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Hippos > Trauma > Flashcards

Trauma Flashcards

1
Q

At what level of shock does hypotension set in?

A

3+

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2
Q

At what level of shock does pulse pressure decrease?

A

2+

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3
Q

What are the percentages of blood loss in I-IV of hemorrhagic shock?

A 
I = 15%
II = 30%
III = 40%
IV = 40%+
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4
Q

What are the pulse rates for the classifications of hemorrhagic shock?

A 
I = less than 100
II = 100-120
III = 120-140
IV = Over 140
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5
Q

What are the components of Beck’s triad?

A
  • Hypotension
  • Muffled heart sounds
  • JVD
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6
Q

What are the general features that are defining for each of the stages of shock?

A 
IV = AMS
III = hypotensive
II= tachy, narrow pulse pressure
I = anxious
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7
Q

What is the most common type of brain herniation, and what is the most commonly associated symptom of this?

A

Subfalcine

Abnl gait

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8
Q

Down and out eye means which CN is affected?

A

III

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9
Q

Describe an uncal herniation.

A

Temporal lobe herniates down through the tentorium cerebelli

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10
Q

What is the presentation of a tonsillar herniation?

A

Coma and death

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11
Q

What becomes mobile with each of the Le Fort fractures?

A 
I = palate
II = nose
III = entire midface
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12
Q

What are the high yield areas of bone fx with Le Fort Fractures?

A 
I = below the nose
II = through the inferior orbits
III = through the Zygomatic arch
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13
Q

What are the s/sx of mandibular fxs?

A
  • Malocclusion
  • Trismus
  • Paresthesias to lower lip
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14
Q

Face fractures are commonly associated with what other injuries?

A

ICH

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15
Q

What is the most common location for mandibular fx:?

A

Condyle

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16
Q

Which Le Fort fx(s) can have CSF rhinorrhea?

A

3

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17
Q

Orbital fractures that involve the sinus need what meds?

A

Abx

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18
Q

What are the borders of Zone II of the neck?

A

Cricoid cartilage to the angle of the mandible

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19
Q

What are the components of the HARD Bruit mnemonic for unstale neck injuries?

A 
Hypotension
Arterial bleeding
Rapidly expanding hematoma
Deficits (neuro, pulse)
Bruit
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20
Q

What are the soft signs of penetrating neck trauma?

A

Hoarse voice
Stridor
SQ emphysema

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21
Q

What is the management for soft signs vs hard signs of penetrating neck trauma?

A 
Hard = OR
Soft = CT angio, +/- scope
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22
Q

What are the three major blunt injuries to the neck that need OR?

A

Pseudoaneurysm
Carotid artery dissection
Tracheal injury

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23
Q

What general physical exam/history findings are concerning for blunt neck trauma? (4)?

A
  • neck seatbelt sign
  • Clothesline injury
  • Steering wheel to the neck
  • Dashboard to neck
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24
Q

What is the management for blunt neck injuries?

A

Airway management ASAP

CT

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25
Q

Blunt neck trauma + neuro findings = what until proven otherwise?

A

Carotid artery dissection

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26
Q

What is the treatment for cardiac contusions?

A

Supportive

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27
Q

What is the most common EKG finding of cardiac contusions?

A

Sinus tachycardia

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28
Q

What is the treatment for a pulmonary contusion?

A

-rpt CXR 6 hr
-Supportive
+/- lung protective vent

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29
Q

What injuries are associated with sternal fx?

A

Myocardial contusions

Mediastinal hematomas

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30
Q

Which rib fractures are particularly bad? (2) Why?

A

1st or 2nd = severe trauma

9-11th ribs = liver/spleen injuries

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31
Q

What are the indications for an ED thoracotomy for a hermathoax? (4)

A
  • Unstable
  • More than 1500 mL of blood
  • More than 200 mL/hr
  • Persistent air leak
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32
Q

What must be done if a PTX exists and you are intubating?

A

Chest tube

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33
Q

What are the two things that will cause a chest tube to not work?

A

tube malfx

Bronchial tear

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34
Q

Where is the incision made in the chest with an ED thoracotomy?

A

5th ICS

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35
Q

Where is the incision made in the pericardium with an ED thoracotomy?

A

Vertical, parallel and anterior to the phrenic nerve

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36
Q

What is the most commonly injured abdominal organ with GSWs? Stab wounds?

A

Small bowel

Liver

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37
Q

What are the borders of the abdomen in terms of penetrating chest trauma?

A

Nipple line to the inferior gluteal fold

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38
Q

True or false; wound exploration is a sterile surgical procedure done in the OR

A

True

39
Q

Where do patients with transabdominal GSWs go?

A

OR

40
Q

What is the Kehr sign?

A

Referred pain to the left shoulder from diaphragmatic injury

41
Q

How good is CT at detecting hallow viscus injuries?

A

Bad

42
Q

What organ is commonly injured with handlebar injuries?

A

Duodenum, pancreas

43
Q

Lap belt injuries most commonly affect which organ?

A

Small bowel injuries

44
Q

What are the rule of 10s for DPLs?

A

If more than 10 mL of blood aspirated initially
If more than 10,000 RBC/mm3 (penetrating) or more than 100,000 RBC/mm3 (blunt)
GO to OR

45
Q

When should retroperitoneal injuries be suspected?

A
  • Sudden deceleration injuries
  • Flank pain/ecchymosis
  • Multi-system trauma
46
Q

How good is CT at picking up retroperitoneal injuries?

A

Very good

47
Q

What is the longest time a penis is recoverable after amputation?

A

8-12 hours

48
Q

What are the physical exam findings concerning for a urethral injury?

A
  • Pelvic fx
  • Gross hematuria
  • Blood at meatus
  • Boggy prostate
  • Perineal bruising
  • Inability to void
49
Q

What must always be done prior to inserting a foley catheter in suspected urethral injury?

A

RUG

CT cystogram

50
Q

What is the dividing line between anterior and posterior urethral injuries?

A

Urogenital diaphragm

51
Q

What are the s/sx of an anterior urethral injury?

A

Hematuria

Swollen penis/scrotum

52
Q

What is a common cause of anterior urethral injuries? Posterior?

A 
Anterior = straddle injury
Posterior = pelvic fx
53
Q

What are the s/sx of a posterior urethral injury?

A
  • Distended bladder

- Normal penis/scrotum

54
Q

What are the indications for a suprapubic catheter?

A

Inability to urinate and need to decompress the bladder

55
Q

What are the contraindications to performing a suprapubic catheter?

A
  • Empty bladder

- Prior surgery or radiation to the bladder

56
Q

What are the s/sx of bladder ruptures?

A
  • Gross hematuria
  • Suprapubic pain
  • Inability to void
57
Q

What is the management for intra and extra peritoneal bladder ruptures respectively?

A 
Intra = OR
Extra = consult uro, cath
58
Q

What is the imaging modality for suspected renan injuries?

A

CT with IV contrast

59
Q

What is the general management for ureteral injuries?

A

OR

60
Q

Are most blunt kidney injuries operative or not?

A

Non-operative

61
Q

How much time do you have to repair a renal avulsion?

A

12 hours

62
Q

Why are renal injuries rarely isolated?

A

Because very well protected in the retroperitoneum

63
Q

What are the components of the “jefferson bit off a hangman’s thumb” mnemonic?

A 
Jefferson (burst) fx
Bilateral facet dislocation
Odontoid fx (type 2, 3)
AA dissociation
Hangman
Teardrop
64
Q

What is a Jefferson fx?

A

Burst fx of C1

65
Q

Why are facet dislocations unstable?

A

Can impinge on the spinal cord

66
Q

What is a hangman’s fracture?

A

C2 pedicular fracture

67
Q

What are teardrop fractures, and why are they unstable?

A

Fx of the anterior part of the vertebral body, can cause retropulsion of the vertebral body and compress spinal cord

68
Q

What is the usual mechanism of a lumbar fx?

A

fall from height or axial loading

Lap belt injury

69
Q

What are wedge fractures?

A

Fractures of the anterior or posterior part of the vertebral body that cause a wedge shape

70
Q

Why are burst fractures of the vertebral body unstable?

A

Retropulsion of the vertebral body fragments can cause spinal cord damage

71
Q

What are chance fractures?

A

Disruption of all three columns of the vertebral body

72
Q

What sort of mechanism produces central cord syndrome?

A

Hyperextension injury

73
Q

Cape like distribution of decreased sensation = ?

A

Central cord

74
Q

What sort of mechanism produces anterior cord syndrome?

A

Hyperflexion

75
Q

When do pain and temp neurons and proprioception neurons decussate respectively?

A

Pain and temp at the level

Dorsal columns at the medulla (medial lemniscus)

76
Q

Where is the L1 dermatome?

A

Inguinal ligament

77
Q

Post void residual over how many mLs is concerning for cauda equina?

A

50-100 mL

78
Q

How do you determine when spinal stun has resolved?

A

When bulbocavernosus reflex returns

79
Q

What is the number to remember with compartment syndrome?

A

30 mmHg (difference between dBP and compartment syndrome less than 30 mmHg or compartment pressure alone is over 30, = compartment syndrome)

80
Q

What two things must be done for all flexor tendon injuries? (test, call)

A
  • X-ray to rule out FBs

- Hand consult

81
Q

What tendon injury produces a mallet finger?

A

Extensor tendon injury

82
Q

What tendon injury produces a boutonniere’s deformity?

A

central slip of the extensor tendon

83
Q

What tendon injury produces a jersey finger?

A

Flexor digitorum profundum

84
Q

What is the viability time for an avulsed finger?

A

6 hours

85
Q

How do you properly preserve an amputated finger?

A

Wrap in saline, then place in bag. Add another bag of ice to outside. Never place directly on ice

86
Q

What lab test, and imaging are needed for pregnant traumas? (3)

A
  • Type/screen
  • US
  • Fetal stress test
87
Q

What position should pregnant women who sustain trauma be placed in?

A

Left lateral decubitus

88
Q

What is the normal fetal heart rate?

A

120-160

89
Q

What is the timeframe for administering rhogam after maternal trauma?

A

72 hours

90
Q

When should you begin a perimortem c-section?

A

if CPR ongoing for more than 5 minutes

91
Q

How many fingerbreadths above the umbilicus indicated about 24 weeks gestation?

A

4 finger breadths

92
Q

What are the indications for a perimortem c-section?

A
  • Witnessed arrest
  • CPR ongoing for 5 minutes
  • at least 24 weeks gestation
93
Q

What are the four parts to blast injuries?

A
  1. Blast wave overpressure
  2. Shrapnel
  3. You are thrown
  4. Burns/smoke/collpase

Hippos (23 decks)

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