Trauma Flashcards
3 zones of the neck?
1 - thoracic inlet to cricoid
2- cricoid to angle of mandible
3- ankle of mandible to base of skull
Best imaging test for penetrating neck injury?
CT-angiography
OR if hard signs (HARD Bruit)
Hard signs of neck injury?
Hypotension Arterial bleed Rapidly expanding hematoma Deficit - neuro of vascular Bruit or thrill
+ stridor, hoarseness
4 types of important structures in the neck?
- airway
- vessel
- esophagus
- spinal cord
Indications for cricothyrotomy in trauma
severe facial or other neck injuries that preclude intubation from above
Triad that suggests laryngeal injury in trauma?
triad of dyspnea, stridor and hemoptysis
Sx consistent with esophageal injury?
neck tenderness, pain, dysphagia, odyniphagia, drooling, crepitus, subcutaneous emohysema, fever, mediastinitis
Most common area for c-spine injury in young kids
higher fulcrum - C1-C4
High risk conditions for c-spine injury
Syndromes ( T21, Maroteaux-Lamy, Klippel-Feil, achondroplasia, congenital cervical stenosis, Chiari malformation, rheumatoid disease, acute soft tissue or bony infection/infiltration)
What are the NEXUS low-risk c-spine criteria?
What age can you use NEXUS criteria?
If meet all 5 criteria - can clear clinically and do not need c-spine xrays:
Alert No districting injury No intox No neuro deficit No midline pain
Use in > 8 yo (younger kids weren’t included in the study)
What are the PECARN c-spine risk factors?
any one of: - altered mental status - neuro deficit - neck pain - substantial torso injury - torticollis - high risk MVC - diving If any 1 factor present --> higher risk --> need imaging. Good for all ages of children
Risk of hard spinal board for a prolonged time?
Pressure sores / skin breakdown
Pain
Respiratory compromise
How to clear the c-spine (rules for each age range)?
Canadian C Spine Rules ( > 16)
Nexus ( > 8 year olds)
PECARN C spine risk factors ( all ages)
< 3 year olds: use clinical exam
Name 3 high-risk criteria in the Canadian c-spine rule
Rule only validated > 16 years old:
- Dangerous mechanism
- Parasthesias
- Unable to actively rotate neck 45 degrees L and R
- age > 65
- Not ambulatory
- Midline C spine tenderness
4 lines on lateral c-spine xray
- anterior vertebral
- posterior vertebral (anterior margin spinal canal)
- spinolaminar line (posterior margin spinal canal)
- spinous process tips
“ABC’s” of c-spine xray interpretation?
A-alignment B- bones C- cartilage S-soft tissues Ensure C1-T1 included
What is the line of Swischuk?
Draw spinolaminar line - drawn from spinous process of C1 to C3, if C2 > 2mm from line, suggests real pathology (vs. psuedosubluxation)
What is a Jefferson fracture?
Burst of C1 from axial load (C1 laterally ofset > 1 mm from C2 on xray)
What is a pseudo-Jefferson fracture?
Not a real fracture. Normal xray finding in up to 90% of 2 year old - looks like lateral offset of C1 on C2 but really just due to radiolucent cartilage artifact (would need CT to tell the difference)
What is a Hangman’s fracture?
Due to neck hyperextension - spondylolisthesis of C2 (differentiate from psuedosubluxation with Swischuk’s line C1 to C3)
What is atlanto-axial subluxation?
Movement between C1 and C2 because of transverse ligament rupture OR fractured dens
What are some causes of atlanto-axial subluxation?
tonsillitis, cervical adenitis, pharyngitis, arthritis or connective tissue disorders, T21
What type of fracture is a Chance fracture?
flexion-distraction fracture
2 main causes of traumatic torticollis?
- muscular spasm (of SCM)
- rotary subluxation
- (also c-spine #, ligamentous injury, clavicle #)
4 infection causes of torticollis?
- RPA
- cervical LN
- Lemierre’s
- meningitis
- osteomyelitis
- upper lobe pneumonia
Label parts of the spinal cord and what they do?
Dorsal columns = vibration and proprioception
Lateral corticospinal = motor control
Spinothalamic (more anterior/lateral) = pain and temperature
What is Brown-Sequard syndrome?
hemi section of cord: contralateral loss of pain and temp with ipsilateral motor findings (weakness or paralysis, below level of the lesion)
What is central cord syndrome?
Most severe damage in the center, arms weakest, legs okay. From hyper flexion injury
What is anterior cord syndrome?
Bilat loss of motor, pain, and temperature. Dorsal columns (vibration and proprioception) are okay
What are the 3 most commons causes of mortality in teenagers ages 15-19y in North America?
- Accidental (MVC most common)
- Suicide
- Homicide
Physiological differences in children related to trauma? (5)
- multisystem trauma more likely
- hypotension is a late finding
- greater BSA: inc heat and insensible losses
- fluid and nutrition requirements vary by age and stage of growth
- Developmental stages = challenges in assessments
6 components of the pediatric trauma score?
Size (weight) Airway SBP Neuro Skin MSK
High score (12 max) is good, lower score = worse prognosis
What four things would you want to find out from EMS for a trauma patient?
ATMIST:
- age
- timing
- mechanism
- injuries identified
- Signs/symptoms
- Tx provided
What do you want to know from the EMT’s about what the scene/car looked like?
- Significant intrusion into vehicle, which part of vehicle
- Airbags deployed
- Presence of car seat
- Extrication
- Anyone dead on scene
- Speed
- Exam on scene (GCS, focal neuro deficits, seizures)
What MVC conditions are associated with a high-risk of significant trauma?
Roll-over Ejection Prolonged extrication Fatalities at the scene High-speed
6 steps EMS needs to take to stabilize his c-spine before getting him to hospital
- Provide in-line manual C-spine stabilization and lower patient to ground/supine position
- Place in a hard cervical collar
- Straighten upper and lower extremities against body (palms inward)
- Rolled onto center of spine board with in-line stabilization
- Trunk, pelvis and lower extremities appropriately secured to board.
- Patient’s head and neck position are secured with tape across the forehead and cervical collar