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CKSx > trauma > Flashcards

trauma Flashcards

1
Q

In the field an airway can

be secured by intubation or cricothyroidotomy. This is called a

A

“definitive airway.”

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2
Q

Intubation in spine injury

A

Another option in that setting is nasotracheal intubation over a fiberoptic bronchoscope.

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3
Q

If severe maxillofacial injuries preclude the use of intubation or intubation is unsuccessful,_________may become necessary

A

cricothyroidotomy

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4
Q

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

A

tracheostomy

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5
Q

Breath sounds indicate________

A

satisfactory ventilation

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6
Q

Pulse

oximetry indicates satisfactory _________

A

oxygenation;

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7
Q

Clinical signs of shock include the following:

A
  • Low BP (<90 mm Hg systolic)
  • Tachycardia (heart rate >100 bpm)
  • Low urinary output (<0.5 ml/kg/h
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8
Q

Hemorrhagic shock tends to cause _________

(CVP), while cardiogenic shock tends to cause elevated CVP with ___________

A

collapsed neck veins due to low central venous pressure

jugular venous distention.

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9
Q

In the setting of trauma, transfusion of blood products should be in a 1:1:1 ratio between _______, ________ and __________

A

packed RBCs, fresh frozen plasma, and platelets

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10
Q

MAP during trauma

A

mean arterial pressure >60 mm Hg should be

maintained to ensure adequate cerebral perfusion

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11
Q

Pericardial tamponade is generally a clinical diagnosis and can be confirmed with ______

A

U/S.

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12
Q

Management requires evacuation of the pericardial space by
1
2
3

A

pericardiocentesis, subxiphoid

pericardial window, or thoracotomy

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13
Q

Intrinsic cardiogenic shock is caused by ______

A 
myocardial damage (e.g. myocardial infarction or
fulminant myocarditis).
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14
Q

___________as a rule requires surgical intervention and repair of the damage.

A

Penetrating head trauma

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15
Q

Signs of a fracture affecting the base of the skull include raccoon eyes, rhinorrhea, otorrhea
or ecchymosis behind the ear ________

A

(Battle’s sign).

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16
Q

Hyperventilation is recommended when there

are signs of herniation, and the goal is________

A

pCO2 35 mm Hg.

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17
Q

_________ occurs in more severe trauma. CT scan shows diffuse blurring of the
gray-white matter interface and multiple small punctate hemorrhages

A

Diffuse axonal injury

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18
Q

_______________ occurs in the very old or in severe alcoholics.

A shrunken brain is rattled around the head by minor trauma, tearing venous sinuses

A

Chronic subdural hematoma

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19
Q

Neck trauma zones

  • zone 1 extends from the ______
  • Zone 2 from the ______
  • Zone 3 from the_______
A

clavicles to the cricoid cartilate

cricoic cartilage to the angle of the mandible

angle of the mandible to the base of the skull

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20
Q 
injuries to zone 1, evaluate with 
1
2
3
4
A

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

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21
Q

For injuries to zone 3, evaluate with ______

A

angiography for vascular injury.

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22
Q

__________ can be deadly in the elderly, because pain impairs respiratory effort, which leads
to hypoventilation, atelectasis, and ultimately, pneumonia

A

Rib fractures

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23
Q

Mx of hemothorax

A

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

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24
Q

Indications for thoracotomy

A
  • 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

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25
Q

_________wounds are obvious from physical exam, as there is a flap that sucks air with
inspiration and closes during expiration

A

Sucking chest

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26
Q

Cx of sucking chest wound

A

Untreated, it will lead to a deadly tension pneumothorax.

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27
Q

___________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).

A

Flail chest

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28
Q 
\_\_\_\_\_\_\_\_\_\_\_ can show up right away after chest trauma with “white-out” of the
affected lung(s) or can be delayed up to 48 hours
A

Pulmonary contusion

29
Q

____________ should be suspected with the presence of sternal fractures. ECG monitoring
will detect any abnormalities.

A

Blunt cardiac injury

30
Q

_________ 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

A

Traumatic rupture of the diaphragm

31
Q

_________ is the ultimate “hidden injury

A

Traumatic rupture of the aorta

32
Q

MC location of aortic rupture

A

junction of the arch and the descending aorta where the relatively mobile aorta is tethered by the ligamentum arteriosum

33
Q

Suspicion of aortic rupture injury should be triggered by one of the following:

A

• 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

34
Q

_______________ is suggested by developing subcutaneous emphysema in the upper chest and lower neck, or by a large “air leak” from a chest tube.

A

Traumatic rupture of the trachea or major bronchus

35
Q

________ should be suspected when sudden death occurs in a chest trauma patient who is intubated and on a respirator.

A

Air embolism

36
Q

Mx of air embolism

A

Immediate management includes cardiac massage, with the patient positioned in Trendelenburg with the
left side down.

37
Q

______may also produce respiratory distress in a trauma patient who may not have
necessarily suffered chest trauma

A

Fat embolism

38
Q

T or F

Any entrance or
exit wound below the level of the nipple line is considered to involve the abdomen

A

T

39
Q

T or F

If the fascia is not violated, the intra-abdominal cavity likely has not been penetrated and no further intervention is necessary.

A

T

40
Q

signs of shock occur when ______ of blood volume is acutely lost, _______ ml in the average-size adult

A

25–30%

~1,500

41
Q

the only places where a volume of blood significant enough to cause shock could “hide” in
a blunt trauma patient that has become unstable

A

abdomen, retroperitoneum, thighs (secondary to a femur fracture), and pelvis

42
Q

Prolonged surgical time and ongoing bleeding can lead to the “triad of death”:

A

hypothermia,

coagulopathy, and acidosis.

43
Q

The ______________ is when the pressure in the peritoneal cavity is elevated and leads to end-organ injury.

A

abdominal compartment syndrome

44
Q

A ________ is the most common source of significant intra-abdominal bleeding in blunt abdominal trauma

A

ruptured spleen

45
Q

The first step for an obvious pelvic fracture in an unstable patient is________

A

external pelvic wrapping for stabilization of the pelvis, which limits the potential space for ongoing
blood loss

46
Q

Next step in pelvic fx injury is?

A

The next step is not surgical exploration but rather angiography

47
Q

In any pelvic fracture, associated injuries have to be ruled out. These include
1
2
3

A

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)

48
Q

Penetrating urologic injuries as a rule are_____

A

surgically explored and repaired

49
Q

In pts with suspected urethral injury, what should be done?

A

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

50
Q

What should not be done in pts with urethral injury?

A

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

51
Q

Dx of bladder injury

A

Bladder injuries can occur in either sex, are usually associated with pelvic fracture, and
are diagnosed by retrograde cystogram or CT cystography

52
Q

A rare but fascinating potential sequela of injuries affecting the renal pedicle is the
development of an _________

A

arteriovenous fistula leading to CHF.

53
Q

Should renal artery stenosis develop after trauma, _________ is another potential sequela

A

renovascular hypertension

54
Q

Scrotal hematomas can attain alarming size, but typically do not need specific intervention unless the____

A

testicle is ruptured.

55
Q

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

A

Doppler studies or CT angiogram

56
Q

Crushing injuries of the extremities resulting in myonecrosis pose the hazard of
1
2
3

A

hyperkalemia and renal failure as well as potential development of compartment syndrome

57
Q

preventive measures for the acute kidney injury

A

Aggressive fluid administration, osmotic diuretics, and alkalinization of the urine with sodium bicarbonate

58
Q

Chemical burns require

A

massive irrigation to remove the offending agent.

59
Q

What are the cx of high volatge burns

A

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

60
Q

What is the rule of 9s

A

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

61
Q

What is the Parkland formula

A

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.

62
Q

How to infuse IVF in burns

A

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

63
Q

Rule of 9s in babies

A

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.

64
Q

Babies need proportionally more fluid than adults, therefore formulas and calculations
in the baby use ________

A

4-6 ml/kg/%.

65
Q

A reliable predetermined rate of infusion for babies is _________

A

20 ml/kg/hour.

66
Q

The standard topical agent for burn is ________

A

silver sulfadiazine

67
Q

If deep penetration is necessary (e.g. a thick eschar or a burn ovar cartilage),___________ is the choice

A

mafenide acetate

68
Q

The most reliable signs of envenomation are

A

severe local pain, swelling, and discoloration developing within 30 minutes of the bite

69
Q

The currently preferred

agent for crotalids is________ of which several vials are usually needed.

A

CROFAB,

CKSx (12 decks)

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