Trauma

Question 1

What are the types of primary brain injury?

Answer 1

• Focal
  
  • Contusion / haematoma
• Diffuse
  
  • Diffuse axonal injury

Question 2

What mechanism results in diffuse axonal injury?

Answer 2

• Mechanical shearing following deceleration
• Causing disruption and tearing of axons

Question 3

What are the different types of intra-cranial haematomas?

Answer 3

• Extradural
• Subdural
• Intracerebral

Question 4

Describe the process of secondary brain injury?

Answer 4

• Original injury is exacerbated:
  
  • Oedema, ischaemia, infection, herniations
• Normal cerebral regulatory processes are disrupted

Question 5

Describe the Cushing’s reflex?

Answer 5

• Late event with brain injury
• Hypertension and bradycardia

Question 6

Describe Extradural (epidural) haematomas?

Answer 6

• Bleeding into space between dura mater and skull
• Acceleration-deceleration trauma / blow to the head
• Mostly in temporal region
  
  • Rupture of middle meningeal artery

Question 7

Features of an extradural haematoma?

Answer 7

• Raised ICP
• Lucuid period may have occurred

Question 8

Describe a subdural haematoma?

Answer 8

• Bleeding into the outermost meningeal layer
• Often around the frontal and parietal lobes

Question 9

Risk factors for a subdural haematoma?

Answer 9

• Old age
• Alcoholism
• Anticoagulation

Question 10

Clinical features of a subdural haematoma?

Answer 10

• Slower onset of symptoms
• Fluctuating confusion/consciousness

Question 11

Describe a subarachnoid haemorrhage?

Answer 11

• Sudden occipital headache
• Spontaenous ruptured cerebral aneurysm
• Can also be from a traumatic brain injury

Question 13

What is the definition of the massive haemorrhage?

Answer 13

• 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

Question 14

What percentage of an adults weight is their blood volume?

Answer 14

7%

Question 15

Following trauma, describe the trimodal distribution of death?

Answer 15

• 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

Question 16

Describe the aspects of trauma management?

Answer 16

• 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

Question 17

Describe the management of a simple pneumothorax?

Answer 17

• Insert chest drain
• Aspiration is risk in trauma
  
  • Pneumothorax from lung lacerbation may convert to tension PTX

Question 18

Describe the management of mediastinal traversing wounds?

Answer 18

• eg stabbings
• Exit and entry wounds in separaate hemithoraces
• CT angiogram and oesophageal contrast swallow
• Thoracotomy may be required for blood loss

Question 19

Describe a tracheobronchial tree injury?

Answer 19

• Haemoptysis and surgical emphysema
• May have a large air leak resulting in a tension PTX

Question 20

Describe a haemothorax?

Answer 20

• 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

Question 21

Describe cardiac contusions?

Answer 21

• Cardiac arrhythmias with overlying sternal fracture
• Perform echo to exclude pericardial effusions and temponande

Question 22

Describe traumatic diaphragmatic injuries?

Answer 22

• Usually left sided
• Direct surgical repair required

Question 23

Describe pulmonary contusions?

Answer 23

• Common
• Insidious onset
• Early intubation and ventilation

Question 24

Describe traumatic aortic disruption?

Answer 24

• Most common cause of death after RTA or falls
• Incomplete laceration near ligamentum arteriosum
• Abnormal chest x-ray

Question 25

What does blood at the urethral meatus suggest?

Answer 25

Urethral tear

Question 26

What does a high riding prostate on PR suggest?

Answer 26

Urethral disruption

Question 27

What is the most commonly damaged structure from a stab wound?

Answer 27

Liver

Question 28

In blunt trauma requiring laparotomy, what structure is most commonly damaged?

Answer 28

Spleen

Question 29

Describe the use of a Diagnostic peritoneal lavage following abdominal trauma?

Indication, advantages and disadvantages?

Answer 29

• Document bleeding if hypotensive
• Early diagnosis and very sensitive
• Invasive and may miss retroperitoneal and diaphragmatic injury

Question 30

Describe the use of an Abdominal CT scan following abdominal trauma?

Indication, advantages and disadvantages?

Answer 30

• Document organ injury if normotensive
• Most specific for localised an injury
• Location of scanner away from facilities, time for reporting, need for contrast

Question 31

Describe the use of an USS following abdominal trauma?

Indication, advantages and disadvantages?

Answer 31

• Document fluid if hypotensive
• Early diagnosis, non invasive, repeatable
• Operator dependent and may miss retroperitoneal injury

Question 32

Describe Flail chest?

Answer 32

• Chest wayy disconnects from thoracic cage
• Multiple rib fractures
• Associated with pulmonary contusion
• Abnormal chest motion

Question 33

Describe Cardiac tamponade?

Answer 33

• Becks triad
• Pulsus paradoxus
• Can occur with 100ml of blood
• Tx: Thoracotomy with direct cardiac repair

Question 34

Describe diaphragmatic disruption?

Answer 34

• RTAs and blunt trauma causing large radial tears
• More common on the left side
• Insert gastric tube, which will pass into the thoracic cavity