trauma Flashcards
In the field an airway can
be secured by intubation or cricothyroidotomy. This is called a
“definitive airway.”
Intubation in spine injury
Another option in that setting is nasotracheal intubation over a fiberoptic bronchoscope.
If severe maxillofacial injuries preclude the use of intubation or intubation is unsuccessful,_________may become necessary
cricothyroidotomy
In the pediatric patient population (age <12),______________is preferred over cricothyroidotomy
due to the high risk of airway stenosis, as the cricoid is much smaller than in the adult
tracheostomy
Breath sounds indicate________
satisfactory ventilation
Pulse
oximetry indicates satisfactory _________
oxygenation;
Clinical signs of shock include the following:
- Low BP (<90 mm Hg systolic)
- Tachycardia (heart rate >100 bpm)
- Low urinary output (<0.5 ml/kg/h
Hemorrhagic shock tends to cause _________
(CVP), while cardiogenic shock tends to cause elevated CVP with ___________
collapsed neck veins due to low central venous pressure
jugular venous distention.
In the setting of trauma, transfusion of blood products should be in a 1:1:1 ratio between _______, ________ and __________
packed RBCs, fresh frozen plasma, and platelets
MAP during trauma
mean arterial pressure >60 mm Hg should be
maintained to ensure adequate cerebral perfusion
Pericardial tamponade is generally a clinical diagnosis and can be confirmed with ______
U/S.
Management requires evacuation of the pericardial space by
1
2
3
pericardiocentesis, subxiphoid
pericardial window, or thoracotomy
Intrinsic cardiogenic shock is caused by ______
myocardial damage (e.g. myocardial infarction or fulminant myocarditis).
___________as a rule requires surgical intervention and repair of the damage.
Penetrating head trauma
Signs of a fracture affecting the base of the skull include raccoon eyes, rhinorrhea, otorrhea
or ecchymosis behind the ear ________
(Battle’s sign).
Hyperventilation is recommended when there
are signs of herniation, and the goal is________
pCO2 35 mm Hg.
_________ occurs in more severe trauma. CT scan shows diffuse blurring of the
gray-white matter interface and multiple small punctate hemorrhages
Diffuse axonal injury
_______________ occurs in the very old or in severe alcoholics.
A shrunken brain is rattled around the head by minor trauma, tearing venous sinuses
Chronic subdural hematoma
Neck trauma zones
- zone 1 extends from the ______
- Zone 2 from the ______
- Zone 3 from the_______
clavicles to the cricoid cartilate
cricoic cartilage to the angle of the mandible
angle of the mandible to the base of the skull
injuries to zone 1, evaluate with 1 2 3 4
angiography, esophagogram (water-soluble, followed
by barium if negative), esophagoscopy, and bronchoscopy to help decide if surgical
exploration is indicated and to determine the ideal surgical approach
For injuries to zone 3, evaluate with ______
angiography for vascular injury.
__________ can be deadly in the elderly, because pain impairs respiratory effort, which leads
to hypoventilation, atelectasis, and ultimately, pneumonia
Rib fractures
Mx of hemothorax
Chest tube placement is necessary to enable evacuation of the accumulated blood
to prevent late development of a fibrothorax or empyema, but surgery to stop the bleeding is
sometimes required
Indications for thoracotomy
- Evacuation of >1,500 mL when the chest tube is inserted
* Collecting drainage of >1 L of blood over 4 hours, i.e., 250 mL/hr
_________wounds are obvious from physical exam, as there is a flap that sucks air with
inspiration and closes during expiration
Sucking chest
Cx of sucking chest wound
Untreated, it will lead to a deadly tension pneumothorax.
___________occurs with multiple rib fractures that allow a segment of the chest wall to cave in
during inspiration and bulge out during expiration (paradoxical breathing).
Flail chest
\_\_\_\_\_\_\_\_\_\_\_ can show up right away after chest trauma with “white-out” of the affected lung(s) or can be delayed up to 48 hours
Pulmonary contusion
____________ should be suspected with the presence of sternal fractures. ECG monitoring
will detect any abnormalities.
Blunt cardiac injury
_________ shows up with bowel in the chest (by physical exam and
x-rays), almost always on the left side (the liver protects the right hemidiaphragm
Traumatic rupture of the diaphragm
_________ is the ultimate “hidden injury
Traumatic rupture of the aorta
MC location of aortic rupture
junction of the arch and the descending aorta where the relatively mobile aorta is tethered by the ligamentum arteriosum
Suspicion of aortic rupture injury should be triggered by one of the following:
• Mechanism of injury
• Widened mediastinum on chest x-ray
• Presence of atypical fractures such as the first rib, scapula, or sternum, which requires
great force to fracture
_______________ is suggested by developing subcutaneous emphysema in the upper chest and lower neck, or by a large “air leak” from a chest tube.
Traumatic rupture of the trachea or major bronchus
________ should be suspected when sudden death occurs in a chest trauma patient who is intubated and on a respirator.
Air embolism
Mx of air embolism
Immediate management includes cardiac massage, with the patient positioned in Trendelenburg with the
left side down.
______may also produce respiratory distress in a trauma patient who may not have
necessarily suffered chest trauma
Fat embolism
T or F
Any entrance or
exit wound below the level of the nipple line is considered to involve the abdomen
T
T or F
If the fascia is not violated, the intra-abdominal cavity likely has not been penetrated and no further intervention is necessary.
T
signs of shock occur when ______ of blood volume is acutely lost, _______ ml in the average-size adult
25–30%
~1,500
the only places where a volume of blood significant enough to cause shock could “hide” in
a blunt trauma patient that has become unstable
abdomen, retroperitoneum, thighs (secondary to a femur fracture), and pelvis
Prolonged surgical time and ongoing bleeding can lead to the “triad of death”:
hypothermia,
coagulopathy, and acidosis.
The ______________ is when the pressure in the peritoneal cavity is elevated and leads to end-organ injury.
abdominal compartment syndrome
A ________ is the most common source of significant intra-abdominal bleeding in blunt abdominal trauma
ruptured spleen
The first step for an obvious pelvic fracture in an unstable patient is________
external pelvic wrapping for stabilization of the pelvis, which limits the potential space for ongoing
blood loss
Next step in pelvic fx injury is?
The next step is not surgical exploration but rather angiography
In any pelvic fracture, associated injuries have to be ruled out. These include
1
2
3
rectum (do a rectal exam and rigid proctoscopy),
vagina in women (do a pelvic exam);
urethra in men (do a retrograde urethrogram), and bladder (addressed in the next section)
Penetrating urologic injuries as a rule are_____
surgically explored and repaired
In pts with suspected urethral injury, what should be done?
The key issue in any of these is that a Foley catheter should not be inserted, as it
might compound an existing injury, but a retrograde urethrogram should be performed
instead
What should not be done in pts with urethral injury?
The key issue in any of these is that a Foley catheter should not be inserted, as it
might compound an existing injury, but a retrograde urethrogram should be performed
instead
Dx of bladder injury
Bladder injuries can occur in either sex, are usually associated with pelvic fracture, and
are diagnosed by retrograde cystogram or CT cystography
A rare but fascinating potential sequela of injuries affecting the renal pedicle is the
development of an _________
arteriovenous fistula leading to CHF.
Should renal artery stenosis develop after trauma, _________ is another potential sequela
renovascular hypertension
Scrotal hematomas can attain alarming size, but typically do not need specific intervention unless the____
testicle is ruptured.
If the penetration is near a major vessel and the patient is asymptomatic,_______ or _____ is performed and will guide the need for a surgical intervention
Doppler studies or CT angiogram
Crushing injuries of the extremities resulting in myonecrosis pose the hazard of
1
2
3
hyperkalemia and renal failure as well as potential development of compartment syndrome
preventive measures for the acute kidney injury
Aggressive fluid administration, osmotic diuretics, and alkalinization of the urine with sodium bicarbonate
Chemical burns require
massive irrigation to remove the offending agent.
What are the cx of high volatge burns
Additional concerns include myonecrosisinduced
acute kidney injury, orthopedic injuries secondary to massive muscle contractions
(e.g., posterior dislocation of the shoulder, compression fractures of vertebral bodies), and
late development of cataracts and demyelinization syndromes
What is the rule of 9s
head and each of the upper extremities are each assigned 9% of body surface; each lower extremity is assigned two 9% units; and trunk is assigned 4 units of 9% each
What is the Parkland formula
The most widely used calculation is the modified Parkland formula, in which body weight
in kilograms is multiplied by the percentage of burn (as a whole number), and multiplied by
4 ml.
How to infuse IVF in burns
The number obtained is the amount of Lactated Ringer’s (LR) required in the first 24 hours, half of which should be infused in the first 8 hours and the other half in the next 16
hours
Rule of 9s in babies
Babies have bigger heads and smaller legs; thus the “rule of 9s” for them assigns two 9s
to the head, and both legs share a total of three 9’s instead of 4.
Babies need proportionally more fluid than adults, therefore formulas and calculations
in the baby use ________
4-6 ml/kg/%.
A reliable predetermined rate of infusion for babies is _________
20 ml/kg/hour.
The standard topical agent for burn is ________
silver sulfadiazine
If deep penetration is necessary (e.g. a thick eschar or a burn ovar cartilage),___________ is the choice
mafenide acetate
The most reliable signs of envenomation are
severe local pain, swelling, and discoloration developing within 30 minutes of the bite
The currently preferred
agent for crotalids is________ of which several vials are usually needed.
CROFAB,
