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ABSITE 2019 > Trauma > Flashcards

Trauma Flashcards

1
Q

Glasgow Coma Scale

A 
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
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2
Q

Most important prognostic indicator from GCS

A

motor score

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3
Q

Lenticular (lens-shaped) deformity on head CT

A

epidural hematoma

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4
Q

Cause of epidural hematoma

A

middle meningeal artery

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5
Q

Diagnosis of abdominal compartment syndrome

A

bladder pressure >25-30

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6
Q

When to do ED thoracotomy:
Blunt Trauma
Penetrating Trauma

A

Blunt: if pressure/pulse lost in ED
Penetrating: if pressure/pulse lost in route to or in ED

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7
Q

How to perform ED thoracotmy

A

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)

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8
Q

Cause of subdural hematoma

A

Tearing of briding veins

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9
Q

Head CT finding for subdural hematoma

A

cresent shaped deformity

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10
Q

Cerbral perfusion pressure

A

CPP = MAP - ICP

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11
Q

Normal ICP

A

10

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12
Q

Elevated ICP

A 
>20
Sedation, parlaysis 
Raise head of bed
Relative hyperventilation 
Mannitol
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13
Q

Cushin’s triad

A

bradycardia
HTN
low respiratory rate

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14
Q

Cause of dilaed pupil (blown pupil)

A

IL temporal lone pressure on CN III

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15
Q

Raccoon eyes

A

Anterior fossa fracture

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16
Q

Battle’s sign

A

Middle fossa fracture (can injure facial nerve CN VII)

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17
Q

Most common site of facial nerve injury

A

Geniculate ganglion

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18
Q

Coagulopathy w/ TBI due to

A

release of tissue thromboplastin

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19
Q

Jefferson Fracture

A

C1 burst

caused by axial loading

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20
Q

Hangman’s fracture

A

C2
caused by distraction and extension
TX: traction + halo

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21
Q

Fracture of dens

A

Type I: above base, stable
Type II: at base, unstable –> fusion/halo
Type III: extends into vertebral body –> fusion/halo

22
Q

3 columns of spine

A

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

23
Q

Spine is considerd unstable when

A

more than 1 spinal column is disrupted

24
Q

Le Fort Type I

A

Maxillary fracture straight across

Tx: reduce, stabilize, intramaxillary fixation, orbital rim suspension wires

25
Q

Le Fort Type II

A

Lateral to nasal bone, underneath eyes towards maxilla

Tx: reduce, stabilize, intramaxillary fixation, orbital rim suspension wires

26
Q

Le Fort Type III

A

Lateral orbital walls

Tx: suspension wiring to stable frontal bone

27
Q

Persistent nose bleed

A

Likely posterior, try balloon tamponade then angioembolization of internal maxillary artery

28
Q

Neck Zone 1

A

Clavicle to cricoid cartilage
Need angiography, bronchoscopy, esophagoscopy, barium swallow
May need median sternotomy to repair injury

29
Q

Neck Zone 2

A

Cricoid to angle of mandible

Need neck exploration

30
Q

Neck Zone 3

A

Angle of mandible to base of skull

Need angiography and laryngoscopy

31
Q

Contained esophageal injury

A

can be observed

32
Q

Small noncontained w/ minimal contamination esophageal injury

A

primary closure

33
Q

neck noncontained esophageal injuries

A

just place drains

34
Q

chest noncontained esophageal injuries

A

chest tubes to drain injury, place spit fistula in neck

will eventualy need esophagectomy

35
Q

Approach to esophageal injuries

A

Neck: left side
Upper 2/3 of thoracic esophagus: right thoracotomy (avoids aorta)
Lower 1/3: left thoracotomy

36
Q

Thyroid injury

A

conrol bleeding w/ sutrue ligation and drainage

37
Q

Chest Tube to Thoracotmy indications

A

> 1500 after initial insertion
250cc/h for 3 hours
2500cc/24h

38
Q

Persistent pneumothorax despite 2 well placed chest tubes

A

Dx: bronchoscopy to look for mucsu plug or tracheobronchial injury

39
Q

Worse oxygenation after chest tube placement

A

May be tracheobroncial injury

40
Q

Where is tear for aortic transection

A

ligamentum arteriosum (just distal to subclavian takeoff)

41
Q

Aortic Transection Tx

A

covered stent endograft (disal transections)

left thoracotomy and repair

42
Q

Penetrating “box” chest injury

A

clavicles, xiphoid process, nipples (boundaries)

need pericardial window, bronchoscopy,esophagoscopy, barium swallow +/- angiogram

43
Q

Penetrating “out of box” chest injury

A

w/o pneumothorax or hemothorax –> chest tube and serial CXR

44
Q

1st and 2nd rib fractures should make you think of

A

aortic transection

45
Q

Anterior Pelvic fracture source of bleeding

A

venous (pelvic venous plexus)

46
Q

Duodenal trauma repair

A

1st, 3-4th segment: segmental resection w/ primary end to end closure
2nd segment: jejunal serosal patch, pyloric exclusion, gastrojejunosotomy

47
Q

Stacked Coins or Coiled Spring on CT scan

A

paraduodenal hematomas

48
Q

Right & Transverse colon injury treatment

A

primary repair or resect and anastomosis

49
Q

Left colon injury treatment

A

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

50
Q

Rectal trauma (intra peritoneal) injury treatment

A

LAR + diverting loop colostomy is always indicated

51
Q

Rectal trauma (extra peritoneal) injury treatment

A

High rectal: primary repair + diverting loop colostomy
Middle rectal: difficult to reach, place end colostomy only
Low rectal: primary repair w/ transanal approach

52
Q

Most common organ injury w/ blunt trauma

A

liver

ABSITE 2019 (8 decks)

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