A

Lens-shaped

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14
Q

does an epidural hematoma cross the suture line?

A

NO

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15
Q

does an epidural hematoma cross the midline?

A

YES

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16
Q

What is the MCC of a subdural hematoma?

A

Venous bleed secondary to tear of BRIDGING VEIN

Acceleration-Deceleration injury

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17
Q

What population are subdural hematoma common in?

A

Elderly

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18
Q

CT findings in a subdural hematoma?

A

Crescent shaped

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19
Q

does a subdural hematoma cross the suture line?

A

YES

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20
Q

does a subdural hematoma cross the midline?

A

NO

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21
Q

Physical exam findings in transtentorial/uncal herniation

A
  1. Fixed dilated pupil-d/t occulomotor nerve compression

2. Contralateral hemiparesis

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22
Q

Progression of sx’s in transtentorial/uncal herniation

A

Hyperventilation –> Decerebrate posturing –> Apnea–>Death

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23
Q

Orbital fracture clinical presentation

A
  1. Periorbital ecchymosis
  2. Lid edema
  3. Chemosis
  4. Subconjunctival hemorrhage
  5. Infraorbital numbness
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24
Q

What are warning signs in a blowout fracture?

A
  1. Enophthalmos
  2. Limited upward gaze
  3. Diplopia with upward gaze 4. Infraorbital anesthesia with inferior muscle entrapment
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25
Q

Treatment in an orbital fracture if they have entrapment of of the inferior rectus muscle?

A
  1. Emergent referral to ENT or OMF

2. Abx

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26
Q

What is the MC facial fracture?

A

Nasal fracture

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27
Q

Treatment for nasal fractures

A
  1. Drain septal hematoma/Control epistaxis bleeding

2. Referral to ENT in 2-5 days

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28
Q

What are the MC causes of mandibular fractures?

A
  1. Assault
  2. MVC
  3. Fall
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29
Q

Physical exam findings in a mandibular fracture?

A
  1. Malaligned teeth

2. Can’t hold tongue depressor down

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30
Q

What is the MCC of spinal trauma?

A

Motor vehicle collisions

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31
Q

Define spinal shock

A

Sudden transient distal areflexia lasting hours to weeks

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32
Q

Signs/sx’s of spinal shock

A
  1. Flaccid quadriplegia: resolves within 24 hours
  2. ↓BP (80-100 SBP)
  3. Paradoxical ↓HR
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33
Q

Clinical findings in spinal shock

A
  1. Paralytic ileus
  2. Urinary retention
  3. Fecal incontinence
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34
Q

Define central cord syndrome

A

Hyperextension injury

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35
Q

Who are central cord syndromes more common in?

A

Elderly

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36
Q

central cord syndromes clinical presentation

A
  1. Weakness, arm > leg
  2. Bladder dysfunction
  3. Sensory loss
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37
Q

central cord syndromes treatment

A

Nonoperatively

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38
Q

Cervical Spinal Cord injury presentation

A
  1. Complete motor paralysis 2. Loss of pain and temperature sensation distal to lesion
  2. Preserved light touch, motion, vibration, and proprioception
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39
Q

Define Brown Sequard

A

Injury to ONE side of cervical spinal cord

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40
Q

Brown Sequard presentation

A
  1. Paralysis
  2. Loss of proprioception and vibratory sensation on lesion side
  3. Loss of pain and temperature on contralateral side
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41
Q

Cause of Brown Sequard

A

Penetrating injury

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42
Q

Flexion Tear drop fracture MOA

A

Sudden forceful flexion

Diving injury

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43
Q

Jefferson burst fracture MOA

A

Axial loving injury causing vertebral inuries

C1 bust fx

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44
Q

Hangmans’s fracture MOA

A

Extreme hyperextension injuries

C2 Pedicle Fx

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45
Q

What would you see on an x-ray in a Hangmans’s fracture

A

C2 slipping forward-Anterior displacement of vertebral body

Fx of pedicle @ C2

46
Q

What thoracolumbar fracture

A

Chance Fracture

47
Q

Spinal Trauma Treatment

A
  1. Inline immobilization/stabilization (not traction)

2. 4 person log roll for emesis

48
Q

What is the MC MOI in neck trauma?

A

Penetrating injury, injuring the platysma

49
Q

List the anatomical structures in the anterior triangle of the neck

A
  1. Carotid
  2. Vertebral Artery
  3. Jugular vein
50
Q

What imaging would you get for neck trauma?

A

CT Angiography

51
Q

What is the most initial treatment/assessment in neck trauma?

A

ABC’s

52
Q

blunt thoracic trauma accounts for what percentage of trauma related deaths?

A

25%

53
Q

Causes for blunt thoracic trauma

A
  1. Direct trauma
  2. Compression
  3. Acceleration/deceleration injuries
54
Q

what blunt thoracic trauma patients have a poor outcome?

A

Cardiopulmonary arrest compared to penetrating trauma

55
Q

When can you close a simple laceration in a blunt thoracic trauma?

A

If it does NOT penetrate pleural

56
Q

What portion of the clavicle is MCly fractured?

A

Middle 1/3=80%

57
Q

Clavicle Fracture treatment

A
  1. Sling

2. Figure-of-8 harness

58
Q

When would surgery be indicated in a clavicle fx?

A
  1. Significant Displacement

2. Distal Fx

59
Q

What is the MCC for sternal fractures?

A

MVC d/t Steering wheel impaction

60
Q

What do sternal fractures have a very high association with? What diagnostics will you order for this?

A

Myocardial Contusion=91%
Seria E’s and EKG’s q8 hrs for 24-36 hrs
Echo: check for motion abnormalities

61
Q

what is the MCC of scapular fractures?

A
  1. High speed MVC

2. Fall form height

62
Q

Scapular Fracture Tx

A
  1. Sling
  2. Ice
  3. Analgesics
  4. Early ROM
  5. Nonsurgical-Most
63
Q

When is surgery indicated a scapular fx?

A

If it involves the:

  1. Glenoid
  2. Coracoid
64
Q

What percentage of rib fractures are NOT seen on a CXR?

A

50%

65
Q

What are you concerned about with fractures of ribs 10-12?

A

Intra-abdominal injury

66
Q

What do you want to avoid with rib fracture treatment? Why?

A

Strapping

Increases risk of pneumonia

67
Q

Define Flail Chest

A
  1. Fx of > 2 segments of > 3 adjacent ribs= Floating segment of ribs
  2. Unstable injury
  3. Impairs ventilation by producing pulmonary contusion
68
Q

Flail Chest treatment

A
  1. Sandbag or direct pressure over involved area

2. Surgery Fixation

69
Q

Define Pulmonary contusion

A

Direct injury to lung causing hemorrhage and edema, in the absence of pulmonary laceration

70
Q

CXR findings in a pulmonary contusion

A

Pulmonary opacity within 6 hours of blunt trauma

71
Q

Pulmonary Contusion Tx

A
  1. Adequate ventilation
  2. Pain control
  3. Chest physiotherapy
72
Q

Pneumothorax sx’s

A
  1. Pleuritic CP-Unilateral, non-exertional
  2. SOB
  3. Tachypnea/Tachycardia
  4. Hypoxia
73
Q

CT US findings in a Pneumothorax?

A

Barcode/stratosphere sign

74
Q

When you can observe a pneumothorax?

A

Ptx < 10% that is not changed on 2 CXR 4-6 hrs apart

75
Q

Tension Pneumothorax sx’s

A
  1. Severe respiratory distress
  2. Decreased BS
  3. Hyperessonance to percussion
  4. Distended neck veins
  5. Tracheal deviation to opposite side
76
Q

Tension Pneumothorax Dx

A

Clinically!!

77
Q

Tension Pneumothorax treatment

A
  1. Need Aspiration: Midclavicular line, 2nd ICS

2. Chest Tube Insertion @ 5th ICS

78
Q

Hemothorax sx’s

A
  1. Decreased BS
  2. DULLNESS to percussion
  3. Hypotension
  4. Hypoxia
  5. JVD
79
Q

What is the best CXR view for a Hemothorax?

A

Upright

80
Q

Define Hamman’s crunch and what it indicates

A

Crunching sound heard over heart during systole

Pneumomediastinum

81
Q

What clinical finding should raise your suspicion for a Pneumomediastinum?

A

Subcutaneous emphysema in neck

82
Q

Beck’s Triad

A

Cardiac Tamponade

  1. JVD
  2. Muffled Heart Sounds
  3. Hypotension
83
Q

Pulsus Paradoxus

A

Cardiac Tamponade sx

10-15 decrease in SBP on inspiration

84
Q

Kussmauls sign

A

Cardiac Tamponade sx

Paradoxical increase in venous distention and pressure during inspiration

85
Q

Electrical Alterans findings on EKG

A

Decreased voltage

86
Q

Cardiac Tamponda treatment

A

Pericardiocentesis

87
Q

MCC of Myocardial Contusion

A

MVC >35 mph

88
Q

Myocardial Contusion Sx’s

A
  1. Sternum Fx!!

2. Arrhythmias

89
Q

Myocardial Contusion treatment

A
  1. Serial cardiac enzymes and EKG’s
  2. Oxygen
  3. Analgesics
90
Q

Traumatic Aorta Rupture

A
  1. Retrosternal or interscapular pain made worse when BP ↑s
  2. SOB
  3. Dysphagia
  4. Stridor
  5. Hoarseness
91
Q

Clinical findings in aortic rupture

A
  1. Acute onset of UE ↑BP
  2. Difference in pulse amplitude between UE and LE
  3. Harsh systolic murmur over pericardium or interscapular areas
92
Q

CXR findings in aortic rupture

A
  1. Superior mediastinal widening > 8cm=MC finding
  2. Deviation of esophagus
  3. Blurring of aortic knob
  4. Tracheal deviation to R
  5. Left pleural effusion
93
Q

How do you diagnose an aortic rupture?

A
  1. TEE
  2. CT
  3. Aortography
94
Q

Aortic rupture treatment

A
  1. Avoid valsalva
  2. Keep SBP < 120mmHG
  3. Surgery
95
Q

Kehr’s Sign

A

Left shoulder pain classically associated with splenic rupture

96
Q

What is the best diagnostic tool to evaluate retroperitoneal injuries?

A

CT

97
Q

What is the MCly injured organ in blunt trauma?

A

Spleen

98
Q

What are splenic injures commonly associated with?

A

Left lower rib fx

99
Q

What is the MCly injured organ in penetrating trauma?

A

Liver

100
Q

Penetrating live injury treatment

A

20% are controlled with suture or hemostatic agents

101
Q

Renal Injury Diagnostics

A
  1. IVP
  2. CT
  3. Angiography
102
Q

Causes for pancreatic injuries

A

Compression of the organ against the spine

  1. Lap belt injury
  2. Bike injury in pads
103
Q

Best imaging for dx of pancreatic injury

A

CT

104
Q

Pancreatic injury Tx

A
  1. Exploratory Laparotomy

2. Intraoperative Pancreatography

105
Q

What is the MCly injured organ with a pelvic fx?

A

Bladder

106
Q

Bladder injury clinical presentation

A
  1. Hematuria

2. Peritoneal signs

107
Q

Bladder injury imaging

A
  1. Cystogram

2. CT with IV contrast

108
Q

You identify that your patient has an open chest wound. What is the significance of this injury?

A

Air moves in and out of wound without exchange of gas

Ineffective ventilation and oxygenation

109
Q

Open wound treatment

A
  1. Cover with 3-sided occlusive dressing-If covered on all 4 sides, then can create tension pneumothorax
  2. Chest tube insertion
110
Q

What is the significance of blood at the urethral meatus, in the setting of a post-trauma patient?

A

Urethral injury

Pelvic fracture

111
Q

How do you evaluate a urethral injury?

A

Retrograde urethrogram or CT with contrast

Clinical Disciplines-ER (4 decks)

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