Trauma Flashcards
What are the types of primary brain injury?
- Focal
- Contusion / haematoma
- Diffuse
- Diffuse axonal injury
What mechanism results in diffuse axonal injury?
- Mechanical shearing following deceleration
- Causing disruption and tearing of axons
What are the different types of intra-cranial haematomas?
- Extradural
- Subdural
- Intracerebral
Describe the process of secondary brain injury?
- Original injury is exacerbated:
- Oedema, ischaemia, infection, herniations
- Normal cerebral regulatory processes are disrupted
Describe the Cushing’s reflex?
- Late event with brain injury
- Hypertension and bradycardia
Describe Extradural (epidural) haematomas?
- Bleeding into space between dura mater and skull
- Acceleration-deceleration trauma / blow to the head
- Mostly in temporal region
- Rupture of middle meningeal artery
Features of an extradural haematoma?
- Raised ICP
- Lucuid period may have occurred
Describe a subdural haematoma?
- Bleeding into the outermost meningeal layer
- Often around the frontal and parietal lobes
Risk factors for a subdural haematoma?
- Old age
- Alcoholism
- Anticoagulation
Clinical features of a subdural haematoma?
- Slower onset of symptoms
- Fluctuating confusion/consciousness
Describe a subarachnoid haemorrhage?
- Sudden occipital headache
- Spontaenous ruptured cerebral aneurysm
- Can also be from a traumatic brain injury
What is the definition of the massive haemorrhage?
- Loss of 100% blood volume within 24 hours
- Loss of 50% blood veolume within 3 hours
- Loss of blood at a rate of 150ml/min
What percentage of an adults weight is their blood volume?
7%
Following trauma, describe the trimodal distribution of death?
- Immediately following injury
- Brain or high spinal injuries, cardiac or great vessel damage
- Early hours following injury
- Splenic rupture, subdural haematomas, haemopneumothoraces
- Days faollowing injury
- Sepsis, multi-organ failure
Describe the aspects of trauma management?
- ABCDE approach
- External haemorrhage should be managed with packing
- NOT tourniquets
- Catheters and NG tubes may be required
- Patients with head and neck injury should be assumed to have C-spine injury
Describe the management of a simple pneumothorax?
- Insert chest drain
- Aspiration is risk in trauma
- Pneumothorax from lung lacerbation may convert to tension PTX
Describe the management of mediastinal traversing wounds?
- eg stabbings
- Exit and entry wounds in separaate hemithoraces
- CT angiogram and oesophageal contrast swallow
- Thoracotomy may be required for blood loss
Describe a tracheobronchial tree injury?
- Haemoptysis and surgical emphysema
- May have a large air leak resulting in a tension PTX
Describe a haemothorax?
- Laceration of the lung vessels or internal mammary artery from rib fracture
- Insert 36F wide pore chest drain
- Indications of thoracotomy
- Loss of >200ml/hr for 2 hours
Describe cardiac contusions?
- Cardiac arrhythmias with overlying sternal fracture
- Perform echo to exclude pericardial effusions and temponande
Describe traumatic diaphragmatic injuries?
- Usually left sided
- Direct surgical repair required
Describe pulmonary contusions?
- Common
- Insidious onset
- Early intubation and ventilation
Describe traumatic aortic disruption?
- Most common cause of death after RTA or falls
- Incomplete laceration near ligamentum arteriosum
- Abnormal chest x-ray
What does blood at the urethral meatus suggest?
Urethral tear
What does a high riding prostate on PR suggest?
Urethral disruption
What is the most commonly damaged structure from a stab wound?
Liver
In blunt trauma requiring laparotomy, what structure is most commonly damaged?
Spleen
Describe the use of a Diagnostic peritoneal lavage following abdominal trauma?
Indication, advantages and disadvantages?
- Document bleeding if hypotensive
- Early diagnosis and very sensitive
- Invasive and may miss retroperitoneal and diaphragmatic injury
Describe the use of an Abdominal CT scan following abdominal trauma?
Indication, advantages and disadvantages?
- Document organ injury if normotensive
- Most specific for localised an injury
- Location of scanner away from facilities, time for reporting, need for contrast
Describe the use of an USS following abdominal trauma?
Indication, advantages and disadvantages?
- Document fluid if hypotensive
- Early diagnosis, non invasive, repeatable
- Operator dependent and may miss retroperitoneal injury
Describe Flail chest?
- Chest wayy disconnects from thoracic cage
- Multiple rib fractures
- Associated with pulmonary contusion
- Abnormal chest motion
Describe Cardiac tamponade?
- Becks triad
- Pulsus paradoxus
- Can occur with 100ml of blood
- Tx: Thoracotomy with direct cardiac repair
Describe diaphragmatic disruption?
- RTAs and blunt trauma causing large radial tears
- More common on the left side
- Insert gastric tube, which will pass into the thoracic cavity
