Trauma Flashcards
At what level of shock does hypotension set in?
3+
At what level of shock does pulse pressure decrease?
2+
What are the percentages of blood loss in I-IV of hemorrhagic shock?
I = 15% II = 30% III = 40% IV = 40%+
What are the pulse rates for the classifications of hemorrhagic shock?
I = less than 100 II = 100-120 III = 120-140 IV = Over 140
What are the components of Beck’s triad?
- Hypotension
- Muffled heart sounds
- JVD
What are the general features that are defining for each of the stages of shock?
IV = AMS III = hypotensive II= tachy, narrow pulse pressure I = anxious
What is the most common type of brain herniation, and what is the most commonly associated symptom of this?
Subfalcine
Abnl gait
Down and out eye means which CN is affected?
III
Describe an uncal herniation.
Temporal lobe herniates down through the tentorium cerebelli
What is the presentation of a tonsillar herniation?
Coma and death
What becomes mobile with each of the Le Fort fractures?
I = palate II = nose III = entire midface
What are the high yield areas of bone fx with Le Fort Fractures?
I = below the nose II = through the inferior orbits III = through the Zygomatic arch
What are the s/sx of mandibular fxs?
- Malocclusion
- Trismus
- Paresthesias to lower lip
Face fractures are commonly associated with what other injuries?
ICH
What is the most common location for mandibular fx:?
Condyle
Which Le Fort fx(s) can have CSF rhinorrhea?
3
Orbital fractures that involve the sinus need what meds?
Abx
What are the borders of Zone II of the neck?
Cricoid cartilage to the angle of the mandible
What are the components of the HARD Bruit mnemonic for unstale neck injuries?
Hypotension Arterial bleeding Rapidly expanding hematoma Deficits (neuro, pulse) Bruit
What are the soft signs of penetrating neck trauma?
Hoarse voice
Stridor
SQ emphysema
What is the management for soft signs vs hard signs of penetrating neck trauma?
Hard = OR Soft = CT angio, +/- scope
What are the three major blunt injuries to the neck that need OR?
Pseudoaneurysm
Carotid artery dissection
Tracheal injury
What general physical exam/history findings are concerning for blunt neck trauma? (4)?
- neck seatbelt sign
- Clothesline injury
- Steering wheel to the neck
- Dashboard to neck
What is the management for blunt neck injuries?
Airway management ASAP
CT
Blunt neck trauma + neuro findings = what until proven otherwise?
Carotid artery dissection
What is the treatment for cardiac contusions?
Supportive
What is the most common EKG finding of cardiac contusions?
Sinus tachycardia
What is the treatment for a pulmonary contusion?
-rpt CXR 6 hr
-Supportive
+/- lung protective vent
What injuries are associated with sternal fx?
Myocardial contusions
Mediastinal hematomas
Which rib fractures are particularly bad? (2) Why?
1st or 2nd = severe trauma
9-11th ribs = liver/spleen injuries
What are the indications for an ED thoracotomy for a hermathoax? (4)
- Unstable
- More than 1500 mL of blood
- More than 200 mL/hr
- Persistent air leak
What must be done if a PTX exists and you are intubating?
Chest tube
What are the two things that will cause a chest tube to not work?
tube malfx
Bronchial tear
Where is the incision made in the chest with an ED thoracotomy?
5th ICS
Where is the incision made in the pericardium with an ED thoracotomy?
Vertical, parallel and anterior to the phrenic nerve
What is the most commonly injured abdominal organ with GSWs? Stab wounds?
Small bowel
Liver
What are the borders of the abdomen in terms of penetrating chest trauma?
Nipple line to the inferior gluteal fold
True or false; wound exploration is a sterile surgical procedure done in the OR
True
Where do patients with transabdominal GSWs go?
OR
What is the Kehr sign?
Referred pain to the left shoulder from diaphragmatic injury
How good is CT at detecting hallow viscus injuries?
Bad
What organ is commonly injured with handlebar injuries?
Duodenum, pancreas
Lap belt injuries most commonly affect which organ?
Small bowel injuries
What are the rule of 10s for DPLs?
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
When should retroperitoneal injuries be suspected?
- Sudden deceleration injuries
- Flank pain/ecchymosis
- Multi-system trauma
How good is CT at picking up retroperitoneal injuries?
Very good
What is the longest time a penis is recoverable after amputation?
8-12 hours
What are the physical exam findings concerning for a urethral injury?
- Pelvic fx
- Gross hematuria
- Blood at meatus
- Boggy prostate
- Perineal bruising
- Inability to void
What must always be done prior to inserting a foley catheter in suspected urethral injury?
RUG
CT cystogram
What is the dividing line between anterior and posterior urethral injuries?
Urogenital diaphragm
What are the s/sx of an anterior urethral injury?
Hematuria
Swollen penis/scrotum
What is a common cause of anterior urethral injuries? Posterior?
Anterior = straddle injury Posterior = pelvic fx
What are the s/sx of a posterior urethral injury?
- Distended bladder
- Normal penis/scrotum
What are the indications for a suprapubic catheter?
Inability to urinate and need to decompress the bladder
What are the contraindications to performing a suprapubic catheter?
- Empty bladder
- Prior surgery or radiation to the bladder
What are the s/sx of bladder ruptures?
- Gross hematuria
- Suprapubic pain
- Inability to void
What is the management for intra and extra peritoneal bladder ruptures respectively?
Intra = OR Extra = consult uro, cath
What is the imaging modality for suspected renan injuries?
CT with IV contrast
What is the general management for ureteral injuries?
OR
Are most blunt kidney injuries operative or not?
Non-operative
How much time do you have to repair a renal avulsion?
12 hours
Why are renal injuries rarely isolated?
Because very well protected in the retroperitoneum
What are the components of the “jefferson bit off a hangman’s thumb” mnemonic?
Jefferson (burst) fx Bilateral facet dislocation Odontoid fx (type 2, 3) AA dissociation Hangman Teardrop
What is a Jefferson fx?
Burst fx of C1
Why are facet dislocations unstable?
Can impinge on the spinal cord
What is a hangman’s fracture?
C2 pedicular fracture
What are teardrop fractures, and why are they unstable?
Fx of the anterior part of the vertebral body, can cause retropulsion of the vertebral body and compress spinal cord
What is the usual mechanism of a lumbar fx?
fall from height or axial loading
Lap belt injury
What are wedge fractures?
Fractures of the anterior or posterior part of the vertebral body that cause a wedge shape
Why are burst fractures of the vertebral body unstable?
Retropulsion of the vertebral body fragments can cause spinal cord damage
What are chance fractures?
Disruption of all three columns of the vertebral body
What sort of mechanism produces central cord syndrome?
Hyperextension injury
Cape like distribution of decreased sensation = ?
Central cord
What sort of mechanism produces anterior cord syndrome?
Hyperflexion
When do pain and temp neurons and proprioception neurons decussate respectively?
Pain and temp at the level
Dorsal columns at the medulla (medial lemniscus)
Where is the L1 dermatome?
Inguinal ligament
Post void residual over how many mLs is concerning for cauda equina?
50-100 mL
How do you determine when spinal stun has resolved?
When bulbocavernosus reflex returns
What is the number to remember with compartment syndrome?
30 mmHg (difference between dBP and compartment syndrome less than 30 mmHg or compartment pressure alone is over 30, = compartment syndrome)
What two things must be done for all flexor tendon injuries? (test, call)
- X-ray to rule out FBs
- Hand consult
What tendon injury produces a mallet finger?
Extensor tendon injury
What tendon injury produces a boutonniere’s deformity?
central slip of the extensor tendon
What tendon injury produces a jersey finger?
Flexor digitorum profundum
What is the viability time for an avulsed finger?
6 hours
How do you properly preserve an amputated finger?
Wrap in saline, then place in bag. Add another bag of ice to outside. Never place directly on ice
What lab test, and imaging are needed for pregnant traumas? (3)
- Type/screen
- US
- Fetal stress test
What position should pregnant women who sustain trauma be placed in?
Left lateral decubitus
What is the normal fetal heart rate?
120-160
What is the timeframe for administering rhogam after maternal trauma?
72 hours
When should you begin a perimortem c-section?
if CPR ongoing for more than 5 minutes
How many fingerbreadths above the umbilicus indicated about 24 weeks gestation?
4 finger breadths
What are the indications for a perimortem c-section?
- Witnessed arrest
- CPR ongoing for 5 minutes
- at least 24 weeks gestation
What are the four parts to blast injuries?
- Blast wave overpressure
- Shrapnel
- You are thrown
- Burns/smoke/collpase
