Trauma Flashcards
Frostnip
1) Definition
2) Pathophysiology
3) Symptoms
4) Treatment
1) very brief exposure to freezing cold results in the formation of ice crystals on the surface of the skin
2) intense and painful vasoconstriction
3) Numbness and pallor
4) rewarming (no long-term damage occurs)
Frostbite
How many degrees?
4 degrees
Numbness and edema which forms a firm plaque…
What degree of frostbite? Treatment? How long to heal?
First-degree frostbite
Treatment:
Healing time: spontaneous after 1 to 4 weeks
Milky-white blister formation…partial-thickness..
What degree of frostbite? Treatment? How long to heal?
Second-degree frostbite
Treatment:
Healing time: atrophic (2-4 weeks)
Hemorrhagic blister formation…full-thickness damage … black eschar forms with possible limb/tissue loss…
What degree of frostbite? Treatment? How long to heal if it does heal?
Third-degree frostbite
Healing time: 1 to 3 months to heal
Extends to the bone…tissues are black or mummified on presentation…
What degree of frostbite? Treatment? How long to heal if it does heal?
Fourth-degree frostbite
Healing time: Does not heal
Describe the 5 Grades in the AAST Kidney Injury Scale?
Grade I:
- Contusion: Microscopic or gross hematuria with normal urologic studies
- Hematoma: Subcapsular, non-expanding without parenchymal laceration
Grade II:
- Hematoma: Non-expanding perirenal hematoma confined to retroperitoneum
- Laceration: < 1.0 cm parenchymal depth of renal cortex without urinary extravasation
Grade III:
- Laceration: >1.0 cm parenchymal depth of renal cortex without urinary extravasation
Grade IV:
- Laceration: Parenchymal laceration involving renal cortex, medulla, collecting system
- Vascular injury: Injury of the main renal artery or main renal vein with contained hemorrhage
Grade V
- Laceration: Shattered kidney
- Vascular injury: Renal hilum avulsion (causing devascularization of the kidney)
How does bilateral injuries change the Grading for AASTI Kidney Injury scale?
Add one grade, up to Grade III.
How you calculate nitrogen balance?
= [g of protein / 6.25] - (total urinary nitogren +2)
or
= [g of protein/6.25] - (urinary urea nitrogen+4)
70-kg man is receiving 125 grams of protein via total parenteral nutrition following a 30% body surface area burn. His 24-hour urinary nitrogen excretion is 30 gm. What is the nitrogen balance of this patient?
-14 g
Calculation:
125/6.25 - (30+4) = -14
What is the definition of hypothermia?
Difference between mild vs. moderate vs. severe vs profound?
Treatment for each?
hypothermia: < 35C or 95F
mild hypothermia: (90-94F): shivering and mild mental changes. +tachycardia. Treatment = active movement
moderate hypothermia (84-89F): agitated/combative, muscle spasticity, dilated pupils, slowing of respiration, a.fib, hypotension. Treatment = passive warming (thermal pack/forced air, heaed blankets, warm IVF)
severe hypothermia (70-84F): prolonged QRS/Osborn wave, flaccid, comatose… v.fib…? death? Treatment: active rewarming (ECMO, cardiopulmonary bypass, thoracic lavage, peritoneal lavage)
Profound hypothermia (<70F): loss of vitals, cardiac activity and EEG tracing
In a hypothermic patient with asystole… what are indications to stop CPR and ACLS?
Temperature warmed to 32C (or 90F)
OR
Serum potassium > 12 mmol/L
What is the difference between primary vs. secondary hypothermia?
Primary hypothermia: prolonged environmental exposure to col temperature overwhelms the body’s natural heat-generating ability
Secondary Hypothermia: body’s normal metabolic responses are impaired by illness or substance abuse
Full thickness skin grafts:
- designed elliptically or as a rectangular?
- heal by primary closure or secondary intent?
- Elliptical
- Heal by primary closure
Large internal jugular vein injury with actively bleeding carotid injury… how do you treat the internal jugular vein?
ligate internal jugular vein then address carotid injury exposure.
23-year-old male fell off his motorcycle and was brought to the trauma bay. He is unable to abduct his shoulder and move his elbow and wrist joints, but his grip is normal. Sensation is preserved along the medial side of the extremity and the 4th and 5th digits. What is the most likely pattern of injury?
Avulsion of C5, C6, C7 nerve roots
C5-C6 nerve root = unable to abduct his shoulder and move his elbow
C7 nerve root = unable to abduct shoulder, deficit in flexion AND extension at elbow and wrist joints.
What is Erb-Duchenne palsy?
Avulsion of C5 and C6 roots causing deficit in shoulder abduction, elbow FLEXION, and sensory deficit along lateral arm and 1st/2nd digits
What is Klumpke palsy?
C8-T1 root injurty = intrinisic hand muscle and sensory deficit in 4th and 5th digits + Horner syndrome (miosis, ptosis and anhidrosis)
What is the most common pattern of brachial plexus injury?
pan plexus injury (Avulsion of all brachial plexus roots (C5-T1) = flail arm and insensate hand
What is the timing for sharp vs. blunt brachial plexus injury?
Sharp/open injury = repaired urgently
Blunt/Closed brachail plexu sinjury = 3-6 weeks post-injury work up (MRI/nerve conduction) every 4 weeks with repair before 1 year. (@18 months, motor end plate degeneration occur)
During tracheostomy in OR after tracheostomy placed… balloon ruptures and there is a fire .. what do you do?
Decrease FIO2 –> remove tracheostomy –> oral intubate –> smother with saline
What are the components of the Mangled Extremity Severity Score (MESS)?
1) Limb ishcemia > 6 hours
2) Limb ischemia [reduced pulse, but normal perfusion = 1; pulseless/parasthesias/slow capillary refill = 2; cool/numb/paralysis/insensate = 3]
3) age (<30; 30-50; >=50)
4) Shock (SBP > 90mmHg = 0; transient hypotension = 1; persistent hypotension = 2)
5) Injury mechanism (stab/GSW/simple fx [low energy] = 1; dislocation/open fx[medium energy] = 2; high speed MVA/rifle [high energy] = 3; high speed trauma with gross contamination [very high energy ] = 4
For TEG, what is normal:
- R time?
- K time?
- Alpha angle?
- Maximum amplitude?
- LY30?
What do you give for each if their abnormal?
- R time: 5 to 10 minutes [FFP]
- K time: 1 to 3 minutes [cryo]
- Alpha angle: 53 to 72 degrees [cryo]
- Maximum amplitude: 50 to 70 mm [platelets/DDAVP]
- LY30: 0 to 8% [TXA or Aminocaproic acid]
