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Nayla clinical disciplines > Trauma > Flashcards

Trauma Flashcards

1
Q

What is blunt thoracic trauma

A

injuries d/t direct trauma, compression, acceleration/deceleration injuries
Blunt trauma+cardiopulmonary arrest= worse outcome than penetrating trauma
-accounts for 1/4 of trauma related deaths

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2
Q

What care do simple vs penetrating lacerations receive

A

Simple lac: can be closed

Penetrating pleural space: cause PTX, treat accordingly

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3
Q

What is the GCS (overview, not specifics)

A

Eyes- 4
Verbal- 5
Motor- 6
(3-15)

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4
Q

What are the EYE scores in GCS

A

4- open spontaneously
3- verbal command
2- painful stimuli
1- no response

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5
Q

What are VERBAL scores in GCS

A 
5- oriented
4- disoriented 
3- inappropriate words 
2- incomprehensible speech 
1- no response
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6
Q

What are MOTOR scores in GCS

A 
6- obeys commands
5- localizes pain
4- flexion withdrawal 
3- Decorticate 
2- Decerebrate 
1- no response
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7
Q

What are key points in a Subdural hematoma

A 
involve VEIN
Blood collects between dura and arachnoid 2/2 tearing of bridging veins (acceleration-deceleration injury) 
Cross SUTURE lines 
Crescent shaped
Common in elderly
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8
Q

What are key points in an Epidural hematoma

A 
involve artery 
Collection of blood between skull and dura 2/2 skull fx tearing MMA
Cross MIDLINE 
Football (lenticular) shaped 
Not common in old
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9
Q

When should you assume abdominal trauma

A

if hypotensive with no chest injury

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10
Q

What is Kehr’s sign

A

referred left shoulder pain associated with splenic rupture (or ectopic)

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11
Q

What are Cullen’s sign and Grey-Turner’s sign

A

indicative of retroperitoneal hemorrhage; do a CT!!

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12
Q

CT’s are not good for evaluating

A

diaphragm, pancreas, or bowel injuries

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13
Q

What is a FAST exam used to assess

A

Morrison’s pouch
splenorenal abscess
Pouch of Douglas

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14
Q

What indicates elevated ICP (>15)

A

*Cushing’s reflex (bradycardia, HTN, decreased respirations)
Elevated ICP associated with head trauma, but if BP is low, think abd

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15
Q

What does an IC lesion cause

A

Anisocoria

paralytics dont affect pupil response

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16
Q

What is a concussion

A

transient LOC immediately after non-penetrating trauma

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17
Q

What is the prognosis of a concussion

A

most resolve spontaneously

Some have persistent HA, memory problems, anxiety, insomnia, dizziness

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18
Q

How do you diagnose and treat a concussion

A

Clinical diagnosis, no imaging

treat with physical and cognitive rest

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19
Q

How do you treat a scalp laceration

A

Close in a layered fashion if deep (scalp has 5 layers and bleeds profusely)
Sutures, staples, glue
**Explore wound after anesthesia

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20
Q

How do you treat a linear, non-displaced fracture with intact skull

A

TRICK QUESTION! no treatment biatch

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21
Q

What are PE findings of a basilar skull Fx

A 
Raccoon eyes 
Battle sign 
Hemotympanum 
CSF is bloody 
\+/- extracranial swelling and blood on XR
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22
Q

What is a transtentorial/uncal herniation

A

Uncus of temporal bone is forced through the tentorial hiatus (tentorium separates cerebrum and cerebellum)

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23
Q

What are PE findings of a transtentorial/uncal herniation

A
  1. CN III compression= fixed ipsilateral pupil
  2. Cerebral peduncle compression= Contralateral hemiparesis
  3. Hyperventilation, Decerebrate, apnea, death
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24
Q

What are the 3 facial fractures (by Le Fort)

A

1: Fx under nasal fossa
2: Fx to maxilla, nasal bone, medial orbit (pyramidal area)
3: Fx to maxilla, zygoma, ethmoid, nasal, base of skull (craniofacial dislocation)

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25
Q

What is the prognosis of facial fractures

A

II and III associated with high level of force= brain and C-spine injury

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26
Q

How do you treat facial fractures

A

Surgery (esp. II and III)

*NO NG or NT tube (can go into brain)

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27
Q

What causes a blowout fracture

A

direct blunt force injury to orbit/globe (weakest ares is floor and medial wall)

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28
Q

What are PE findings in Blowout Fx

A

Periorbital ecchymosis
lid edema
chemosis (conjunctival swell)
subconj. hemorrhage

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29
Q

What are more dangerous Sx 2/2 blowout fracture

A

infraorbital numbness=IR trapped

Enopthalmos, limited upward gaze, diplopia w/ upward gaze, prominent sulcus

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30
Q

What is a common CXR finding in blowout fx

A

Water’s view; tear drop sign

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31
Q

How do you treat blowout Fx

A

refer to ENT or OMF surgery
Emergency if IR trapped
Give ABX and tetanus prophylaxis

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32
Q

What is the MC facial fracture

A

nasal fracture!
MOA direct trauma to nose
Causes epistaxis, nasal septal hematoma, and other facial fractures

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33
Q

What is important about a nasal septal hematoma

A

DRAIN THEM! just like an auricular hematoma

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34
Q

How do you manage a nasal fracture

A

refer to ENT in 2-5 days (swelling has to decrease to know true deformity)

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35
Q

What is the second MC fractured facial bone

A

Mandible, MC at angle, then body, then parasymphysial region
MOA assault, MVC, fall

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36
Q

What are signs of a mandibular fracture

A

teeth malaligned

cant hold tongue depressor while twisting it

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37
Q

What is a central cord C-spine injury

A

hyperextension injury in elderly
Causing arm weakness, bladder dysfunction, and arm sensory loss
Treated NON-operatively

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38
Q

What is an anterior cord C-spine injury

A

Spinal cord injury causing complete motor paralysis and loss of pain/temp distal to lesion
However, light touch, motion, vibration, and proprioception remain intact

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39
Q

What is Brown-Sequard c spine injury

A

Injury to one side of the cord 2/2 penetrating injury
Causing paralysis, loss of proprioception, and vibration on lesion side// loss of pain and temp on contralateral side
*Treat operatively

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40
Q

What is a Flexion tear drop fracture

A

Sudden forceful flexion (diving injury) breaking all 3 columns- highly unstable d/t ligament instability

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41
Q

What is an extension teardrop

A

Sudden extension causing tear drop break more superior

42
Q

What is Hangman’s fracture

A

C2 bilateral pedicle Fx 2/2 hyperextension/ sudden deceleration (hanging)
Unstable, but it actually relieves pressure on the cord

43
Q

What is a Jefferson’s fracture

A

C1 burst fx 2/2 vertical compression (axial load), moderately unstable
Need odontoid view to see broken sides

44
Q

What is Clay Shoveler’s fracture

A

Avulsion fracture of spinous process C6-T1 2/2 flexion (MC C7-C6-T1)

45
Q

What is a Chance Fracture

A

Bone splits horizontally through spinous process, laminae, pedicles, and vertebral 2/2 intra-abdominal injury
Owl eyes on XR

46
Q

What is a wedge/compression fracture

A

2/2 axial load and flexion
Generally stable, no neuro impairment bc front doesnt involve SC, so Tx symptomatically
MC L1-L2-T12

47
Q

How do you treat spinal trauma

A

Immobilize, C-collar, 4 person log roll, back board

Methylprednisone and Sellick’s maneuver no longer recommended

48
Q

What is a neck trauma

A

Penetrating injury violating the platysma, need surgical eval
MOI is penetrating injury

49
Q

What are the causes of death 2/2 neck trauma

A

MC: CNS injury
exsanguination
airway compromise

50
Q

What are Sx of neck trauma

A 
hoarseness
neck pain
hemoptysis
pain with speaking
tracheal deviation
51
Q

What imaging is preferred for neck trauma

A

CT angio!

can also get CXR (might show ptx, htx, pneumomediastinum)

52
Q

How do you manage next trauma

A

Oral ET tube–>Cricothyrotomy–>Tracheostomy
-do NOT blindly clamp vessels, wait until OR to explore
If you suspect a subclavian injury, need at least 1 IV in the LE

53
Q

What is the MC location for a clavicle fx

A

Middle, MOI direct blow

Will notice injured arm slumps in and down

54
Q

How do you treat a clavicle fracture

A

**Sling!

figure 8 harness not really used, surgery for significant displacement and distal Fx

55
Q

What is the MCC of a sternal fracture

A

MVC steering wheel!

also occurs in 8% of blunt chest trauma, esp if elderly

56
Q

What are associated Sx in sternal fracture

A

Myocardial contusion, esp older women (CT can show blood in retroperitoneal space)

57
Q

What diagnostics should you get for a sternal fx

A

Serial electrolytes and ECG q8 hr for 24-36 hrs

Echo for motion abn

58
Q

What is the MCC of a scapular Fx

A

high speed MVC or fall from height (need a LOT of force)

59
Q

How do you treat a scapular fx

A

sling, ice, analgesics

Surgery only if glenoid or coracoid are involved

60
Q

What are rib fractures associated with

A

other underlying injuries
assume serious if ribs 1-2 are Fx
assume intra-abdominal injury if ribs 10-12 fx

61
Q

What diagnostics do you get for rib fractures

A

CXR (even though 50% arent seen on XR)

US to see the break, but not through the bone

62
Q

How do you treat a rib fracture

A

symptomatically

DONT strap, will decrease ventilation, cause atelectasis, and increase PNA risk

63
Q

What is Flail chest

A

Fx of 2+ segments on 3+ adjacent ribs (creates floating segment)
**MCC of hypoxia is lung contusion, not flail chest!!

64
Q

What will you see on PE with a flail chest

A

Paradoxical inward on inspo, outward on expo

65
Q

What does a lung contusion (ass. w/ flail chest) cause (Sx)

A

CP, SOB, tachypnea, HYPOXIA

66
Q

What diagnostics should you get for flail chest

A

CXR (contusion, looks like PNA)

67
Q

How do you treat flail chest

A

Sandbag/direct pressure
Mechanical vent only if in shock, 8+ ribs fx, >65, etc.
For contusion, maintain ventilation, pain control, and chest physiotherapy

68
Q

What is a PTX

A

air in pleural space causing CP, SOB, tachy, tachy, hypoxia

69
Q

What diagnostic for a PTX

A

Expiratory CXR q6 hours with I/E views

US will show barcode sign (instead of seashore sign)

70
Q

How do you treat a PTX

A

Needle decompression at 2ICS at MCL

Chest tube at 5ICS on top of the rib at midaxillary line (avoid tube going into abdomen on inspo

71
Q

What is a tension PTX

A

PTX 2/2 blunt or penetrating trauma, increased pressure causes mediastinal shift, absent vasculature, and deep sulcus sign on CXR

72
Q

What are Sx of a tension PTX

A

Early: CP, dyspnea, anxiety, HYPERRESONANCE, diminished BS
Late: decreased LOC, contralateral trach dev, hypotension, neck vein distention, cyanosis
Respiratory distress
**Dx is clinical, shouldnt get a radiograph to diagnose

73
Q

What is a hemothorax

A

Collection of blood in pleural cavity 2/2 direct lung injury (spontaneously stops bleeding)
can also be 2/2 arterial injury in surgery

74
Q

What are Sx of hemothorax

A

decreased BS, DULL to percussion, hypotension, hypoxia JVD

Get a CXR upright to show you >200ml

75
Q

How do you manage a hemothorax

A

chest tube behind lateral border of pec major, remove blood on full inspo
Thoracotomy if unstable

76
Q

What is an open chest wound

A

“sucking chest” 2/2 penetrating chest or back wound causing aeration of pleural space w/o gas exchange
Intubate if large, pt wont be able to create enough intrapleural pressure

77
Q

What is pneumomediastinum

A

air in the mediastinum +/- laryngeal, tracheal, bronchial, or esophageal injuries
Causes Subcutaneous emphysema in neck

78
Q

What is Hamman’s crunch

A

Crunch over heart during systole in pneumomediastinum

79
Q

What is the MCC of a diaphragm injury

A

penetrating injury to chest or upper abdomen, R/L equally injured
*Will see NG tube curve upward into chest!
Tx with surgery

80
Q

What is cardiac tamponade

A

blood in pericardial sac so heart cant fully expand, MC 2/2 penetrating trauma

81
Q

What is are S/Sx of cardiac tamponade

A

Becks triad (JVD, muffled heart sounds, hypotension)– becks can be absent if hypovolemic
Kussmaul sign (increased venous distention and pressure on inspo)
Electrical alternans and low voltage ECG
+/- RV collapse on US

82
Q

How do you manage cardiac tamponade

A

Pericardiocentesis (paraxiphoid approach pointing to L scap tip) 1/ 18 gauge 20cc syringe
-Use ECG to observe cardiac injury

83
Q

Where else can you see Beck’s triad

A

Tension PTX
acute MI
myocardial contusion
systemic air embolism

84
Q

what is the MCC of a myocardial contusion

A

MVC, especially >35 with chest Sx

Can cause **Sternal fx, AFib, PVC, conduction abnormalities, impaired heart fxn

85
Q

How do you manage myocardial contusion

A

Serial E’s and ECG (if no change in 24 hrs, injury unlikely), Oxygen, analgesics
No prophylaxis for arrhythmias

86
Q

What is the most dangerous chest trauma

A

Traumatic rupture of aorta; MC at aortic isthmus btwn L subclavian and ligamentum arteriosum

87
Q

What are S/Sx of traumatic aortic rupture

A

Retrosternal or intrascapular pain, worse w/ high BP
Dysphagia, stridoe, dyspnea, hoarseness
Suspect if acute onset high UE BP, and difference in pulse bwtn UE and LE
**Harsh systolic murmur over pericardial/intrascapular areas

88
Q

What diagnostics should you get for a traumatic aortic rupture

A

CT*
CXR (sup. mediastinal widening >8cm, esophagus deviated right, blurred aortic knob, elevated R bronchus, left pleural effusion, rib 1-2 fx)
TEE, aortography

89
Q

How do you manage traumatic aortic rupture

A

Avoid valsalva and vomiting
Keep SBP <120
surgery

90
Q

What is pneumoperitoneum

A

air in the peritoneum

Shows up w/ air inferior to lungs on CXR

91
Q

What is the MC injured organ in blunt trauma

A

Spleen!
+/- left lower rib Fx
Graded I-Iv in severity
Peds ruptures are usually non-operative

92
Q

What is the MC injured organ 2/2 penetrating trauma

A

Liver! 50% are non-bleeding

similar grading to splenic injury

93
Q

How do you manage a liver injury

A

Best w/ sutures or hemostatic agents

11% mortality, 22% morbidity if grade IV or V

94
Q

What is the MCC of renal injury

A

Direct impact to flank
Decelerating force
Seen best on CT*, can also do IVP and angiography
Graded by major or minor injuries

95
Q

What is a PE finding of kidney injury

A

Gross microscopic hematuria

96
Q

What is the major MOA of pancreatic injuries

A

compression of the organ against the spine (seat belt lap band only, falling over handle bars)

97
Q

What are common PE findings with pancreatic injury

A

Difficult early detection bc serum amylase is not reliable, and DPL is not diagnostic

98
Q

What imaging should you get for pancreatic injury

A

CT
ERCP
Exploratory laparotomy
inoperative pancreatography

99
Q

What is the MC injury with a pelvic fx

A

Bladder! intra or extraperitoneal

Causes gross microscopic hematuria and peritoneal signs

100
Q

What diagnostics are used in bladder injuries

A

Cystogram (FULL bladder, post evacuation film)

CT w/ contrast

Nayla clinical disciplines (8 decks)

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