Trauma Flashcards
Trauma peaks for death
- 0-30min major vascular/brain stem injury, 2. 30min-4hr (golden hour) head injury(most common after ED arrival) and hemorrhage( most common cause in 1st hour) death 3. days-wks multi organ failure (infection)
Most common mechanism and organ
Blunt liver trauma (vs spleen)
Penetrating trauma organ injured
small bowel
Best access site for venous cutdown
saphenous at the ankle
Seat belt (chance fracture)
80% have internal injury -> small bowel
goal of Damage control surgery
early control of bleeding and control of contamination
Hemostatic resuscitation indication
more then 4 prbc in 1 hour or 10 / 24hr
hemostatic resuscitation
1:1:1
diagnostic peritoneal lavage
positive if >10ccblood, 100,000rbc/cc or gross contaminate
FAST = focused abdominal Sonography for Trauma
perihepatic/perisplenic/pelvis and pericardium
Abdominal Compartment Pressure
Distended abdomina, increased airway peak pressures, prolonged transport time. decreased urine output. Bladder pressure >25-30mmHG
Indication for ED thoracotomy
Blunt trauma: pulses/pressure lost in ED
Penitrating Trauma: pulses/pressure lost in route to ED
Thoracotomy step
anterior/lateral 4-5th intercostal space. open pericardium ant phrenic nerce, cross clamp aorta
What hormones increase after trauma (which doesnt)
ADH, ACTH and glucagon (thyroid does not)
Indications for Head CT, 7+ reasons for…
- Skull penitration, 2.CSF/Blood from nose 3.hemotympanie/csf ears 4. head injury with intoxication 5. altered mentation at exam 6.neurologic deficits 7. unconcious
Epidural hematoma
Arterial bleed from middle menigeal, lens shaped deformity, lucid interval, operate with shift >5mm
Sub dural hematoma
Tearing of venous plexus, crescent shape CT, mass effect >1cm or decline in mentationto OR
Intra cebebral hematoma
usually frontal or temportal can cause mass effect requiring OR
Diffuse Axonal injury exam of choice
Is MRI
Cerebral perfusion pressure
CPP = MAP - ICP
When to use ICP monitor
GCS less then 8,
Treatment for elevated icp
Sedation,paralysis, raise head of bed, pco2 of 30-35 ok for intermittent hyperventilating. Serum osm of 295-310, na140-150. Mannitol 1g/kg . Barb coma
Cushing triad
Bradycardia, Htn, low resp rate
Raccoon eyes
Peri orbital edema , anterior fossa fracture
Battle sign
Mastoid eccyhmosis, middle fossa fracture, facial nerve - if acute facial nerve injury need exploration and repair,., if delayed likely related to edema.
Temporal skull fracture injuries
CN 7/8 , most common site is facial nerve -> geniculate ganglion
Skull fracture operative indications that
Depressed > 1cm, contaminated or persistent csf leak
C-1 Burst fracture tx
Rigid collar
C2 Hangman fracture tx
traction and halo
C2 odontoid fracture types (3) and tx
type 1 - Above base = stable type 2 - as base = unstable need fusion type 3- extends into vertebral body (need fusion )
Facet fracture or dislocations
can cause cord injury - hyper extension
Thoracic fracture types
compression (stable/TLSO brace) / Burst fracture (unstable need fusion )
Indication for MRI in Spinal fracture
for neurologic deficits without bony injyr to check for ligamentous injury and pre vertebral soft tissue swelling
Indication for emergent surgical spine decompression
fracture or dislocation not reducible, open fracture, progressive neurologic dysfunction
Most common max face fracture and injury
Temporal bone and facial nerve
Le Fort types (3) and tx
1.Maxillary fracture straight across - reduction and stabilization intramaxillary fixation 2. Lateral to nasal bone eye and diagonal toward maxilla - same as 1. 3. Lateral orbital walls - suspension wiring to stable frontal bone
Nasoethmoidal orbital fracture concer
70% have a CSF leak ( tau protein)
Treatment of nosebleed
Anterior pack, posterior try balloon tamponade
Neck Zones (3)
- clavicl to cricoid need angio/bronch and esophagoscopy
- cricoid to mandible - neck exploration if deep to the plattismus
- mandible to skull base - need angio/ larygnoscopy
Any hard vascular signs of injury to neck need or concern for airway injury
Neck exploration
