Trauma Flashcards
What is blunt thoracic trauma
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
What care do simple vs penetrating lacerations receive
Simple lac: can be closed
Penetrating pleural space: cause PTX, treat accordingly
What is the GCS (overview, not specifics)
Eyes- 4
Verbal- 5
Motor- 6
(3-15)
What are the EYE scores in GCS
4- open spontaneously
3- verbal command
2- painful stimuli
1- no response
What are VERBAL scores in GCS
5- oriented 4- disoriented 3- inappropriate words 2- incomprehensible speech 1- no response
What are MOTOR scores in GCS
6- obeys commands 5- localizes pain 4- flexion withdrawal 3- Decorticate 2- Decerebrate 1- no response
What are key points in a Subdural hematoma
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
What are key points in an Epidural hematoma
involve artery Collection of blood between skull and dura 2/2 skull fx tearing MMA Cross MIDLINE Football (lenticular) shaped Not common in old
When should you assume abdominal trauma
if hypotensive with no chest injury
What is Kehr’s sign
referred left shoulder pain associated with splenic rupture (or ectopic)
What are Cullen’s sign and Grey-Turner’s sign
indicative of retroperitoneal hemorrhage; do a CT!!
CT’s are not good for evaluating
diaphragm, pancreas, or bowel injuries
What is a FAST exam used to assess
Morrison’s pouch
splenorenal abscess
Pouch of Douglas
What indicates elevated ICP (>15)
*Cushing’s reflex (bradycardia, HTN, decreased respirations)
Elevated ICP associated with head trauma, but if BP is low, think abd
What does an IC lesion cause
Anisocoria
paralytics dont affect pupil response
What is a concussion
transient LOC immediately after non-penetrating trauma
What is the prognosis of a concussion
most resolve spontaneously
Some have persistent HA, memory problems, anxiety, insomnia, dizziness
How do you diagnose and treat a concussion
Clinical diagnosis, no imaging
treat with physical and cognitive rest
How do you treat a scalp laceration
Close in a layered fashion if deep (scalp has 5 layers and bleeds profusely)
Sutures, staples, glue
**Explore wound after anesthesia
How do you treat a linear, non-displaced fracture with intact skull
TRICK QUESTION! no treatment biatch
What are PE findings of a basilar skull Fx
Raccoon eyes Battle sign Hemotympanum CSF is bloody \+/- extracranial swelling and blood on XR
What is a transtentorial/uncal herniation
Uncus of temporal bone is forced through the tentorial hiatus (tentorium separates cerebrum and cerebellum)
What are PE findings of a transtentorial/uncal herniation
- CN III compression= fixed ipsilateral pupil
- Cerebral peduncle compression= Contralateral hemiparesis
- Hyperventilation, Decerebrate, apnea, death
What are the 3 facial fractures (by Le Fort)
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)
What is the prognosis of facial fractures
II and III associated with high level of force= brain and C-spine injury
How do you treat facial fractures
Surgery (esp. II and III)
*NO NG or NT tube (can go into brain)
What causes a blowout fracture
direct blunt force injury to orbit/globe (weakest ares is floor and medial wall)
What are PE findings in Blowout Fx
Periorbital ecchymosis
lid edema
chemosis (conjunctival swell)
subconj. hemorrhage
What are more dangerous Sx 2/2 blowout fracture
infraorbital numbness=IR trapped
Enopthalmos, limited upward gaze, diplopia w/ upward gaze, prominent sulcus
What is a common CXR finding in blowout fx
Water’s view; tear drop sign
How do you treat blowout Fx
refer to ENT or OMF surgery
Emergency if IR trapped
Give ABX and tetanus prophylaxis
What is the MC facial fracture
nasal fracture!
MOA direct trauma to nose
Causes epistaxis, nasal septal hematoma, and other facial fractures
What is important about a nasal septal hematoma
DRAIN THEM! just like an auricular hematoma
How do you manage a nasal fracture
refer to ENT in 2-5 days (swelling has to decrease to know true deformity)
What is the second MC fractured facial bone
Mandible, MC at angle, then body, then parasymphysial region
MOA assault, MVC, fall
What are signs of a mandibular fracture
teeth malaligned
cant hold tongue depressor while twisting it
What is a central cord C-spine injury
hyperextension injury in elderly
Causing arm weakness, bladder dysfunction, and arm sensory loss
Treated NON-operatively
What is an anterior cord C-spine injury
Spinal cord injury causing complete motor paralysis and loss of pain/temp distal to lesion
However, light touch, motion, vibration, and proprioception remain intact
What is Brown-Sequard c spine injury
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
What is a Flexion tear drop fracture
Sudden forceful flexion (diving injury) breaking all 3 columns- highly unstable d/t ligament instability
What is an extension teardrop
Sudden extension causing tear drop break more superior
What is Hangman’s fracture
C2 bilateral pedicle Fx 2/2 hyperextension/ sudden deceleration (hanging)
Unstable, but it actually relieves pressure on the cord
What is a Jefferson’s fracture
C1 burst fx 2/2 vertical compression (axial load), moderately unstable
Need odontoid view to see broken sides
What is Clay Shoveler’s fracture
Avulsion fracture of spinous process C6-T1 2/2 flexion (MC C7-C6-T1)
What is a Chance Fracture
Bone splits horizontally through spinous process, laminae, pedicles, and vertebral 2/2 intra-abdominal injury
Owl eyes on XR
What is a wedge/compression fracture
2/2 axial load and flexion
Generally stable, no neuro impairment bc front doesnt involve SC, so Tx symptomatically
MC L1-L2-T12
How do you treat spinal trauma
Immobilize, C-collar, 4 person log roll, back board
Methylprednisone and Sellick’s maneuver no longer recommended
What is a neck trauma
Penetrating injury violating the platysma, need surgical eval
MOI is penetrating injury
What are the causes of death 2/2 neck trauma
MC: CNS injury
exsanguination
airway compromise
What are Sx of neck trauma
hoarseness neck pain hemoptysis pain with speaking tracheal deviation
What imaging is preferred for neck trauma
CT angio!
can also get CXR (might show ptx, htx, pneumomediastinum)
How do you manage next trauma
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
What is the MC location for a clavicle fx
Middle, MOI direct blow
Will notice injured arm slumps in and down
How do you treat a clavicle fracture
**Sling!
figure 8 harness not really used, surgery for significant displacement and distal Fx
What is the MCC of a sternal fracture
MVC steering wheel!
also occurs in 8% of blunt chest trauma, esp if elderly
What are associated Sx in sternal fracture
Myocardial contusion, esp older women (CT can show blood in retroperitoneal space)
What diagnostics should you get for a sternal fx
Serial electrolytes and ECG q8 hr for 24-36 hrs
Echo for motion abn
What is the MCC of a scapular Fx
high speed MVC or fall from height (need a LOT of force)
How do you treat a scapular fx
sling, ice, analgesics
Surgery only if glenoid or coracoid are involved
What are rib fractures associated with
other underlying injuries
assume serious if ribs 1-2 are Fx
assume intra-abdominal injury if ribs 10-12 fx
What diagnostics do you get for rib fractures
CXR (even though 50% arent seen on XR)
US to see the break, but not through the bone
How do you treat a rib fracture
symptomatically
DONT strap, will decrease ventilation, cause atelectasis, and increase PNA risk
What is Flail chest
Fx of 2+ segments on 3+ adjacent ribs (creates floating segment)
**MCC of hypoxia is lung contusion, not flail chest!!
What will you see on PE with a flail chest
Paradoxical inward on inspo, outward on expo
What does a lung contusion (ass. w/ flail chest) cause (Sx)
CP, SOB, tachypnea, HYPOXIA
What diagnostics should you get for flail chest
CXR (contusion, looks like PNA)
How do you treat flail chest
Sandbag/direct pressure
Mechanical vent only if in shock, 8+ ribs fx, >65, etc.
For contusion, maintain ventilation, pain control, and chest physiotherapy
What is a PTX
air in pleural space causing CP, SOB, tachy, tachy, hypoxia
What diagnostic for a PTX
Expiratory CXR q6 hours with I/E views
US will show barcode sign (instead of seashore sign)
How do you treat a PTX
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
What is a tension PTX
PTX 2/2 blunt or penetrating trauma, increased pressure causes mediastinal shift, absent vasculature, and deep sulcus sign on CXR
What are Sx of a tension PTX
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
What is a hemothorax
Collection of blood in pleural cavity 2/2 direct lung injury (spontaneously stops bleeding)
can also be 2/2 arterial injury in surgery
What are Sx of hemothorax
decreased BS, DULL to percussion, hypotension, hypoxia JVD
Get a CXR upright to show you >200ml
How do you manage a hemothorax
chest tube behind lateral border of pec major, remove blood on full inspo
Thoracotomy if unstable
What is an open chest wound
“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
What is pneumomediastinum
air in the mediastinum +/- laryngeal, tracheal, bronchial, or esophageal injuries
Causes Subcutaneous emphysema in neck
What is Hamman’s crunch
Crunch over heart during systole in pneumomediastinum
What is the MCC of a diaphragm injury
penetrating injury to chest or upper abdomen, R/L equally injured
*Will see NG tube curve upward into chest!
Tx with surgery
What is cardiac tamponade
blood in pericardial sac so heart cant fully expand, MC 2/2 penetrating trauma
What is are S/Sx of cardiac tamponade
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
How do you manage cardiac tamponade
Pericardiocentesis (paraxiphoid approach pointing to L scap tip) 1/ 18 gauge 20cc syringe
-Use ECG to observe cardiac injury
Where else can you see Beck’s triad
Tension PTX
acute MI
myocardial contusion
systemic air embolism
what is the MCC of a myocardial contusion
MVC, especially >35 with chest Sx
Can cause **Sternal fx, AFib, PVC, conduction abnormalities, impaired heart fxn
How do you manage myocardial contusion
Serial E’s and ECG (if no change in 24 hrs, injury unlikely), Oxygen, analgesics
No prophylaxis for arrhythmias
What is the most dangerous chest trauma
Traumatic rupture of aorta; MC at aortic isthmus btwn L subclavian and ligamentum arteriosum
What are S/Sx of traumatic aortic rupture
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
What diagnostics should you get for a traumatic aortic rupture
CT*
CXR (sup. mediastinal widening >8cm, esophagus deviated right, blurred aortic knob, elevated R bronchus, left pleural effusion, rib 1-2 fx)
TEE, aortography
How do you manage traumatic aortic rupture
Avoid valsalva and vomiting
Keep SBP <120
surgery
What is pneumoperitoneum
air in the peritoneum
Shows up w/ air inferior to lungs on CXR
What is the MC injured organ in blunt trauma
Spleen!
+/- left lower rib Fx
Graded I-Iv in severity
Peds ruptures are usually non-operative
What is the MC injured organ 2/2 penetrating trauma
Liver! 50% are non-bleeding
similar grading to splenic injury
How do you manage a liver injury
Best w/ sutures or hemostatic agents
11% mortality, 22% morbidity if grade IV or V
What is the MCC of renal injury
Direct impact to flank
Decelerating force
Seen best on CT*, can also do IVP and angiography
Graded by major or minor injuries
What is a PE finding of kidney injury
Gross microscopic hematuria
What is the major MOA of pancreatic injuries
compression of the organ against the spine (seat belt lap band only, falling over handle bars)
What are common PE findings with pancreatic injury
Difficult early detection bc serum amylase is not reliable, and DPL is not diagnostic
What imaging should you get for pancreatic injury
CT
ERCP
Exploratory laparotomy
inoperative pancreatography
What is the MC injury with a pelvic fx
Bladder! intra or extraperitoneal
Causes gross microscopic hematuria and peritoneal signs
What diagnostics are used in bladder injuries
Cystogram (FULL bladder, post evacuation film)
CT w/ contrast
