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CP3 Crit Care > Trauma > Flashcards

Trauma Flashcards

1
Q

What does AMPLE stand for?

A 
A - Allergies 
M - Meds + drugs 
P - PMH
L - Last meal 
E - events leading to an accident
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2
Q

Primary Survery (3)

A

Full systems exam
Trauma Series Xray
FAST scan

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3
Q

Trauma xray series (3)

A

C-spine
CXR
Pelvic XR

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4
Q

What is a FAST scan

A

Focused abdominal sonography for trauma

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5
Q

What type of injuries are pelvic disurptions usually associated with?

A

Visceral - bladder, urethral, rectal

Vascular - iliac aa/retroperitoneal vv

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6
Q

Ix pelvic disruptions

A

Pelvic XR

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7
Q

Mx pelvic disruptions (3)

A

Initially - pelvic splint
Arteriography
Surgery

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8
Q

Haemorrhagic shock - blood loss (1-4)

A

1- <750/ 15%
2 - 750-1500/15-30%
3 - 1500-2000/30-40%
4 - >2000/>40%

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9
Q

Haemorrhagic shock - HR (1-4)

A

1 - <100
2 - 100-20
3 - 120-40
4 - >140

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10
Q

Haemorrhagic shock - BP (1-4)

A

1 - no change
2- no change
3 - decr
4 - decr

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11
Q

Haemorrhagic shock - Pulse pressure (1-4)

A

1 - incr/no change
2- decr
3 - decr
4 - decr

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12
Q

Haemorrhagic shock - RR (1-4)

A

1 - 14-20
2 - 20-30
3 - 30-40
4 - >35

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13
Q

Haemorrhagic shock - Urine output (1-4)

A

1 - 30ml/hr
2 - 20-30mls/hr
3 - 5-15ml/hr
4- negligible

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14
Q

Haemorrhagic shock - CNS (1-4)

A

1 - slightly anxious
2 - mildly anxious
3 - anxious/confused
4 - confused/lethargy

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15
Q

What does ATOM FC stand for

A 
Indicates common causes of life threatening chest injury 
A = Airway 
T = Tension pneumothorax 
O = Open pneumothorax 
M = Massive haemothorax
F = Flail chest 
C = cardiac tamponade
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16
Q

Indications of airway compromise (3)

A

Stridor
Noisy breathing
Surgical emphysema

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17
Q

Mx Airway

A

Head tilt/chin lift
Suction
temporary airway
ETT = definitive Mx

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18
Q

Indications of tension pneumothorax (3)

A

Absent breathsounds
hyperresonant lung 1 side
Tracheal shift to NORM side

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19
Q

Which way does the trachea shift in tension pneumothorax?

A

Towards the normal side

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20
Q

Mx tension pneumothorax

A

Needle decompression 2 ICS MCL

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21
Q

What is an open pneumothorax

A

A direct communication betw pleural cavity and environment

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22
Q

Mx open pnuemothorax (3)

A

Asherman valve
Chest drain
Surgical closure

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23
Q

What is a massive haemothorax

A

> 1500ml of blood

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24
Q

Cause of massive haemothorax

A

Rib fracture –> vv injury

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25
Q

PS Massive haemothorax (3)

A

Shock
Dull percussion
No breath sounds

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26
Q

Mx massive haemothorax

A

Large chest drain - 6ICS MCL
Admit
Thoractomy

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27
Q

What is flail chest

A

When chest wall disconnects from thoracic cage

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28
Q

Cause of flail chest

A

> 2 rib fractures in >2 places

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29
Q

PS Flail chest (3)

A

Pain
Withdrawal of chest on inspiration
Rapid shallow breathing

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30
Q

Mx Flail chest

A

Intercostal anaesthesia
Aggressive pulmonary toilet
CPAP

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31
Q

Causes cardiac tamponade (2)

A

Penetrating trauma

Pericarditis

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32
Q

What is Beck’s triad

A

Distended neck vv
Distant heart sounds
Decr BP

33
Q

How is cardiac tamponade diagnosed

A

Echo

34
Q

Mx cardiac tamponade (2)

A

Pericardiocentesis

Thoractomy

35
Q

What is pulmonary contrusion

A

Blood is alveolar space

36
Q

Cause of pulmonary contrusion

A

Blunt trauma

37
Q

XR appearance pulmonary contrusion

A

Diffuse alveolar shadowing

38
Q

What causees aortic disruption?

A

Acceleration-deceleration injury –> laceration by ligamentum arteriosum

39
Q

PS aortic disruption (3)

A

Incr BP
Tearing pain towards back
Widened mediastinum

40
Q

Mx aortic disruption

A

Fatal

Hence needs instant repair

41
Q

What is Tracheobronchial or Oesophageal Disruption

A

Damage to bronchial tree

42
Q

What Sx suggest Tracheobronchial or Oesophageal Disruption

A

Haemopytsis

Surgical emphysema

43
Q

Mx Tracheobronchial or Oesophageal Disruption

A

Intubate and ventilate

44
Q

Cause diaphragmatic disruption

A

Blunt/penetrating trauma

45
Q

Mx diaphragmatic disruption

A

Laparotomy

46
Q

What is myocardial contrusion

A

bruising of myocardium

47
Q

Cause of myocardial contrusion

A

Steering wheels/sternal fracture

48
Q

Ix myocardial contrusion

A

ECG

ECHO - rule out tamponade

49
Q

Mx myocardial contrusion

A

Supportative

50
Q

Most common abdo organ damaged: blunt trauma

A

Spleen

51
Q

Most common abdo organ damaged: stab wound

A

Liver

52
Q

Most common abdo organ damaged: Gun shot

A

Small bowel

53
Q

What does a FAST scan do?

A

Detects free fl/organ haematomas and lacerations

54
Q

-ve FAST

A

Less reliable than CT

55
Q

+ve FAST

A

Can be done on less stable pt’s

56
Q

What 5 areas does the FAST scan focus on? (5 Ps)

A 
Perihepatic
Perisplenic
Pelvic
Pleural 
Pericardial
57
Q

What are focal head injuries due to?

A

Mechanical force

58
Q

What is cerebral contrusion?

A

Bruising of brain

59
Q

Cause of cerebral contrusion ?

A

Countercoup injury

60
Q

Cause of epidural haemorrhage?

A

Damage to middle meningeal aa q

61
Q

Cause of subdural haemorrhage?

A

Damage to bridging of vv

62
Q

What is Cushings reflex

A

Incr BR and decr HR in a brain injury

Late and terminal sign :(

63
Q

Criteria for CT head (<8hrs) (5)

A 
On warfarin 
LOC/Amnesia since injury +
>  +65
> Hx bleeding/clotting disorder 
> Dangerous injury mechanism 
> >30mins retrograde amnesia
64
Q

Criteria for immediate CT head (<1h) (7)

A 
GCS <13 initial assessment 
GCS <15 @ 2hrs admission
Suspected skull fracture 
Basal skull fracture 
Post traumatic seizure 
Focal neuro defecit 
>1 ep vomiting
65
Q

Battle’s sign

A

Bruise located behind ear

Indicates basal skull fracture

66
Q

Cerebral perfusion eq

A

= MAP - ICP

67
Q

What value must MAP not fall below in ITU

A

65

68
Q

How can you incr MAP

A

Fluids

Inotropes - Noradrenaline/vasopressin/ADH

69
Q

How can you decr ICP

A

Avoid XS fl

Elevating head @ 30’

70
Q

Ix - head injury patient

A

Beside: BM, ABG, GCS
Lab: ETOL, FBC, U+E, clotting, G+S
Image: CT brain+ spine

71
Q

What are the 4 outcomes for neurosurgery patients

A

Urgent neurosurgery
ICU
Ward care
Catastrophic - no chance of survival

72
Q

GCS - eyes

A

4 - spontaneous
3 - to speech
2 - to pain
1 - no response

73
Q

GCS - verbal

A 
5 - oriented to time, person + place 
4 - confused 
3 - inapprop words 
2 - incomprehensible sound 
1 - no response
74
Q

GCS - motor

A 
6 - obey command 
5 - moves to localised pain 
4 - flexes away from pain 
3 - abnormal flexion 
2 - abnormal extension 
1 - no response
75
Q

PS Incr ICP (5)

A 
Nocturnal headache, worse on movement 
Changes in mental state 
Vomiting NO nausea 
Pupil changes
Papilloedenma
76
Q

Causes Incr ICP (8)

A 
Localised mass 
Neoplasm 
Abscess 
Foecal oedema 
Diffuse swelling 2' to infection/SAH, Reye's syndrome 
Disruption in CSF flow 
Obstructed venous sinus 
Idiopathic HTN
77
Q

Mx incr ICP (7)

A 
Avoid pyrexia 
Mx seizures 
CSF drainage
Elevate head 
Analgesia + sedation 
Mannitol 
Hyperventilation
78
Q

How do you drain CSF

A

Intraventricular catheter

CP3 Crit Care (9 decks)

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