Trauma and Critical Care Flashcards
1
Q
Identify the Maneuver to establish an airway
A
Jaw-thrust Maneuver
1
Q
What are the 4 regions to scan in Focused Assessment Sonography in Trauma (FAST)
A
Pericardial sac
Hepatorenal fossa
Splenorenal fossa
Pelvis or pouch of Douglas
2
Q
at what PaC02 level will a patient experience cerebral ischemia
A
2
Q
Identify the BLADDER PRESSURES at the following Conditions:
Mildly elevated
Moderately elevated
Severely elevated
Normal
Normal after abdominal Surgery
A
Mildly elevated 10-20mmHg
Moderately elevated >20mmHg
Severely elevated >40mmHg
Normal 0mmHg
Normal after abdominal Surgery 0-15mmHg
3
Q
Criteria for Brain Death
A
- GCS 3
- non reactive pupils
- absent brainstem reflex (oculocephalic, corneal, Doll’s eye gag)
- no spontaneous ventilatory effort on formal apnea testing
3
Q
Ancillary Studies may confirm diagnosis of brain death by (3)
A
- EEG no activity at high gain
- ICP exceeds MAP for ≥ 1 hour
- cerebral angiography
3
Q
Develops when the pressure within an osteoclastal compartment of muscle causes ischemia and subsequent necrosis
A
Compartment Syndrome
3
Q
What is a late sign of Compartment Syndrome?
A
Absence of pulse
4
Q
Causes of IAH and Abdominal Compartment Syndrome include:
A
- intraperitoneal blood
- interstitial edema from fluid resuscitation peritonitis
- ascites
- gaseous bowel distention
5
Q
Implies no possibility of recovery of brain function
A
Brain Death
6
Q
Indications for using Mannitol
A
- acute neurologic deterioration (1g/kg)
- dilated pupil
- hemiparesis
- LOC while being observed
7
Q
Blast Injury Mechanism
Where the effects of the blast wave itself is considered
A
Primary Blast Mechanism
7
Q
Determine the boundaries of the 3 neck zones
A
- Zone 1 - thoracic inlet to cricoid cartilage
- Zone 2 - cricoid cartilage to mandible
- Zone 3 - angle of mandible to base of skull
7
Q
Damage Control is Indicated when?
A
at the Manifestation of “bloody vicious cycle”
8
Q
a.k.a. Atlas fracture
A
Jefferson Fracture
9
Q
Large defects of chest wall that remains open can result into open pneumothorax where there is a chest wound that sucks air from the environment and into the pleural space
A
Open Pneumothorax
9
Q
what are the key phases in damage control?
A
Preoperative
Operative
Resuscitation
Re-operate
10
Q
6 steps in Adjuncts to Primary Survey and Resuscitation
A
STEP 1 ABG analysis and ventilatory rate
STEP 2 CO2 monitoring
STEP 3 ECG monitoring
STEP 4 Urinary cath, gastric cath
STEP 5 Radiologic examination
STEP 6 FAST or DPL
11
Q
What should be the position of the patient’s neck during airway management?
A. Hyperflexed
B. Hyperextended
C. Rotated
A
None of the above
11
Q
What are the 2 fluids of choice when Starting Fluid resuscitation?
A
IV bolus of Isotonic Crystalloid
Lactated Ringer’s
13
Q
What are the common ways to manage breathing of the patient?
A
A. Administer high-concentration oxygen
B. Mask ambubagging
C. Alleviate tension pneumothorax
D. Seal open pneumothorax
E. C02 monitoring
F. Pulse oxymeter
13
Q
Identify the fracture
A
Open Book Fracture
14
Q
the orientation of the longitudinal axis of the missile to its trajectory
A
Yaw
15
Q
Ways to establish Patent Airway (4) in Step 2 (Management)
A
A. Chin-Lift or jaw-thrust maneuver
B. Clear airway of foreign body
C. Insert oropharyngeal airway
D. Establish definitive airway
16
Identify the procedure
Closed Tube Thoracostomy
17
True or False. The speed of the bullet is much more important than its weight in determining kinetic energy.
True
17
Identify the fracture
Vertical Shear Fracture
18
Normal Blood Volume:
Adults
Children
A. Adults (7% of kg body weight = blood volume in liters)
B. Children (8-9% of kg body weight = blood volume in liters)
18
Hypothermic patients more likely to suffer?
* cardiac arryhthmias
* reduced CO
* increased SVR
* alteration in O2-Hgb dissociation curve
* profound worsening of coagulopathy
19
What are the common causes of transient response to fluid resuscitation?
1. Underestimation of blood loss
2. Continuing blood loss
3. Cardiac tamponade
4. Recurrent/Persistent Penumothorax
20
reduces incidence of seizures in
first week of injury but not thereafter
Prophylactic Phenytoin
20
Transverse fracture through vertebral body
Chance Fracture
21
What are the Manifestations of "bloody vicious cycle"
Coagulopathies
Hypothermia
Metabolic Acidosis
22
What type of Trauma (Blunt ot Penetrating) commonly results to the injury shown?
Blunt trauma
The injury is Diaphragmatic Rupture
Blunt trauma produces large radial tears that lead to herniation whereas penetrating trauma produces small perforations that often take some time to develop into diaphragmatic hernias
24
Procedures in Assessment of Breathing of Patient
A. Expose the neck and chest,
ensure immobilization of head & neck
B. Determine rate & depth of respiration
C. Inspect & palpate neck & chest
tracheal deviation unilateral or bilateral chest movement signs of injury
D. Percussion: dullness, hyperresonance
E. Auscultation
25
What is the estimated blood loss (in volume) if an adult patient lost 25% of his/her blood?
(Assuming BW = 70kg)
Computation:
Adult: 70kg x 0.07 = 4900ml
what is the 25% of 4900ml?
4900ml x 0.25 = **1225ml**
26
collision against the side of a vehicle that accelerates the occupant away from the point of impact
Lateral Impact
27
Cervical Spine X-ray Assessment for **Alignment** (ABCD)
* All 7 cervical vertebrae (A)
* Identify ant vertebral line (B)
* Identify ant spinal line (C)
* Identify spinous porcess (D)
28
2 types of trauma
Blunt
Penetrating
29
```
Dertermine the class of blood loss in the following cases:
\*assuming a 70kg person
```
(You will be needing a paper for this)
1. Blood Pressure 120/80 (normal)
2. 5ml/hr urine output
3. RR = 38; Lethargic
4. 1200 blood loss
5. Px is Confused and Anxious
6. PP is decreased and the Px is given crystalloid only for fluid replacement
7. Pulse rate of 157
8. Blood pressure is already decreased
9. 25ml/hr urine output
10. Px is given blood as fluid resuscitation
1. Class 1
2. Class 3
3. Class 4
4. Class 2
5. Class 3
6. Class 2
7. Class 4
8. Class 3 & 4
9. Class 2
10. Class 3 & 4
31
What are the types of Patients according to their responsiveness to Fluid Resuscitation?
1. Responders
2. Transient Responders
3. Non-Responders
32
Develops when a 1-way valve air leak occurs from the lung or through chest wall
Air is forced into the thoracic cavity and completely collapses affected lung
Tension Pneumothorax
33
Identify the fracture
Open Book Fracture
35
Identify the normal urine output of the following:
## Footnote
Adult
Children
\< 1 year old
Adult: **0.5**ml/kg per hour
Children: **1**ml/kg per hour
\< 1 year old: **2**ml/kg per hour
36
what are the landmarks of this vessel shown?
Great Saphenous Vein
1cm anterior and 1 cm superior to the medial malleolus
36
unrestrained occupant can impact any part of the passenger compartment
Roll over
36
there is a tear in what artery in an Epidural Hematoma?
Middle Meningeal Artery
38
What is a quick simple way to assess the patient in 10 seconds?
Primary Survey
1. **A**irway maintenance with cervical spine protection
2. **B**reathing and ventilation
3. **C**irculation with hemorrhage control
4. **D**isability: Neurologic status
5. **E**xposure/Environmental control: undress, prevent hypothermia
40
4 steps in Airway Maintenance with cervical spine protection
1. Assessment
2. Management
3. Maintain cervical spine in neutral position with manual immobilization as necessary when establishing an airway
4. Reinstate immobilization of the
c-spine with appropriate devices after establishing an airway
42
What are the structures to assess in checking for any signs of Airway obstruction?
1. foreign bodies
2. facial functions
3. mandibular functions
4. tracheal functions
5. laryngeal functions
42
What is the estimated blood loss (in volume) if a pediatric patient lost 48% of his/her blood?
## Footnote
Weight = 10kg
Computation:
Pediatric: 10kg x 0.09 = 900ml
what is the 48% of 900ml?
900ml x 0.48 = **432ml**
43
Identify the Maneuver to establish an Airway
Chin-Lift Maneuver
44
diagnostic Beck's triad of Cardiac Tamponade
o dilated neck veins
o muffled heart tones
o decline in arterial pressure
45
vehicle is at a complete stop and is struck from behind by another vehicle
Rear Impact
45
Identify the Brain Injury
Intraparenchymal Hemorrhage with R→L midline shift
45
Results from the rapid accumulation of more than 1.5L of blood or one-third or more of the patient’s blood volume in the chest cavity
Massive Hemothorax
45
the image shown has \_\_\_% sensitivity for intraperitoneal bleeding
98%
Diagnostic Peritoneal Lavage
45
Splinting device that uses straps attaching over the pelvis or hip as an anchor, a metal rod to mimic normal bone stability and a mechanical device to apply traction to the limb.
Traction Splinting
46
Contraindications for Emergency Department Thoracotomy
* Penetrating trauma: CPR \>15 min and no signs of life (pupillary response, respiratory effort, motor activity)
* Blunt trauma: CPR \>5 min and no signs of life or asystole
48
True or False.This alternative method of oral airway insertion is traditionally done in children to push the soft palate away from the tongue
False.
Do not do this in children
Do thid instead.
50
collision with an object in front of a vehicle that suddenly reduces its speed
Frontal Impact
51
Identify the procedure
Sucking wound
(Dressing for treatment of Pneumothorax)
53
What are the steps in **Circulation assessment**?
A. Identify source of external exanguinating hemorrhage
B. Identify potential source of internal hemorrhage
C. Assess pulse: rate, rhythm
D. Skin color
E. Blood pressure
54
it is indicated due to refractory to other measures to reduce ICP
Barbiturates
56
Identify the Brain Injury
Biconvex, lenticular
Pushes dura away from inner table
Epidural hematoma
57
Results from penetrating or blunt injuries that cause the cardium to fill with blood from the heart, great vessels or pericardial vessels, and particularly the atrial appendage.
Cardiac Tamponade
59
Classification of Brain injury according to severity
Identify the GCS score:
1. Minor
2. Moderate
3. Severe
1. Minor **13-15**
2. Moderate **9-12**
3. Severe **1-8**
60
What is the meaning of AMPLE?
Allergies
Medications currently used
Past Illnesses and Pregnancy
Last meal
Events/Environment related to injury
61
What are the three assessment areas of the GCS?
**(EMV)**
* Eye Opening
* Motor Response (Best)
* Verbal Response
62
Medical Therapy for Brain Injury (6)
* Intravenous fluids
* Hyperventilation
* Mannitol
* Steroids
* Barbiturates
* Anticonvulsants
63
What is the procedure shown?
Cricothyroidotomy
64
WHAT TO DO IN AN UNCONTROLLED HEMORRHAGE IN THE PROFOUNDLY HYPOTENSIVE PATIENT?
Digital control of the aorta
Aortic cross-clamping
Proximal-distal control
66
Factors to consider in Falls:
* abrupt change in velocity
* ability of the stationary surface to arrest the forward motion of the body
* position of the body in relation to impact surface
68
Types of Blunt Trauma
* Vehicular Impact w/ patient inside vehicle
* Pedestrian injury
* Injury to cyclist
* Assault
* Fall
* Blast Injury
70
effects of the missiles being propelled by the blast force
Secondary Blast Mechanism
71
you hit a wall upon impact (coup-contrecoup)
Tertiary Blast Mechanism
72
Identify the fracture
Closed Fracture
73
CRITERIA for “POSITIVE” FINDING ON Diagnostic Peritoneal Lavage for Thoracoabdominal Stab Wounds
RBC count
WBC count
Amylase level
Alkaline phosphatase level
Bilirubin level
RBC count **\>10,000/mL**
WBC count **\>500/mL**
Amylase level **\>19 IU/L**
Alkaline phosphatase level **\>2IU/L**
Bilirubin level **\>0.01 mg/dL**
75
What is the starting volume of fluid resuscitation for Adults?
2 liters
77
Theseare characteristics of:
Responder
Transient Responder
Non-Responder
Non-Responder
78
Name the procedure
Pericardiocentesis
79
What are the steps in _**D**isability Assessment?_
1. Determine LOC (level of Consciousness) via GCS (Glasgow Coma Scale)
2. Assess Pupillary S-E-R (Size Eqaulity Reaction)
80
What is the starting volume of fluid resuscitation for pediatric patients?
2oml/kg body wieght
82
Types of Blast Injury Mechanisms
Primary Blast Mechanism
Secondary Blast Mechanism
Tertiary Blast Mechanism
83
What is the estimated blood loss (in volume) if an adult patient lost 43% of his/her blood?
(Assuming BW = 70kg)
Also determine the volume of Replacement fluids
Computation:
Adult: 70kg x 0.07 = 4900ml
what is the 43% of 4900ml?
4900ml x 0.43 = **2107ml**
Replacement rule: 3:1 (300ml electrolyte/100ml blood loss)
2107ml x 3 = **6.3 Liters of electrolytes**
84
CRITERIA for “POSITIVE” FINDING ON Diagnostic Peritoneal Lavage for Anterior Abdominal Stab Wounds
RBC count
WBC count
Amylase level
Alkaline phosphatase level
Bilirubin level
RBC count **\>100,000/mL**
WBC count **\>500/mL**
Amylase level **\>19 IU/L**
Alkaline phosphatase level **\>2IU/L **
Bilirubin level **\>0.01 mg/dL**
85
what are the primary objectives of Damage Control Laparotomy?
Control Bleeding
Limit GI spillage
86
Indications for Emergency Department Thoracotomy
* Patients sustaining witnessed penetrating trauma with
* Patients sustaining witnessed blunt trauma with
* Cardiac Tamponade
* Hemorrhage-intrathoracic, intra-abdominal, extremity, cervical
* Air embolism
87
Early sign of compartment syndrome is?
numbness between 1st and 2nd toes
88
Identify the Brain Injury
Contusions and Intracerebral Hematoma
89
Determine the GCS score in the following scenarios:
\*you will be needing a paper for this
1. Spontaneous eye opening, with abnormal flexion and confused conversation
2. The patient produces incomprehensible sounds does not have any motor response and eyes do not open
3. Px can localize the pain experienced, has proper spatial and temporal orientation and eyes are both open
4. opens eyes to pain, Has abnormal extension of lower limbs and uses inappropriate words
5. as soon as the physician asked the patient to sit down, the Px opened both eyes and immediately obeyed. however Px cannot utter any sounds whatsoever
1. E= 4, M=3, V=3 GCS=**10**
2. E=1, M=1, V=2 GCS=**4**
3. E=4, M=5, V=5 GCS=**14**
4. E=2, M=2, V=3 GCS=**7**
5. E=3, M=6, V=1 GCS=**10**
90
3 distinct regions of the abdomen
o Peritoneal cavity
o Retroperitoneal space
o Pelvic cavity
91
at what temperature is considered an independent predictor of mortality
\< 35ºC (or equal to)
92
Fracture of the Axis bone (C2)
Hangman's Fracture
93
reduces elevated ICP
Mannitol
94
Anterior portion of the torso ceases to move forward posterior and internal organs continue their motion Organs eventually compressed from behind by advancing posterior thoracoabdominal wall & vertebral column in front by the impacted anterior structure
Compression Injury
95
What is the indication in the following condition?
1. Unconscious
2. Cyanotic
3. Massive blood loss and the need for resuscitation
4. Apnea
5. Severe Maxillofacial Fractures
6. Stridor
A. need for airway protection
B. need for ventilation/oxygenation
1. A
2. B
3. B
4. B
5. A
6. A
96
Steps in Secondary Survey and Management
1. AMPLE history taking
2. Identify Mechanism of Injury
98
What are the procedures in **Management** of **Circulation** and **Hemorrhage**
A.Direct pressure to external bleeding sites
B.Consider internal hemorrhage & potential need for surgical intervention
C.Two large caliber IV catheters
D.Blood extraction
E.IV fluid warmed crystalloid, blood
F.Prevent hypothermia
99
Where are the common Access points in Circulation with Hemorrhage control? (4)
1. Internal Jugular Access
2. Great Saphenous Vein Access
3. Femoral Vein Access
4. Tibial Access (Pediatrics)
100
Upon CT scan, blood seen conforms contour of the brain. Shearing bridging blood vessels in the cerebral cortex
Subdural Hematoma
102
stabilizing portion of an organ ceases forward motion with the torso while the movable body part continues to move forward
Common areas of injury:
renal pedicle
ligamentum teres
descending thoracic aorta
Deceleration Injury
103
Identify the fracture
Vertical Shear Fracture
104
True or False.
Hypotension is a reliable sign of early hypovolemia
False.
a decrease of 30% in blood volume is needed to elicit a decrease in blood pressure. That is no longer early!!!!
105
Identify the fracture
Closed Fracture
