Trauma and Shock Flashcards
What are the signs of acute arterial insufficiency?
The five Ps
Pain, paresthesias, pallor, pulselessness, paralysis
Air fluid level in the lower lung field and nasogastric tube coils upward into the left chest. What is it? Management?
Acute diaphragmatic rupture
Immediate laparotomy
Management of acute arterial insufficiency?
Immediate exploration and repair
when is exploration of a wound indicated?
Presence of “hard signs”:
Expanding hematoma, pulsatile bleeding, audible bruit, palpable thrill, evidence of absence distal pulses or evidence of distal ischemia
penetrating wounds between the clavicle and costal margin and medial to the midclavicular line
Echocardiography to evaluate for pericardial effusion in the setting of penetrating cardiac injury
Which type of injuries require neck exploration?
Acute signs of airway distress: stridor, hoarseness, dysphonia
Visceral injury: subcutaneous air, hemoptysis, dysphagia
Hemorrhage: expanding hematoma, unchecked external bleeding
All hemodynamically unstable patients with a penetrating neck injury
Neurologic symptoms referable to carotid injury
Brachial plexus injury
Upper G.I. series shows coiled spring appearance of the second and third portions of the duodenum. What is it?
Duodenal hematoma resulting from Blunt abdominal trauma
Management of blunt carotid artery injury?
Full systemic anticoagulation to prevent stroke – heparin
Most common initial manifestation of increased intracranial pressure?
Change in level of consciousness
Cushing Triad
Hypertension, bradycardia, irregular respirations – a sign of increased intracranial pressure
Emergency measures to reduce intracranial pressure in the face of inadequate volume resuscitation?
Hyperventilation. Mannitol infusion and elevation of the head of the bed or reverse Trendelenburg may worsen hypotension
Management of flail chest?
Adequate analgesia, Chest physiotherapy, mechanical ventilation of respiratory compromise develops
Inability to flex three radial digits
Median nerve injury
Treatment for Trumatic: injury due to gunshot wound?
Primary repair
Which test should be ordered’s for suspected rectal perforation from gunshot wound?
CT scan.
Barium contraindicated because spillage and parasail cavity miixed with feces would increase the likelihood of intra-abdominal abscesses
What is enophthalmos?
Enophthalmos is the posterior displacement of the eyeball within the orbit due to changes in the volume of the orbit (bone) relative to its contents (the eyeball and orbital fat), or loss of function of the orbitalis muscle.
When is surgery indicated for an orbital blowout fracture?
– Extraocular muscle entrapment
– Enophthalmos greater than 2 mm
– Diplopia on primary or inferior gaze
– Fracture greater than 50% of the orbital floor
Management of low-grade kidney injuries?
Non-operatively with a high success rate. Patient was placed on strict bedrest for the first 24 to 72 hours with serial hemoglobins
Indications for thoracotomy
-release cardiac tamponade in patients with penetrating thoracic trauma
– Allow crossclamping of the sending aorta in patients with intra-abdominal bleeding
– Allow effective internal cardiac massage and patients arriving in everything or absent pulses distant heart sounds
How should patients with enterocutaneous fistula’s be treated initially?
bed rest, total parenteral nutrition, correction of electrolyte abnormalities
Management of extra peritoneal bladder injuries? How does this compare to intraperitoneal bladder injuries?
Initial catheter drainage followed by repeat imaging to confirm healing. Intraperitoneal injuries are repaired surgically
What is normal central venous pressure?
2 to 6 mmHg
Standard fluid resuscitation
Isotonic crystalloid resuscitation with either normal saline or lactated ringer at a dose of 20 mL per kilogram bodyweight
If patient responds, second bolus should be administered
If sustained response, decrease fluids to maintenance.
If no response, repeat bolus then initiate transfusion PRBC
Management when systolic blood pressure falls by greater than 10 mmHg with inspiration.
Pulses paradoxes – cardiac tamponade
Emergent pericardiocentesis or sub xiphoid pericardial drainage under local anesthesia in the operating room
What are the indications to perform a thoracotomy for a hemothorax?
Greater than or equal to 1500 mL of immediate drainage of blood through the thoracostomy tube or
Greater than 200 mL per hour of continuous drainage of blood for several hours after the original evacuation
Management of free fluid in the abdomen or pelvis in the absence of solid organ injury
Exploratory laparotomy to evaluate for small bowel or mesenteric injury
Findings seen on CT scan suggestive of small bowel injury
Wall thickening, pneumoperitoneum, mesenteric fat streaking, extravasation of luminal or vascular contents
Management of open pneumothorax
Placement of an occlusive dressing over the defect
Airway needed in patient with GCS <8?
Patients with a GCS <= 8 run a high risk of airway loss and thus require a definitive airway (Orotracheal intubation).
Airway needed in patient with GCS <8 with oroal-maxillofacial trauma and failed ET intubation?
Endotracheal intubation is the primary definitive airway sought. In the presence of oral- maxillofacial trauma, endotracheal intubation may prove to be difficult and thus a surgical airway, cricothyroidotomy, becomes the method of choice for obtaining an urgent definitive airway.
