Trauma Flashcards
Cushing’s reflex
**Signs of ICP
- HTN
- bradycardia
- Irregular respiratory pattern
Most important factor for neuro assessment in head trauma
level of consciousness
Most common cause of traumatic brain injury?
motor vehicle collision
Best treatment for decreasing ICP?
mannitol (osmotic diuretic)
What are key findings on a blowout fracture exam?
- enopthalmos
- Limited upward gaze
- Diplopia with upward gazev
- Loss of sensation below the orbit
What should you do with a patient with a blowout fracture?
- Emergent referral for ENT surgery
- Antibiotics (ex. amoxicillin-clauvulanate, levofloxicin)
- Tetanus prophylaxis
What should you look for on xray for a possible blow out fracture?
Tear drop sign on Water’s view*
What is the first and second most commonly fractured facial bones?
- Nose
2. Mandible
Central Cord Syndrome
- Hyperextension injury
- Arm weakness
- Bladder dysfunction
Anterior cord syndrome
- Complete motor paralysis and loss of pain and temperature sensation distal to lesion
- Preserved light touch, motion, vibration, and proprioception
Brown-Sequard
- one-sided cord injury
- Same side: loss of voluntary motor
- Opposite side: loss of temperature and pain sensation
Spinal injuries fro most severe to least severe
- Flexion teardrop
- Extension teardrop
- Hangman’s
- Jefferson
- Clay shoveler’s
Flexion Teardrop: MOI
- Diving injury
- Sudden forceful flexion
Jefferson Fracture: MOI
C1 burst fracture
-Vertical compressive force
Hangman’s Fracture: MOI
C2 pedicle fracture
-Hyperextension injury
Clay shoveler’s Fracture
Avulsion fracture of spinous process fo C6-T1
-Flexion injury
Where is the most common location of a wedge or compression fracture?
L1, then L2, then T12
unlikely to have neurologic effects
Chance Fracture
- bone splits horizontally through spinous process, laminae, pedicles, vertebral body
- “owl eyes”**
- associated with intra-abdominal injuries
Spinal Trauma: treatment
- Inline immobiliation/stabilization
- Sellick’s Maneuver for intubation
- 4 person log roll for emesis
Which of the zones of neck trauma need angiography?
Zone 1 - below the cricoid cartilage
Zone 2 - above the angle of the mandible
Is a pneumothorax seen best on expiratory or inspiratory view?
expiratory
Flail chest
3 ribs, each broken in two places
- inward motion during inspiration
- outward during expiration
Most common cause of hypoxia in flail chest
lung contusion
How is pulmonary contusion diagnosed?
pulmonary opacity seen within 6 hours of blunt trauma
What will pneumothorax look like on US?
barcode
What is normal lung look like on US?
seashore sign
Where is a chest tube placed for a pneumothorax?
5th intercostal space
Above the rib (to avoid neurovascular bundle)
midaxillary line
Hamman’s crunch
crunching sound heard over the heart during systole
if subcutaneous emphysema in neck (be suspicious)
Beck’s triad
Cardiac tamponade
- JVD
- muffled heart sounds
- Hypotension
Cardiac tamponade: classic signs
- Beck’s Triad
- pulsus paradoxus
- Kussmaul sign - neck veins pop out with taking a breath
- Electrical alternans
- shortened QRS
What fracture is most significantly associated with myocardial contusion
sternum fracture
Traumatic rupture of aorta most commonly involves what?
aortic isthmus (between left subclavian and ligamentous arteriosum)
What is the most common complaint of someone with traumatic rupture of the aorta?
retrosternal or interscapular pain made worse when BP increases
What is the key finding for traumatic rupture of the aorta?
Difference in pulse amplitude between UE and LE
Aorta rupture CXR findings
- Mediastinal widening
- Esophagus deviation to the right***
- Blurring aortic knob
- Tracheal deviation to the right
- Left pleural effusion
Most common organ injured in penetrating trauma is _____
liver
Most common organ injured in blunt trauma is _____
spleen
What type of injury should you assume if patient has trauma and is hypotensive?
Abdominal injury
Kehr’s Sign
Left shoulder pain classically associated with splenic rupture
Best radiographic study for abdominal trauma?
CT
What is the name for the most posterior portion on the right side between the liver and the kidney?
Morrison’s Pouch
