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X Emergency Med Exam 3 > Trauma > Flashcards

Trauma Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Most common cause of preventably mortality in trauma

A

Hemorrhage!! (CNS injury is most common cause in all trauma deaths tho)

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2
Q

When is there an increased chance of mortality in trauma?

A

Lower Glascow coma scale and older age

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3
Q

Standard of care for trauma patients

A

ATLS (advanced trauma life support)

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4
Q

SALT

A

Sort
Assess
Life saving
Treatment

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5
Q

How to sort in the triage algorithm

A

Walk: assess third
Wave/purposeful movement: assess 2nd
Still/obvious life threat: assess 1st

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6
Q

Lifesaving interventions to try with trauma pt

A

Control major hemorrhage
Open and position airway
Chest decompression
(antidotes maybe)

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7
Q

Levels of trauma center

A

1: high levels of care with leaders in research
2: definitive care in wide range of complex traumas
3: provides initial stabilization, can care for uncomplicated trauma
4/5: initial stabilization and transfer all traumas to definitive care

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8
Q

Primary eval of trauma patient

A 
PPE
Airway
Breathing
Circulation
Disability
Exposure
FAST exam
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9
Q

How to assess consciousness of patient (airway too)

A

Ask simple questions like WHATS YOUR NAME, what happened, where hurt etc

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10
Q

Components of airway assessment in trauma

A

Observe
Inspect
Inspect and palpate (anterior neck)
Unconscious pt (airway and cervical spine protection)

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11
Q

Definitive airways

A 
Endotracheal intubation (in line cervical stabilization)
Surgical cricothyroidtomy
*definitive b/c protects the airway
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12
Q

When to do cricothyroidotomy?

A

Attempt ET intubation first and then cric

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13
Q

Components of breathing assessment in trauma

A

Inspect chest wll
Palpate
Immediate threats to life
Unstable pts get CXR

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14
Q

Signs of pneumothorax

A

Hypotension, dyspnea, ipsilateral decreased breath sounds

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15
Q

Where to do needle decompression with pneumothorax?

A

5th intercostal space, anterior to mid axillary line in adults!!!!
(kids is 2nd intercostal space, MCL)

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16
Q

What do to after needle decompression?

A

Tube thoracostomy

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17
Q

What to do with unstable trauma patient

A 
Anticipate hemo and pneumothorax
Tube thoracostomy (5th intercostal space at midaxillary line)
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18
Q

Components of circulation assessment in trauma

A

Palpate central pulses
Observe (exsanguinating external injury)
Don’t need exact BP (permit to SBP 80-100)
IV catheters (16 gauge)

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19
Q

Treatment of shock

A

1 L crystalloid NS or LR
1-2 units O neg PRBC
Start massive transfusion protocol
1:1:1 PRBC:fresh frozen plasma: platelets

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20
Q

Components of disability and neuro assessment in trauma

A

LOC/mental status (GCS)
Pupils
Motor/sensory (lateralize extremity movement and level of sensation/sensory deficits)
Imaging (motor deficit, spinal cord sensory level)

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21
Q

When to intubate with GCS?

A

< or equal to 8 (max for intubated pt is 10)

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22
Q

Components of exposure assessment in trauma

A 
Visualize body (completely undressed)
Hypothermia <35 C (warm blankets, IVF and blood, warming devices etc)
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23
Q

Lethal triad and acute coagulopathy of trauma/shock

A

Hypothermia (remove wet clothes and warm pt_
Coagulopathy (permit hypotension and give blood products over the crystalloids)
Acidosis (stop the bleeding and treat shock)

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24
Q

What is the secondary survey?

A

Done after primary survey is complete
Head to toe exam
Detailed history and physical exam
Adjunct studies

25
Q

AMPLLE history for secondary survery

A

Allergies Meds PMH Last meal LMP Events that lead to trauma
Antiplatelet or anticoagulation (blood thinners)
Pregnant?

26
Q

What are you looking for in secondary survey: skin

A

Lacerations, abrasions, ecchymosis, hematoma

27
Q

What are you looking for in secondary survey: head and face

A

Inspect and palpate entire bony structure

28
Q

What are you looking for in secondary survey: neck

A

All blunt trauma, assume injury
Distended neck veins
Evaluate C spine

29
Q

What are you looking for in secondary survey: chest

A

Inspect and palpate entire chest wall

Careful auscultation

30
Q

What are you looking for in secondary survey: abdomen

A

Inspect and palpate entire abdomen, can be unreliable

31
Q

What are you looking for in secondary survey: rectum and GU

A

Inspect rectum and perineum

Sign of pelvic injury

32
Q

What are you looking for in secondary survey: MSK

A

Inspect entire length of all 4 extremities: tenderness, deformity,

33
Q

What are you looking for in secondary survey: neuro

A

Serial exams

Status can change over time

34
Q

Nexus C spine rule

A 
Xray unnecessary is pt satisfies ALL of the low risk criteria:
No midline cervical tenderness
No focal neuro deficits
Normal alertness
No intoxication
No painful distracting injury
35
Q

PECARN rule for CT of head in kids younger than 2 YO

A

AMS or GCS<15 or palpable skull fracture is automatic CT

If not: LOC>5 sec, nonfrontal hematoma, not acting normally or severe mechanism then discharge (must decide observation or CT if have either)

36
Q

PECARN rule for CT of head in kids older than 2 yrs

A

AMS or GCS<15 or signs of basilar skull fx is automatic CT

If not: history of LOC, history of vomiting, severe HA or severe mechanism then discharge (must decide observation or CT if have either)

37
Q

What injuries to look for with shoulder seat belt?

A

Blunt carotid or strangle injury

38
Q

Chance fracture

A

Seatbelt pulled the vertebrae back and fractured

39
Q

Diagnostics for secondary survey of abdomen

A

CT with contrast abd and pelvis

FAST u/s

40
Q

Bruising signs to look for in abdomen

A 
Cullens sign (internal abd bleeding can cause bleeding around umbilicus)
Gray turners (flank)
41
Q

Most frequently injured organ in penetrating trauma

A

Liver (2nd most in blunt abd trauma)

42
Q

Most frequently injured organ in blunt trauma in adults

A

Spleen

43
Q

Indications for rectal exam during secondary survey of trauma patient

A

Spinal cord injury (assess sacral sparing)
Pelvic fracture (assess for open fracture)
Penetrating abd fracture (assess for gross blood)

44
Q

When to not use foley in trauma pt

A

Urethral injury so either blood at meatus or pelvic fracture

45
Q

Hard signs of vascular injury from penetrating trauma to extremity

A 
Active or pulsatile bleeding
Expanding hematoma
Pulseless limb
Shock (attributed to vascular injury-no other injury to explain shock)
Compartment syndrome
Bruit thrills (rare)
46
Q

Soft signs of vascular injury from penetrating trauma to extremity

A

Small non expanding hematoma
Venous oozing
History of pulsatile bleeding
Unexplained neuro deficit (Sensory or motor)

47
Q

Abnormal ABI used in lower extremity injury

A
48
Q

Hard vs soft signs indicating tx of extremity penetrating trauma

A

Hard: OR!
Soft: if ABI>.9 the no arterial injury but if ABI

49
Q

Management for fractures (open or closed)

A

Assess neuro and vascular (reduce and get better alignment if cold and pulseless)
Pressure or tourniquet if bleeding
Immobilize to prevent further bleeding
Tetanus and abx

50
Q

6 Ps of compartment syndrome

A 
Pain (worse on passive stretch)
Paresthesia
Pallor
Pulselessness
Poikilothermia
Paralysis
51
Q

Trauma PAN SCAN

A

Non contrast CT of head, maxillary-face, cervical/thoracic/lumbar spine (bony stuff)
CT with contrast chest/abd/pelvis

52
Q

HIV/severe immunodeficiency patients needing tetanus prophylaxis

A

If have contaminated wound (even minor) should get also get TIG regardless of history of tetanus immunizations—all patients <3 or with unknown history of vaccinations will need TIG with all other wounds that aren’t clean and minor

53
Q

What kind of fluids for burn pt?

A

Lactated ringers based on parkland formula

54
Q

How to lay pregnant trauma pt

A

Left lateral decubitus position

55
Q

Perimortem cesarean section after how long of maternal arrest

A

Baby has best survival rate if delivered within 5 min of maternal arrest (remove fetus and continue resuscitation of both mother and fetus)

56
Q

Geriatric considerations for trauma

A

Meds: consider bleeding and hemodynamics (warfarin will increase risk of mortality after trauma significantly)
Must determine if MI or MVC came first
Might have hidden injury

57
Q

How long should you prescribe an opioid for?

A

3 days (other options like gapapentin or lidocaine patches)

58
Q

Inpatient tx

A

Caution with NSAIDs

Augment opiates with non opiods

X Emergency Med Exam 3 (5 decks)

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