Trauma

Question 1

What key features comprise the rapid history taken in trauma situations? - SAMPLE

Answer 1

SAMPLE

• signs & sx
• allergies
• medicines & drugs
• past medical hx
• last oral intake/bowel movement
• events leading to accident

Question 2

What is the primary survey in trauma situations?

Answer 2

ABCDE from ATLS

Question 3

What is the secondary survey in trauma situations?

Answer 3

Full systemic examination

Examination of peripheries

Question 4

What makes up a trauma series of X-rays?

Answer 4

C-spine XRs (often not done immediately)
CXR
Pelvic XR

Question 5

What is a FAST scan?

Answer 5

Focused abdominal sonography for trauma

• performed for suspected abdo injury/bleeding
• can detect organ lacerations/haematomas/free fluid
• can detect pericardial effusion

Perihepatic
Perisplenic
Pelvic
Pleural
Pericardial

Question 6

When should CT scanning occur?

Answer 6

Once pt is stable

Question 7

What sort of injuries are present in pelvic trauma?

Answer 7

Visceral & vascular injuries, high energy trauma

• bladder, urethral & rectal trauma
• iliac arteries/retroperitoneal vv injuries (massive haemorrhage)

Question 8

How can pelvic trauma be diagnosed?

Answer 8

History
Examination - bimanual compression of iliac wings produces pain, legs may bow
AP XR (90%)

Question 9

How should pelvic trauma be managed?

Answer 9

Pelvic splint if pt unstable
Arteriography to determine site of bleed
Surgical management often required

Question 10

What are the immediate life threatening injuries that may occur in chest trauma?

Answer 10

ATOM FC

• airway obstruction
• tension pneumothorax
• open pneumothorax
• massive haemothorax
• flail chest
• cardiac tamponade

Question 11

What features suggest airway obstruction?

Answer 11

Stridor
Noisy breathing
s.c. emphysema

Question 12

How should airway obstruction be managed?

Answer 12

Jaw thrust
Examination/suction
Temp airway
Definitive airway management (int/vent)

Question 13

How should tension pneumothorax be managed?

Answer 13

Emergency needle thoracocentesis

-grey cannula into 2nd ics, mid-clavicular line

Question 14

What is an open pneumothorax?

Answer 14

Direct communication b/w pleural cavity & external environment

Question 15

What features suggest an open pneumothorax?

Answer 15

Obvious on examination w/ bubbling wound

-tension pneumothorax may develop

Question 16

How should an open pneumothorax be managed?

Answer 16

Asherman valve
   -sterile dressing sealed on 3 sides
Chest drain
   -situated away from wound itself
Surgical closure

Question 17

What is a massive haemothorax?

Answer 17

> 1500ml of blood w/i pleural cavity OR

>200ml/hr for 4hrs (blood entering pleural cavity)

Question 18

What is the most common cause of a massive haemothorax?

Answer 18

Rib fracture causing venous injury

Question 19

What features suggest a massive haemothorax?

Answer 19

Shock
Lung dull to percussion
No breath signs

Question 20

How should a massive haemothorax be managed?

Answer 20

Large chest drain in 6th ics, mid-clavicular line
Admit for obs
Thoracotomy (if >200ml for 4 consecutive hrs)

Question 21

What is a flail chest?

Answer 21

Multiple rib fractures causing a mobile segment that in-draws on inspiration
-underlying pulmonary contusion

Question 22

What features suggest a flail chest?

Answer 22

V. painful
Respiratory depression
-rapid, shallow

Question 23

How should a flail chest be managed?

Answer 23

Intercostal block/anaesthesia

Mechanical ventilation if in resp failure/exhausted

Question 24

What is cardiac tamponade?

Answer 24

Bleeding into pericardial cavity, preventing ventricular filling and causing a fall in cardiac output

Question 25

What causes cardiac tamponade?

Answer 25

Penetrating trauma
Pericarditis
-slower, heart able to adapt

Question 26

What features suggest cardiac tamponade?

Answer 26

Beck's triad
   -raised JVP
   -low SBP
   -muffled heart sounds
DIAGNOSTIC ECHO

Question 27

How should cardiac tamponade be managed?

Answer 27

Immediate pericardiocentesis

Thoracotomy

Question 28

What are the common, non-immediate life threatening injuries resulting from chest trauma?

Answer 28

Pulmonary contusion
Aortic disruption
Myocardial contusion

Question 29

What is a pulmonary contusion?

Answer 29

Blood in alveolar space

-usually due to blunt trauma

Question 30

What features suggest a pulmonary contusion?

Answer 30

Worsening hypoxia over 24hrs

Alveolar shadowing on CXR

Question 31

What causes an aortic disruption?

Answer 31

Severe acc-decc injury

Question 32

What features suggest an aortic disruption?

Answer 32

Presents as aortic dissection

-tearing chest pain, radiating to back

Question 33

What is the prognosis of an aortic disruption?

Answer 33

Fatal unless false aneurysm develops in mediastinum

If not immediately fatal then have several hrs to manage

Question 34

What is a myocardial contusion?

Answer 34

Bruising of myocardium

• occurs w/ steering wheel injuries/sternal fractures
• appears similar to MI on ECG
• manage conservatively

Question 35

When should a tetanus booster be given for open wounds?

Answer 35

Clean minor wounds
-if uncertain vacc hx/>10yrs since last dose
All other wounds
-give unless tetanus booster given <5yrs

Question 36

What key features comprise the rapid history taken in trauma situations? - CHAMPS

Answer 36

CHAMPS

• chief complaint
• history
• allergies
• medicines
• prev activity
• signs/sx

Question 37

What is the preferred mode of venous access in children in trauma?

Answer 37

Interosseseus

Question 38

What are the indications for Groshong and Hickman lines?

Answer 38

long term therapeutic requirements e.g. chemotherapy

Question 39

What is a PICC?

Answer 39

peripherally inserted central cannula

central venous access

Question 40

What are the complications of long term ventilation?

Answer 40

tracheo-oesophageal fistula formation