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Emergency Med > Trauma > Flashcards

Trauma Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Triage: mechanism of injury that makes something a “major trauma”

A
  • Falls >20 ft (adult)
  • Falls 2x height of child
  • High risk auto: intrusion, ejection, death of occupant, vehicle data high risk
  • Auto-bike: thrown, run-over, >20mph
  • Motorcycle: >20mph
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2
Q

Triage: clinical info that makes something a “major trauma”

A
  • Penetration injury to head/neck/torso/proximal extremities
  • ≥2 long bone fx
  • Amputations, crushed, mangled extremity
  • Burns + multi-trauma
  • Paralysis
  • GSC ≤13
  • SBP <90
  • RR <10 or >29 or vent support needed
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3
Q

What is the 1st, 2nd, and 3rd peak in the trimodal death distribution?

A

1st: immediate
2nd: minutes - hours
3rd: days - weeks

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4
Q

What are the causes of death in the 1st peak of the trimodal death distribution?

A
  • High C spine
  • Brain injury
  • Great vessel injury
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5
Q

How do we treat pt. the 1st peak of the trimodal death distribution?

A

Prevention!

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6
Q

What are the causes of death in the 2nd peak of the trimodal death distribution?

A
  • Intracranial injury
  • Pelvic fx
  • Abd & lung injuries
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7
Q

How do we treat pt. the 2nd peak of the trimodal death distribution?

A

Good pre-hospital and ATLS care

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8
Q

What are the causes of death in the 3rd peak of the trimodal death distribution?

A
  • Sepsis

- MSOF

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9
Q

How do we treat pt. the 3rd peak of the trimodal death distribution?

A

Good ATLS & inpt. care

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10
Q

Injuries are the #__ reason for death in persons <45 and #__ leading cause of death overall

A

1; #3

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11
Q

Injuries: ___ are minor, ___ are moderate

A

1/2; 1/3

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12
Q

Trauma related mortality is __%

A

5

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13
Q

What 3 types of injuries have the highest case fatality rate?

A
  • Suffocation
  • Drowning/submersion
  • Firearms
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14
Q

3 leading causes of trauma injury

A
  1. Falls (esp children <7, elderly >75)
  2. MVC (esp adolescents, young adults)
  3. Firearm (12-22yo)
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15
Q

Most likely cause of shock in trauma pt.

A

Hemorrhage

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16
Q

Class I hemorrhage:

A 
Blood loss: up to 750ml, up to 15%
Pulse rate: <100
BP: normal 
PP: normal or increased
RR: 14-20 
UO: >30ml/hr
Cognition: slightly anxious
Fluid replacement: crystalloid
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17
Q

Class II hemorrhage:

A 
Blood loss: 750-1000ml, 15-30%
Pulse rate: >100
BP: normal 
PP: decreased
RR: 20-30
UO: 20-30ml/hr
Cognition: mildly anxious
Fluid replacement: crystalloid
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18
Q

Class III hemorrhage:

A 
Blood loss: 1500-2000ml, 30-40%
Pulse rate: >120
BP: decreased
PP: decreased
RR: 30-40
UO: 5-15
Cognition: anxious, confused
Fluid replacement: crystalloid + blood
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19
Q

Class IV hemorrhage:

A 
Blood loss: >2000ml, >40%
Pulse rate: >140
BP: decreased
PP: decreased
RR: >35
UO: negligible
Cognition: confused, lethargic 
Fluid replacement: crystalloid + blood
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20
Q

Hemorrhage general trends as it increases in severity (Class I-IV)

A 
Blood loss (ml, %): ↑
Pulse rate:↑
BP: ↓
PP: ↓
RR: ↑
UO: ↓
Cognition: anxious → confused → lethargic 
Fluid replacement: add blood to crystalloid in class III
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21
Q

Mechanism of injury: frontal impact of MVC

Suspected injury pattern:

A
  • Cervical spine fx
  • Anterior flail chest
  • Myocardial contusion
  • PTX
  • Traumatic aortic disruption
  • Lacerated spleen/liver
  • Posterior fx or dislocation of hip or knee
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22
Q

Mechanism of injury: side impact

Suspected injury pattern:

A
  • Contralateral neck sprain
  • Cervical spine fx
  • Lateral flail chest
  • PTX
  • Traumatic aortic disruption
  • Diaphragmatic rupture
  • Fx spleen/liver/kidney
  • Pelvis fx
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23
Q

Mechanism of injury: rear impact

Suspected injury pattern:

A
  • Cervical spine injury

- Soft tissue neck injury

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24
Q

Mechanism of injury: ejection

Suspected injury pattern:

A

Greater risk for all injury mechanisms

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25
Q

Mechanism of injury: MVC vs. pedestrian

Suspected injury pattern:

A
  • Head injury
  • Traumatic aortic disruption
  • Abd visceral injuries
  • Fractured LE/pelvis
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26
Q

Who gets a C collar?

A

EVERYONE in major trauma

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27
Q

__% of unconscious trauma pt. have a serious C-spine injury

A

10%

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28
Q

What fraction of spine injuries are cervical?

A

2/3

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29
Q

What cervical vertebrae are most commonly affected?

A

C2, C5

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30
Q

Presumptive evidence for an unstable c-spine fx

A

Para or quadriplegia

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31
Q

1 reason for fetal demise

A

Maternal shock/death

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32
Q

CV changes during pregnancy that conceal shock

A
  1. CO increases
  2. Plasma volume increases
  3. Blood loss directs blood away from uterus
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33
Q

Fetus is most vulnerable to radiation in what trimester

A

1st

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34
Q

When to admit a pregnant pt. after trauma

A
  • Bleeding
  • Cramping
  • Amniotic fluid leak
  • Hypovolemia
  • Fetal distress concerns
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35
Q

If a fetuses EGA is _____, the mothers is referred to OB care after initial trauma eval (major trauma has been ruled out)

A

> 20 wks

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36
Q

If a fetuses EGA is _____, the mothers remains in the ED for monitoring (major trauma has been ruled out)

A

<20 wks

37
Q

In what ways do pediatric airways differ from adult airways?

A
  • Large tongue
  • Glottis more anterior & superior
  • Occiput is large, slight flexion is supine (place rolled towel/pad under neck or shoulders to achieve extension)
38
Q

M/C cause of death in children

A

MVC

39
Q

M/C pediatric injury

A

Falls

40
Q

If children do not respond to a 40cc/kg fluid bolus, what should they be given

A

10cc/kg bolus of PRBC’s

41
Q

Children are more susceptible to what two “environmental” conditions

A

Hypotheramia, hypoglycemia

42
Q

Factors that make pt. difficult to intubate

A
  • Obesity
  • Short neck
  • Large incisors, tongue
  • Narrow mouth
  • Limited neck mobility
43
Q

Mallampati Class I (what’s visible)

A

Soft palate, uvula, fauces, tonsilar pillars

44
Q

Mallampati Class II (what’s visible)

A

Soft palate, uvula, fauces

45
Q

Mallampati Class III (what’s visible)

A

Soft palate, base of uvula

*considered difficult to intubate

46
Q

Mallampati Class IV (what’s visible)

A

Hard palate only

*considered difficult to intubate

47
Q

Indications for RSI

A
  • GCS <9 w/ gag reflex
  • Facial trauma
  • Head injury, stroke
  • Burn pt. w/ airway involvement
  • Resp exhaustions (asthma, CHF, COPD w/ hypoxia, & failure of non-invasive support)
  • Overdose w/ AMS
  • COVID-19
48
Q

7 P’s of RSI

A
  1. Preparation
  2. Pre-oxygen w/ 100% O2 for 4-5min
  3. Pre-medicate (etomidate or midazolam)
  4. Paralytic (succinylcholine or rocuronium)
  5. Pass tube
  6. Proof of placement (listen, CXR, EtCO2)
  7. Post intubation care (secure tube, ventilate)
49
Q

Highest risk age for both TBI and SC injury

A

15-24yo

50
Q

ETOH present in ~__% of TBI

A

50%

51
Q

Primary brain injury vs. secondary brain injury

A 
1 = direct insult
2 = cellular damage following 1
52
Q

What is cerebral autoregulation?

A

Allows for constant cerebral blood flow across a range of arterial pressure (as long as BBB is maintained)

53
Q

How does an increase in PCO2 (d/t apnea, respiratory depression following TBI) affect……

  • CBF
  • ICP
  • CPP
A
  • CBF ↑
  • ICP ↑ (also ↑ d/t edema, expanding mass)
  • CPP ↓
54
Q

What is the Monroe-Kelli Doctrine

A

= Total volume of the brain parenchyma, cerebrospinal fluid, and blood remains constant

  • Least compressible is brain
  • CSF first to decrease (& venous flow)
  • Blood may decrease, but maintains adequate perfusion d/t autoregulation
  • herniation begins after you can’t let off anymore CSF or venous blood
55
Q

How does increased ICP affect BP and HR? What is this phenomena called?

A

↑ BP, ↓ HR

= Cushing’s reflex

56
Q

How to reduce ICP?

A

Raise HOB, IV mannitol

57
Q

Causes of TBI

A
  • Concussion (mTBI)
  • Epidural, subdural, intra-cranial, SAH hemorrhage
  • Cerebral contusion
  • Diffuse axonal injury
  • Penetrating cranial injury
  • Skull fx
58
Q

Adult head CT indications

A

Head trauma +…….

  • GCS <15 after 2 hours
  • GCS<13
  • Skull fx
  • Age >65
  • LOC >5 or anterograde amnesia
  • Dangerous mech
  • Recurrent vomiting
  • Alcohol intox
  • Pt. on anticoags/antiplts
59
Q

Epidural hematoma (mech, presentation, dx, tx)

A

Mech: direct blow to temporal region
Presentation: LOC, return to consciousness, then AMS (lucid interval), dilated + fixed ipsilateral pupil (uncal herniation)
Dx: lenticular lesion on CT
Tx: emergent craniotomy & clot evac

60
Q

Subdural hematoma (mech, presentation, dx, tx)

A

Mech: falls, acceleration, deceleration
Presentation: focal deficits, depressed MS
Dx: cresent shaped lesion on CT
Tx: emergent craniotomy & clot evac if decompensation

61
Q

Which has poorer prognosis: epidural or subdural?

A

Subdural

62
Q

Decorticate positioning represents ________ lesion and pt. demonstrates ______ of the UE

A

Hemispheric lesion; flexion

63
Q

Decerebrate positioning represensts ________ lesion and pt. demonstrates ______ of the UE

A

Brainstem lesion; extension

64
Q

If a neck injury violates the platysma muscle, what is the next step in mgmt

A

Consult surgery

65
Q

Neck injury - zone I

A

Extends from manubrium of the sternum to the bottom of the cricoid

66
Q

Neck injury - zone II

A

Extends from bottom of cricoid through the body of the mandible

67
Q

Neck injury - zone III

A

Above the body of the mandible

68
Q

Management of zone I, III injuries

A

Testing to r/o injury (CT, angio, esophageal studies)

69
Q

Management of zone II injuries

A

Surgical exploration, routine or selective testing

70
Q

What functions do you lose with…..
Central cord lesion
Anterior cord lesion
Brown Sequard

A

Central: motor (UE >)
Anterior: paralysis, pain & temp
Brown Sequard: ipsilateral motor, contralateral pain & temp.

71
Q

SC injuries above what cervical vertebrae require mechanical ventilation and why?

A

C4

Phrenic n. (supplies diaphragm) is innervated by C3-5

72
Q

Indication for operative thoracotomy w/ a hemothorax

A
  • Initial tube drainage >20 cc/kg or 1500 cc
  • Continued bleeding > 7 cc/kg/hr for 3-4 hr
  • Persistent hypotension despite resuscitation
  • Lack of lung re-expansion
73
Q

M/C potentially lethal chest injury

A

Pulmonary contusion

74
Q

1 and #2 solid organ injury

A 
#1 spleen
#2 liver
75
Q

Indications for immediate laparotomy w/ blunt abd trauma

A
  • Hypotensive pt. w/ peritoneal signs
  • (+) FAST US w/ hypotension
  • Free air (abd or retroperitoneum)
76
Q

GSW most often injure

A

Large & small bowel

77
Q

Stab wounds most often injure

A

Liver & small bowel

78
Q

Indications for immediate laparotomy w/ penetrating abd trauma

A
  • Hemodynamic instability
  • Any GSW
  • Peritoneal signs
  • Evisceration
  • Signs of fascial penetration (do NOT prob wound)
79
Q

Mechanism of most GU trauma

A

Blunt

80
Q

Indication for CT in penetrating renal trauma

A

Any hematuria

81
Q

Indication for CT in blunt renal trauma

A
  • Frank ecchymosis
  • Gross hematuria
  • BP <90
  • Known abd injury
82
Q

Indications for surgery/embolization in renal trauma

A
  • Expanding/pulsatile/non-contained hematoma

- Renal avulsion

83
Q

Tx of renal injury w/ contusion & micro hematuria

A

D/C, UA in 1 wk

84
Q

Tx of renal injury w/ gross hematuria or high grade

A

Admit for ob

85
Q

M/C GU injury in kids

A

Renal contusion

86
Q

When do we use CT in kids w/ GU injury

A

> 50 RBC/HPF

87
Q

What type of bladder injury is M/C and how is it managed?

A

Extraperitoneal - place foley

88
Q

What is the most important part of your exam with penetrating extremity trauma

A

Assessing arterial injury

89
Q

“Hard signs” of penetrating extremity trauma

A
  • Absent/diminished pulses
  • Obvious arterial injury
  • Expanding hematoma
  • Bruit/thrill
  • Distal ischemia

Emergency Med (3 decks)

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