Trauma

Question 1

What are the signs and symptoms most predictive of an intracranial bleed secondary to trauma? What are not predictive of a bleed?

Answer 1

Loss of consciousness, age over 60, amnesia of the event, intoxication, anticoagulation, seizure prior to the injury.

Headache, dizziness, vertigo, nausea and external hematomas or lacerations are not predictive of intracranial bleed. Exception is presence of a depressed skull fracture.

Question 2

What is the most sensitive predictor of a traumatic intracranial lesion?

Answer 2

Declining level of consciousness

This makes serial GCS scores more important than a single one.

Question 3

Under what conditions is imaging not required for a suspected nasal bone fracture?

Answer 3

Pain and swelling is isolated to the bridge of the nose and no other fractures are suspected
Both nares are patent
No septal deviation (nose is straight)
No septal hematoma

Question 4

How soon does a nasal fracture need to be seen by otolaryngology?

Answer 4

10 days for adult
4 days for a kid
Time before fibrosis happens and interventions are more difficult to implement

Question 5

Describe primary blast injuries, give examples

Answer 5

From the shockwave

Tympanic membranes, lungs, eyes, concussion, air filled GI organs

Question 6

Describe secondary blast injuries

Answer 6

From the shrapnel

Penetrating injuries, amputations

Question 7

Describe tertiary blast injuries

Answer 7

THRee=THRow

Objects thrown into the person or the person thrown against something

Question 8

Describe quaternary blast injuries

Answer 8

Environmental contamination from the device

Burn, inhalation, toxic substances

Question 9

Describe quinary blast injuries

Answer 9

Bodily absorption of blast additives

Hypermetabolic state

Question 10

What are the hard signs of vascular injury in neck trauma?

Answer 10

Active hemorrhage, expanding or pulsatile hematoma, bruit, thrill, massive hematemesis/hemoptysis, shock, or aerodigestive tract injury, decreased or absent radial pulse, fluid non-responsive shock, cerebral ischemia

Question 11

What are soft signs of aerodigestive or neurovascular injury in penetrating neck trauma?

Answer 11

Chest tube air leak, dysphagia, dysphonia, dyspnea, focal neuro findings, hematemesis, mediastinal emphysema, non-expanding hematoma, subcutaneous emphysema

Question 12

Which zone of the neck has the highest morbidity and mortality?

Answer 12

Zone I (clavicle to cricoid)

Question 13

Which zone of the neck has best prognosis in traumatic injury?

Answer 13

Zone II (cricoid to mandible) easiest access