Trauma Flashcards
primary survey involves
A Airway & C-spine protection B Breathing & Ventilation C Circulation w/ Hemorrhage control D Disability/Neurologic status E Exposure/Environmental control
how to monitor breathing
Inspect for symmetrical chest movements. Auscultate for breath sounds bilaterally. Palpate the trachea for deviation and the chest wall for fractures or emphysema
segment of the rib cage breaks under extreme stress and becomes detached from the rest of the chestwall and moves independently
flail chest
where to do a needle decompression
2nd ICP MCL
universal blood
O-
any hypotensive trauma pt think
hemorrhagic shock
GCS EYE
4-opens spontaneously
3-opens to speech
2-open to pain
1-none
GCS VERBAL
5-oriented 4-confused 3-inappropriate 2-incomprehensible/mumbling 1-none
GCS MOTOR
6-obeys commands 5-moves to pain 4-moves away from pain 3-abnormal flexion 2-abnormal extension (decerebrate) 1-none
two parts of an organ accelerate or decelerate at different rates.
shear
what vessels can be injured in the scalp?
middle meningeal artery or dural sinus
CSF leak
Raccoon Eyes
Battle’s Sign
basilar skull fracture
how to tx closed, uncomplicated skull fx
Symptomatic management
Observation for 2-3 days
No need for Antibiotics
how to tx basilar skull fx
Single dose antibiotic prophylaxis
Do not pack nose or ears to stop CSF leaking (danger of meningitis)
Put patient in semi-sitting position
ICP range
10 mm Hg = Normal
>20 mm Hg = Abnormal
>40 mm Hg = Severe
epidural hematoma
Blood btw skull & dura
Classic: Tear of middle meningeal artery
subdural hematoma
Tears to bridging vessels of cerebral cortex
Rapid surgical evacuation recommended, especially if > 5 mm shift of midline
how to dx SAH
blood in CSF
diffuse axonal injury
CT may initially be normal
seen in high velocity impact
No gross pathology. Transient LOC. CT Scan is normal
concussion
Bruising of brain surface underneath a fracture or at under-surface of frontal & temporal lobes, due to shearing forces Seen on CT scan
contusion
Tearing of brain substance. Seen on CT Scan
laceration
localized in glial cells, myelin sheaths & intercellular spaces. May cause ICP
**May not be seen initially on CT scan.
brain edema
severe brain injury GCS score
moderare
mild
3-8
9-12
13-15
what can you use for severe brain injury with swelling?
hyperventilation
hypertonic-preferable
mannitol
what should you do with penetrating trauma
leave the item in!! get imaging
which part of orbit is MC injured?
floor
enophthlamos, infraorbital anesthesia, diploplia on upward gaze, stepoff deformity
how to control bleeding?
pressure!
gold standard for detecting source of bleed
arteriogram
Non accessible injuries or injuries to the vertebral arteries best managed w/
anticoag 3 months
lesions below ( ) result in paraplegia
T1
Traumatic flexion & distraction
Most pt’s die of brainstem destruction and apnea or have profound neurologic impairments (ventilator dependent and quadriplegic)
Common cause of death in Shaken baby Syndrome
atlanto-occipital dislocation
aka orthopedic decapitation
C1 (atlas) fx
burst/jefferson
MOI Axial loading
Best seen on open mouth view of C1 & C2 region
C1 rotary subluxation
Most often seen in children
May occur spontaneously or w/ minor & major trauma
Persistent rotation of the head (torticollis)
Hangman fx
Posterior elements of C2 (pedicles)
Extension Injury
Anterior dislocation of C2 vertebral body
Transverse fractures through vertebral bodies
MOI: MVC crash w/ restraint only by lap belt
chance fx
Injury to this part of the cord results in bladder and bowel dysfunction as well as decreased sensation & strength to lower extremities
T11-L1
anterior cord syndrome
Complete paralysis below lesion (legs>arms)
Loss of pain & temperature sensation
Preservation of proprioception & vibratory function
central cord syndrome
Quadriparesis- greater in upper extremities
brown sequard
Ipsilateral spastic paresis
Loss of proprioception and vibratory sensation
Contralateral loss of pain & temperature sensation
neurogenic shock
bradycardia
warm skin
nrl urine output
hypovolemic shock
tachy
cold skin
low urine output
