Trauma and Accidents Flashcards
What is a closed loop obstruction in the abdomen?
Bowel obstructed at 2 separate points
Surgical emergency as bowel distends until it becomes ischaemic/perforates
What symptom is not common in closed loop obstruction?
Vomiting
Valvulae conniventes vs haustra
Folds in small bowel vs large bowel
What is rebound tenderness?
Pain on release of pressure compared to pain on palpation
On palpation of abdomen for obstruction, when would pt have guarding or rebound tenderness?
Ischaemia
What are neck of femur fractures typically caused by?
Low energy injuries - frail + elderly, falls
High energy injuries - younger, RTC, fall from heights
What is functional bowel construction/paralytic ileus?
Bowel X mechanically blocked but X work properly
e.g. inflam, electrolyte derangement, recent surgery
Why is CT scan preferred over AXR for bowel obstruction?
more sensitive for bowel obstruction;
differentiate between mechanical/pseudo obstruction
demonstrate site + cause of obstruction
may demonstrate presence of metastases if caused by a malignancy
What are the difference between a primary and secondary spinal injury?
Primary - immediate, unavoidable, spinal cord oft appears normal immediately after trauma (unless penetrating)
Secondary - min + hrs, preventable, progressive neurological deterioration
Examples of primary and secondary spinal injuries
Primary - compression, contusion, shear injury
Secondary - ischaemia, hypoxia, inflammation
What are some high risk factors for C-spine assessment?
Age > 65
Dangerous mechanism
Paresthesia in extremities
When imaging for spinal injuries, what views should you get?
Cervical - AP, lateral, open mouth PEG
Thoraco-lumbar - AP, lateral
What is neurogenic shock?
sudden loss of SNS signals
Hypotension, Warm flushed skin, Bradycardia, Hypothermia, Priapism (long-lasting painful erection)
What is spinal shock?
immediate temporary loss of total power, sensation reflexes below level of spinal cord injury
Why is hard to assess spinal shock?
Can only assess when bulbous cavernosus reflex returns - marks end of spinal shock
Mechanism of neurogenic shock and spinal shock?
Neurogenic - disruption of autonomic pathways ==> loss of sympathetic tone + vasodilation
Shock - peripheral neurons temporarily unresponsive to brain stimuli
What type of fractures is the lumbar spine subject to?
Axial compression
How to calculate cerebral perfusion pressure
Cerebral perfusion pressure = mean arterial pressure + intracranial pressure
What are the 5 signs of a base of skull fracture?
Panda eyes, subhyaloid haem, subconjunctival haemorrhage, oto/rhinorrhea, Battle’s sign
How do you kill bugs that enter the ear?
Mineral oil/lidocaine
When are Abx given in cases of tympanic membrane perforation?
Which one should you avoid and why?
In evidence of infection
Gentamicin, toxic to inner ear
What test should you carry out in pt with tonsilitis?
Mono spot - EBV
How do you treat tonsillitis when pt presents to hospital?
IV paracetamol, dexamethasone, fluids, Abx
What is aphonia?
Complete upper airway obstruction
