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RS Absite > Trauma > Flashcards

Trauma Flashcards

1
Q

What component of GCS has most prognostic ability?

A

motor score

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2
Q

GCS at which intubation is warranted

A

GCS < 8 = intubate

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3
Q

What information does a unilateral fixed and dilated pupil give you?

A

ipsilateral space occupying lesion with compression on optic nerve

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4
Q

What information does bilateral pinpoint pupils give you?

A

Pontine hemorrhage, or narcotic overdose

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5
Q

what patient’s need ICP monitor?

A

GCS < 8 with intracranial abnormality on CT

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6
Q

what is the difference between a bolt and a ventriculostomy?

A

ventriculostomy - in ventricle and can drain CSF

bolt - in parenchyma

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7
Q

what is cushing’s reflex? and what does it indicate?

A

hypertension, bradycardia and altered respirations

indicates impending herniation

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8
Q

initial management of patient with cushing’s reflex

A

sedate, elevate HOB, PaCO2 <35, mannitol or 3%, paralytic

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9
Q

classic presentation of epidural hematoma

A

head injury with lucid interval with rapid GCS decline

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10
Q

describe the CTH of epidural hematoma

A

lenticular lucency contained by suture lines

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11
Q

describe CTH of SDH

A

crescent shaped lucency that crosses suture lines

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12
Q

CPP = ?

goal CPP and ICP

A

CPP = MAP - ICP

CPP >60 and ICP < 20

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13
Q

interventions to reduce ICP? (5 examples)

A
  1. elevate HOB
  2. hyperventilate
  3. remove C collar
  4. 3% or mannitol
  5. sedate or paralyze
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14
Q

reversal agent for coumadin in the trauma setting

A

PCC for rapid reversal
FFP is okay
Vitamin K

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15
Q

reversal agent for pradaxa (dabigatran)

A

dialysis or praxbind (idarucizumab)

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16
Q

reversal agent for apixaban/rivaroxaban

A

PCC gives partial reversal, dialysis

andexanet alpha

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17
Q

clinical clearance for spine trauma (3 criteria)

A
  1. no distracting injuries
  2. no intoxication and GCS 15
  3. no midline tenderness or neuro deficits
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18
Q

injury pattern for central cord syndrome?

A

upper extremity weakness and burning - ‘cape and gloves’

ex. elderly with spinal stenosis

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19
Q

injury pattern for brown sequard?

A

ipsilateral motor deficit and contralateral pain/temp deficit below injury
ex. stab wound

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20
Q

injury pattern for anterior cord syndrome?

A

motor deficit below the level of injury

ex. vascular injury to anterior spinal artery

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21
Q

difference between neurogenic shock and spinal shock

A

neurogenic shock - hemodynamics affected

spinal shock - sensory/motor affected. no bulbocavernosus or cremasteric reflex. some functions may return.

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22
Q

what constitutes an ‘unstable’ spinal cord injury

A

when 2/3 ligamentous columns are disrupted - need operative fixation

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23
Q

borders of zones of the neck ?

A

Zone 1 - clavicles to cricoid
Zone 2 - cricoid to angle of mandible
Zone 3 - mandible to skull base

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24
Q

next best step in management: penetrating neck injury with unstable hemodynamics

A

OR

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25
Q

next best step in management: penetrating neck injury with hard sign of vascular injury

A

OR

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26
Q

What are hard signs of vascular injury? (4 examples)

A
  1. Observed pulsatile bleeding.
  2. Arterial thrill (ie, vibration) by manual palpation.
  3. Bruit over or near the artery by auscultation.
  4. Visible expanding hematoma.
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27
Q

NBS penetrating neck injury without hard sign of vasc injury?

A

CT neck with angiogram

-if concerned for esophageal injury - esophagram or EGD

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28
Q

how to repair esophageal injury?

A

extend myotomy to see mucosal injury extend, repair in 2 layers, buttress, drain

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29
Q

Who to consider for CTA for BCVI?

A 
hanging mechanism
neuro exam not explained by brain imaging 
DAI 
skull base fx involving foramen lacerum 
Horner syndrome 
LeFort II or III
C1-C3 fracture 
cervical bruit
cervical seatbelt sign
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30
Q

most common site for BCVI

A

distal internal carotid artery

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31
Q

Tx for BCVI

A

mostly heparin vs antiplatelet therapy
endovascular approach for some grade III injuries
coil embolization for grade IV and V

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32
Q

Chest tube output where going to OR is indicated?

A

initial output >1500cc or >200 cc/hr for 4 hours

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33
Q

definition of flail chest

A

3 or more consecutive ribs fractured in two locations

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34
Q

tx for flail chest

A

pain control, PPV, rib plating?

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35
Q

Initial workup for blunt cardiac injury

A

EKG - look for Tachycardia or PVCs

troponins are controversial…negative EKG and troponins effectively rule out cardiac injury

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36
Q

NBS patient with blunt cardiac injury with hemodynamic instability or persistent new arrhthmia?

A

Echocardiogram

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37
Q

location for most blunt aortic injuries?

A

proximal descending aorta just distal to ligamentum arteriosum

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38
Q

Tx for retained hemothorax despite tube thoracostomy?

A

Early VATS superior to placing second tube

39
Q

initial Tx for aortic dissection?

A

anti-hypertensive regimens to maintain <120 mmHg

esmolol +/- nitroprusside

40
Q

is open or endovascular repair of blunt aortic injury preferred?

A

endovascular

41
Q

Tx for hemodynamically stable patient with solid organ blush on CT?

A

angioembolization

42
Q

clinical indications to go to the OR for penetrating injuries? (3 of them)

A

hemodynamic instability, peritonitis, evisceration

43
Q

imaging test of choice to get for flank stab wounds?

A

triple contrast CT (oral, rectal, IV) - controversial

44
Q

best way to assess thoracoabdominal stab wounds?

A

diagnostic laparoscopy. this injury is frequently missed on CT

45
Q

how do you repair sm bowel injury if >50% of circumference is damaged?

A

resect and anastomosis

46
Q

how do you repair sm bowel injury if segment is devascularized?

A

resection and anastomosis

47
Q

Tx of <50% sm bowel injury without devascularization

A

primary repair

48
Q

how do you repair large bowel injury if >50% of circumference is damaged?

A

primary repair

49
Q

how do you repair large bowel injury if segment is devascularized or >50% circumferential injury ?

A

resection and anastomosis

50
Q

what is a bucket handle injury?

A

mesentery of bowel torn from bowel. bowel intact

51
Q

Tx for bucket handle injury?

A

resect

52
Q

Tx distal pancreatic injury without duct disruption?

A

leave drains

53
Q

Tx distal pancreatic injury with duct disruption?

A

distal pancreatectomy with splenectomy

54
Q

Tx injury to head of pancreas with duct disruption

A

drainage only

55
Q

Tx injury to head of pancreas withOUT duct disruption

A

drainage only

56
Q

where is zone 1 of the retroperitoneum

A

centrally located - aorta and vena cave

57
Q

where is zone 2 of the retroperitoneum

A

kidneys

58
Q

where is zone 3 of the retroperitoneum

A

pelvis (iliac)

59
Q

penetrating injury to what retroperitoneal zones mandates exploration

A

ALL 3 zones need to be explored in penetrating injury

60
Q

Tx blunt zone 1 injury?

A

explore

61
Q

Tx blunt zone 2 injury?

A

explore only if pulsatile or expanding hematoma

62
Q

Tx blunt zone 3 injury?

A

do not explore. pack and angiography

63
Q

Next step in open book pelvic fx with hypotension?

A

place abdominal binder

64
Q

definitive Tx in stable patient with pelvic fx and hemorrhage?

A

angioembolization

65
Q

Next step, open book pelvic fx, with binder, unstable?

A

OR for preperitoneal packing

66
Q

Blood loss needed for Class I hemorrhage?

A

0-15%

no physiologic changes

67
Q

Blood loss needed for Class II hemorrhage?

A

15-30%

tachycardia, narrowed pulse pressure

68
Q

Blood loss needed for Class III hemorrhage?

A

30-40%

hypotension

69
Q

Blood loss needed for Class IV hemorrhage?

A

> 40%

70
Q

what is the earliest sign of shock ?

A

tachycardia and narrow pulse pressure

71
Q

what is the triad of death?

A

coagulopathy, hypothermia, acidosis

72
Q

principal of damage control surgery?

A

control sepsis/spillage and hemorrhage
temporary abdominal closure
resuscitation
return to OR when more physiologically stable

73
Q

First signs of abdominal compartment syndrome? (2)

A

decreased UOP

increased peak pressures on vent

74
Q

how to diagnose abdominal compartment syndrome?

A

bladder pressure >20

75
Q

Tx abdominal compartment syndrome?

A

decompressive laparotomy

except in burn patients - place drains to drain ascites

76
Q

Adjunct to give bleeding trauma patient requiring MTP?

A

TXA 1g within 3 hours of injury then 1g over the next 8hr

77
Q

ROTEM/TEG

What product to give if clot formation time (CFT) prolonged?

A

FFP

78
Q

ROTEM/TEG

What product to give if alpha angle low?

A

cryoprecipitate

79
Q

ROTEM/TEG

What product to give if amplitude of clot is low?

A

platelets

80
Q

ROTEM/TEG

What product to give if LY30 (lysis) is high?

A

TXA

81
Q

tx intraperitoneal bladder injury?

A

operative repair

82
Q

Tx extraperitoneal bladder injury?

A

foley drainage

83
Q

tx mid ureteral injury?

A

primary anastomosis over double J stent with absorbable suture

84
Q

tx distal ureteral injury?

A

reimplant into bladder

85
Q

tx distal ureteral injury if not enough length to reach bladder?

A

psoas hitch

86
Q

Dx for urethra injury?

A

retrograde urethrogram

87
Q

hard signs of vascular injury?

A

pulsatile bleeding, expanding hematoma, absent pulses, bruit/thrill

88
Q

soft signs of vascular injury

A

non expanding hematoma, decreased ABI <0.9

89
Q

Dx for soft signs of vascular injury?

A

CT angiogram

90
Q

Tx extremity arterial trauma ?

A

typically reverse saphenous vein graft

91
Q

Tx extremity venous injury?

A

primary repair if possible or ligate

92
Q

What do you need to do after popliteal artery and vein repair?

A

fasciotomy

93
Q

crystalloid bolus amount for pediatric?

A

20cc/kg

94
Q

blood bolus for pediatrics?

A

10cc/kg

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