Trauma Flashcards
Glasgow Coma Scale
Motor (ARM+LEG) = 6 6 - follows commands 5 - localizes pain 4 - withdraws from pain 3 - flexion w/ pain (decorticate) 2 - extensionw / pain (decerebrate) 1 - no response
VERBAL (VOICE) = 5 5 - oriented 4 - confused 3 - inappropriate words 2 - incomprehensible sounds 1 - no response
Eye opening (EYES) = 4 4 - spontaneous opening 3 - open to command 2 - open to pain 1 - no response
Most important prognostic indicator from GCS
motor score
Lenticular (lens-shaped) deformity on head CT
epidural hematoma
Cause of epidural hematoma
middle meningeal artery
Diagnosis of abdominal compartment syndrome
bladder pressure >25-30
When to do ED thoracotomy:
Blunt Trauma
Penetrating Trauma
Blunt: if pressure/pulse lost in ED
Penetrating: if pressure/pulse lost in route to or in ED
How to perform ED thoracotmy
Through 4th/5th intercostal spaces using anterolateral approach
Pericardium opened anterior to phrenic nerve
Heart rotated out of the way
Cross clamp aorta (watch for esophagus which is anterior to aorta)
Cause of subdural hematoma
Tearing of briding veins
Head CT finding for subdural hematoma
cresent shaped deformity
Cerbral perfusion pressure
CPP = MAP - ICP
Normal ICP
10
Elevated ICP
>20 Sedation, parlaysis Raise head of bed Relative hyperventilation Mannitol
Cushin’s triad
bradycardia
HTN
low respiratory rate
Cause of dilaed pupil (blown pupil)
IL temporal lone pressure on CN III
Raccoon eyes
Anterior fossa fracture
Battle’s sign
Middle fossa fracture (can injure facial nerve CN VII)
Most common site of facial nerve injury
Geniculate ganglion
Coagulopathy w/ TBI due to
release of tissue thromboplastin
Jefferson Fracture
C1 burst
caused by axial loading
Hangman’s fracture
C2
caused by distraction and extension
TX: traction + halo
Fracture of dens
Type I: above base, stable
Type II: at base, unstable –> fusion/halo
Type III: extends into vertebral body –> fusion/halo
3 columns of spine
Anterior: anterior 1/2 of vertebral body and anterior longitudinal ligament
Middle: posterio 1/2 of vertebral body and posterior longitudinal ligament
Posterior: facet joints, lamina, spinous processes
Spine is considerd unstable when
more than 1 spinal column is disrupted
Le Fort Type I
Maxillary fracture straight across
Tx: reduce, stabilize, intramaxillary fixation, orbital rim suspension wires
Le Fort Type II
Lateral to nasal bone, underneath eyes towards maxilla
Tx: reduce, stabilize, intramaxillary fixation, orbital rim suspension wires
Le Fort Type III
Lateral orbital walls
Tx: suspension wiring to stable frontal bone
Persistent nose bleed
Likely posterior, try balloon tamponade then angioembolization of internal maxillary artery
Neck Zone 1
Clavicle to cricoid cartilage
Need angiography, bronchoscopy, esophagoscopy, barium swallow
May need median sternotomy to repair injury
Neck Zone 2
Cricoid to angle of mandible
Need neck exploration
Neck Zone 3
Angle of mandible to base of skull
Need angiography and laryngoscopy
Contained esophageal injury
can be observed
Small noncontained w/ minimal contamination esophageal injury
primary closure
neck noncontained esophageal injuries
just place drains
chest noncontained esophageal injuries
chest tubes to drain injury, place spit fistula in neck
will eventualy need esophagectomy
Approach to esophageal injuries
Neck: left side
Upper 2/3 of thoracic esophagus: right thoracotomy (avoids aorta)
Lower 1/3: left thoracotomy
Thyroid injury
conrol bleeding w/ sutrue ligation and drainage
Chest Tube to Thoracotmy indications
> 1500 after initial insertion
250cc/h for 3 hours
2500cc/24h
Persistent pneumothorax despite 2 well placed chest tubes
Dx: bronchoscopy to look for mucsu plug or tracheobronchial injury
Worse oxygenation after chest tube placement
May be tracheobroncial injury
Where is tear for aortic transection
ligamentum arteriosum (just distal to subclavian takeoff)
Aortic Transection Tx
covered stent endograft (disal transections)
left thoracotomy and repair
Penetrating “box” chest injury
clavicles, xiphoid process, nipples (boundaries)
need pericardial window, bronchoscopy,esophagoscopy, barium swallow +/- angiogram
Penetrating “out of box” chest injury
w/o pneumothorax or hemothorax –> chest tube and serial CXR
1st and 2nd rib fractures should make you think of
aortic transection
Anterior Pelvic fracture source of bleeding
venous (pelvic venous plexus)
Duodenal trauma repair
1st, 3-4th segment: segmental resection w/ primary end to end closure
2nd segment: jejunal serosal patch, pyloric exclusion, gastrojejunosotomy
Stacked Coins or Coiled Spring on CT scan
paraduodenal hematomas
Right & Transverse colon injury treatment
primary repair or resect and anastomosis
Left colon injury treatment
1: Primary repair
2: left sided colectomy for destructive lesions
3: diverting ileostomy for gross contamination, >6h since injury, >6 units pRBC given
4: if patient is in shock and primary repair can’t be completed –> end colostomy and Hartmann’s pouch
Rectal trauma (intra peritoneal) injury treatment
LAR + diverting loop colostomy is always indicated
Rectal trauma (extra peritoneal) injury treatment
High rectal: primary repair + diverting loop colostomy
Middle rectal: difficult to reach, place end colostomy only
Low rectal: primary repair w/ transanal approach
Most common organ injury w/ blunt trauma
liver
