Trauma Flashcards
When do you intubate? (GCS)
GCS of 9 or less requires intubation
What leads to hypotension in a tension pneumothorax
Increased intrathoracic pressure decreasing preload
Loss of left heart blood flow due to loss of pulmonary vasculature to affected lung
Compression of mediastinum
Tension pneumothorax is a CLINICAL diagnosis and Xrays are not appropriate in this setting. If tension pneumothorax is suspected, immediate needle decompression is undertaken
Treatment for tension pneumothorax
needle decompression using 14-16 gauge long angiocath inserted at midclavicular line in the second intercostal space, over the rib to avoid the neurovascular bundle
Massive hemothorax
Consider a massive hemothorax in patients in shock with no breath sounds and/or percussion dullness.
Treatment of a hemothorax
placing a large (36 f) chest tube and possibly a trip to the operating room (OR) for hemorrhage control.
How high is the blood pressure if the femoral or carotid are palpable?
If the femoral or carotid are palpable, these suggest a systolic blood pressure of at least 60 mm Hg
How high is the blood pressure if the radial is palpable?
suggests a systolic blood pressure of at least 80 mm Hg.
Not all patients in shock or with circulatory problems are tachycardic. Examples?
Neurogenic shock to sympathetic cord disruption
Beta blockade, Calcium channel blockade
Elderly
Children and young adults
Conditioned athletes start with a lower basal level. Doubling their resting heart rate of 45-50 shows a falsely reassuring heart rate of 90-100.
Classifications of hemorrhagic shock
Class I: Normal BP, Normal to fast HR, <15% blood loss, treat with NS
Class II: Normal to fast HR, Normal to low BP, 15-30% blood loss, treat with NS. Narrowed Pulse Pressure
Class III: Fast HR, Low BP, 30-40% blood loss, treat with NS and blood. Altered Mentation.
Class IV: Fast HR, Low BP, >40% blood loss, treat with NS and Blood. Obtunded.
Disability Neurological check. What does AVPU stand for?
Alert – a fully awake patient.
Voice – the patient responds when verbally addressed. Response to voice can be verbal, motor, or with eyes.
Pain – the patient makes a response on any of the three component measures only when pain stimulus is delivered.
Unresponsive – If the patient does not give any Eye, Voice or Motor response to voice or painful stimuli.
Glasgow Coma Scale
Eyes: 4 – Spont 3 – Loud voice 2 – To Pain 1 - None Verbal: 5 – Oriented 4 – Confused 3 – Inapprop words 2 – Incomprehensible sounds 1 – No Sounds Motor: 6 – Obeys 5 – Localizes to pain 4 – Withdraws to pain 3 – Abnormal flexion posturing 2 – Abnormal extension posturing 1 – None
If a patient has evidence of fluid on FAST exam and is unstable, do you get a CT or go to OR straight?
If the patient is unstable,they should go to OR and NOT to CT scanner
What is the battle sign?
left, ecchymosis behind ear indicative of basilar skull fracture
What is the raccoon’s eyes?
right, periorbital ecchymosis without edema indicative of basilar skull fracture.
Motor Strength
0: Total paralysis
1: Palpable/visible contraction
2: FROM w/gravity eliminated
3: FROM against gravity
4: FROM, less than normal strength
5: Normal strength
In order to clear cervical spine
Alert, not intoxicated Absence of neck pain Absence of midline neck tenderness Absence of distracting injury Absence of sensory or motor complaint
Penetrating trauma to the neck may result in
injury to major vascular structures, pharynx, larynx, trachea, esophagus
Blunt trauma to the neck may result in
crushed larynx, tracheal disruption, expanding hematoma, esophageal leak.
A tracheobronchial tree disruption presents as
present on physical as subcutaneous emphysema. You may notice that after placing a chest tube, the lung refuses to inflate. There may be a persistent air leak. You may need to place a second chest tube, and if this fails, the patient needs to go to the OR.
A pulmonary contusion presents as
may initially present as mild hypoxia but after fluid resuscitation, the corresponding pulmonary edema worsens and so does the hypoxia. This can be diagnosed on chest x-ray (or CT) and is treated by proper oxygenation and ventilation (often with intubation), and maintaining normovolemia.
A blunt cardiac injury presents as
Often the only sign may be an abnormal ECG or tracing on the cardiac waveform. Echocardiography may show a hypokinetic heart. Treatment consists of medicating dysrhythmias that effect hemodynamics.
Traumatic aortic disruption
caused by a rapid acceleration (or deceleration) causing a tear in the aorta. Normally this is immediately fatal, but those who survive may show a widened mediastinum on CXR. This can be confirmed with CT scan or angiography of the aorta and requires prompt surgical correction.
Flail chest
caused by two or more fractures in 2+ contiguous ribs creating a free-floating segment of chest wall. This segment will move in the opposite direction of the rest of the chest wall during inspiration and expiration and disrupts the normal negative-pressure ventilatory mechanics.
What does diminished sphincter tone indicate?
spinal cord injury
