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FRACS study > Trauma > Flashcards

Trauma Flashcards

Sterility is a luxury in trauma and other pearls of wisdom

1
Q

Traumatic Brain Injury (TBI) classification

A

TBI an be classified by both severity and cause

Severity

  • Mild
    • GCS 13-15
    • Also:
      • LOC <30mins
      • PTA <1 day
  • Moderate
    • GCS 9-12
    • Also:
      • PTA 1-7 days
      • LOC 0.5-24 hours
  • Severe
    • GCS 3-8
    • Also:
      • PTA >7 days
      • LOC >24 hours

Cause

  • Primary
    • fracture
    • haemorrhage
    • DAI
  • Secondary
    • hypoperfusion and hypoxia
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2
Q

Management of ICP

A

Needs to be below 20mmHg

nursing at 30 degrees

check collar (or remove)

EVD

Mannitol

Hyperventillation to PaCO2 of 30-35mmHg

Decompressive craniectomy

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3
Q

Anatomy of an underwater sealed drain

A
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4
Q

Considerations of extent of trauma in animal bites

A

May represent blunt and penetrating trauma

  • Blunt
    • Animals limbs
    • Crushing with jaws
    • Body weight
    • Rotational distortion injuries
  • Penetrating
    • Amputation
    • Penetration of body cavities
  • Transmisable disease
    • Bacterial
    • Rabies (Rhabdovirus)
    • Viral
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5
Q

Dog bite management

A

TRAUMA and EMST management, ABCDE approach

Tetanus

Antibiotics with Augmentin

  • or cefoxitin
  • consider pip-taz in severe infection

Wound care- the most important intervention for both bacterial and zoonotic infections e.g rabies

  • clean
  • debride
  • healing by primary, delayed primary or secondary intention depending on wound and site
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6
Q

Fight bite

A

Human bite injury to the extensor surface of the metacarpophalangeal joint.

  • due to striking closed fist against teeth
  • high risk injuries
    • NB: often appear minor
  • tendon and joint are often involved
  • secondary infection can be devastating to hand function.
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7
Q

Mammalian bite bacteriology

A

Pasteurella (most common esp canine and feline)

Staph species

Strep species

Humans: Eikenella corrodens

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8
Q

Name the key organism in human bite infections

A

Eikenella corrodens

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9
Q

Neck trauma zones

A
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10
Q

AAST liver injury grading:

Grade I

A
  • Haematoma: subcapsular, <10% surface area
  • Laceration: capsular tear, <1 cm parenchymal depth
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11
Q

AAST renal injury grading

Grade I

A

grade I

  • subcapsular hematoma or contusion, without laceration
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12
Q

AAST renal injury grading

Grade II

A

grade II

  • superficial laceration ≤1 cm depth not involving the collecting system (no evidence of urine extravasation)
  • perirenal hematoma confined within the perirenal fascia
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13
Q

AAST renal injury grading

Grade III

A

grade III

  • laceration >1 cm not involving the collecting system (no evidence of urine extravasation)
  • vascular injury or active bleeding confined within the perirenal fascia
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14
Q

AAST renal injury grading

IV

A

grade IV

  • laceration involving the collecting system with urinary extravasation
  • laceration of the renal pelvis and/or complete ureteropelvic disruption
  • vascular injury to segmental renal artery or vein
  • segmental infarctions without associated active bleeding (i.e. due to vessel thrombosis)
  • active bleeding extending beyond the perirenal fascia (i.e. into the retroperitoneum or peritoneum)
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15
Q

AAST renal injury grading

Grade V

A

grade V

  • shattered kidney
  • avulsion of renal hilum or laceration of the main renal artery or vein: devascularisation of a kidney due to hilar injury
  • devascularised kidney with active bleeding
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16
Q

AAST splenic injury grading

All grades

A

grade I

  • subcapsular hematoma <10% of surface area
  • parenchymal laceration <1 cm depth
  • capsular tear

grade II

  • subcapsular hematoma 10-50% of surface area
  • intraparenchymal hematoma <5 cm
  • parenchymal laceration 1-3 cm in depth

grade III

  • subcapsular hematoma >50% of surface area
  • ruptured subcapsular or intraparenchymal hematoma ≥5 cm
  • parenchymal laceration >3 cm in depth

grade IV

  • any injury in the presence of a splenic vascular injury* or active bleeding confined within splenic capsule
  • parenchymal laceration involving segmental or hilar vessels producing >25% devascularisation

grade V

  • shattered spleen
  • any injury in the presence of splenic vascular injury* with active bleeding extending beyond the spleen into the peritoneum
17
Q

AAST splenic injury grading

Grade I

A

grade I

  • subcapsular haematoma <10% of surface area
  • parenchymal laceration <1 cm depth
  • capsular tear
18
Q

AAST splenic injury grading

Grade II

A

Grade II

  • subcapsular haematoma 10-50% of surface area
  • intraparenchymal haematoma <5 cm
  • parenchymal laceration 1-3 cm in depth
19
Q

AAST splenic injury grading

Grade III

A

Grade III

  • subcapsular haematoma >50% of surface area
  • ruptured subcapsular or intraparenchymal haematoma ≥5 cm
  • parenchymal laceration >3 cm in depth
20
Q

AAST splenic injury grading

Grade IV

A

Grade IV

  • any injury in the presence of a splenic vascular injury or active bleeding confined within splenic capsule
  • parenchymal laceration involving segmental or hilar vessels producing >25% devascularisation
21
Q

AAST splenic injury grading

Grade V

A

Grade V

  • shattered spleen
  • any injury in the presence of splenic vascular injury with active bleeding extending beyond the spleen into the peritoneum
22
Q

AAST pancreatic injury grading

A

grade 1:

  • haematoma with minor contusion/laceration but without duct injury

grade 2:

  • major contusion/laceration but without duct injury

grade 3:

  • distal laceration or parenchymal injury with duct injury

grade 4:

  • proximal (i.e. to the right of the superior mesenteric vein) laceration or parenchymal injury with an injury to bile duct/ampulla

grade 5:

  • massive disruption of the pancreatic head
23
Q

Injury Severity Score (ISS) score

A

Score is intended primarily for research but does correlate with LOS, ICU days so may have wider uses esp in ICU for prognostication

Score 0-75 points

Calculated mathematically from simple parameters

  • 6 body regions
    • Head and Neck
    • Facial
    • Chest
    • Abdomen
    • Extremity
    • External
  • Graded:
    • No injury
    • Minor
    • Moderate
    • Serious
    • Severe
    • Critical
    • Unsurvivable
24
Q

How can blast injuries be classified?

A

Primary

  • Wounding of air filled viscera as a result of blast wave

Secondary

  • Penetrating trauma from bomb fragments and other projectiles

Tertiary

  • Casualties propelled by blast- usual blunt injury mechanisms

Quaternary

  • Crush from structural collapse
  • Burns
  • Other mechanisms not classed as primary, secondary, tertiary
25
Q

What is the most common injury in underwater blast injuries

A

Bowel perforation

  • often delayed presentation with developing peritonitis 24-48 hours later
26
Q

Techniques used to control bleeding in liver trauma

A

Pack, Pringle, Angio

Juxtahepatic caval injuries- sternotomy

Balloon tamponade of missile tracts

Haemostatic agents

27
Q

In trauma the pancreas is like a lobster

A

Bite the Tail

Suck the Head

Top knife includes the distal pancreas in “the take-outables”

28
Q

What is the lethal triad

A

The triad is:

  • Acidosis
  • Coagulopathy
  • Hypothermia

This triad is a late sign of severe trauma which, if develops, almost certainly heralds death

  • avoid it developing, get out fast where possible.
29
Q

What are the options for major traumatic vascular injury

A

Temporary

  • Pressure
    • Finger
    • Packing
    • Clamping
  • Balloon occulsion
    • REBOA
  • Shunt

Definitive

  • Ligation
    • Almost anything can be ligated
      • Even the portal vein if necessary
  • Repair
    • Interposition
    • Primary
30
Q

The Mattox maneouvre

A

Left sided medial visceral rotation

  • Useful for access to the midline supramesocolic retroperitoneus
    • Especially great vessels
  • An expanding haematoma will often do most of the dissection for you
  • Mobilise left colon
    • Incise the white line of Toldt,
      • continue it posteriorly around the kidney if you want to access the aorta well or
      • Infront of the kidney if you want to access the kidney to remove it
      • and superiorly around the spleen
    • Roll the viscera to the midline
  • Provides access to the non paired visceral aortic branches
    • Division of the left crus superiorly can facilitate aortic access as high as T6 for clamping
31
Q

AAST liver injury grading:

Grade II

A

Haematoma: subcapsular, 10-50% surface area

Haematoma: intraparenchymal <10 cm diameter

Laceration: capsular tear 1-3 cm parenchymal depth, <10 cm length

32
Q

AAST liver injury grading:

Grade III

A

Haematoma: subcapsular, >50% surface area or ruptured subcapsular or parenchymal hematoma

Haematoma: intraparenchymal >10 cm

Laceration: capsular tear >3 cm parenchymal depth

Vascular injury with active bleeding contained within liver parenchyma

33
Q

AAST liver injury grading:

Grade IV

A

Laceration: parenchymal disruption involving 25-75% hepatic lobe or involves 1-3 Couinaud segments

Vascular injury with active bleeding breaching the liver parenchyma into the peritoneum

34
Q

AAST liver injury grading:

Grade V

A

Laceration: parenchymal disruption involving >75% of hepatic lobe

Vascular: juxtahepatic venous injuries (retrohepatic vena cava / central major hepatic veins)

35
Q

What is the AAST liver trauma grading system

What are the elements

What is the range of grades given

A

A standardised radiological grading system for severity of liver injury

Elements include

  • Haematoma
    • Capsular
    • Parenchymal
  • Laceration
  • Vascular
    • Arterial and minor venous
    • Juxtahepatic great veins

Graded in severity from grade I to grade V

36
Q

In median sternotomy for access to the great vessels, which 2 structures will usually need to be divided

A

The remnant thymus

The left innominate vein

37
Q

Landmarks for an anterolateral thoracotomy

A

4th or 5th intercostal space

In women use the inframammary fold

In men go below pec major ideally as it simplifies the entry

38
Q

Explain the concept of damage control in trauma

A
39
Q

What are the key principles of damage control resuscitation

A
  1. Permissive hypotension
    • the aim is to achieve end organ perfusion while minimising blood loss
      • systolic of 80mmHg
      • MAP of 80mmHg in severe head injury
  2. Minimise the use of crystalloid in early trauma
    • switch to the use of blood products early
  3. Use an MTP with balanced RBC, platelets and FFP
  4. Targeting coagulopathy with use of TEG/RoTEM
  5. Restore normothermia

FRACS study (13 decks)

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