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Emed 4 > Trauma in adults > Flashcards

Trauma in adults Flashcards

1
Q

Mandated Reference documentation for tracking trauma

A

Trauma care systems planning and development act of 1990

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2
Q

*American college of surgeons trauma def

A

Injured pt undergoes multidisciplinary eval, dx/therapeutic interventions performed w/ smooth transitions between ED, rad, operating room and post-op intensive care settings

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3
Q

Level 1 trauma room characteristics

A

24h surgeons in all subspecialities (including cardiac surgery/bypass)

24h neuroradiology/hemodialysis

Organized trauma research program

Program establishes/monitors injury pvt and education efforts

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4
Q

Trauma entry criteria

A 
SBP <90
GCS <14
inadequate airway/req immediate intubation
-injury patterns
-MOI
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5
Q

As part of the primary survey - EMS req to report to receiving ED what?

A 
MOI/MOA
suspected injuries
Vitals
S/S
Exam findings
Any TXT given
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6
Q

*Primary survey - ED trauma care starts w/?

A

Initial assessment for serious injuries

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7
Q

*During Primary survey - any identified derangements req?

A

TXT immediately

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8
Q

Order of identified

A

ABC > head-to-toe exam

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9
Q

Dx tests, further therapies, disposition is reserved for what portion of trauma management?

A

Secondary survey

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10
Q

Primary survey - airway patency steps

A

Inspect for FOB/Fx
Jaw thrust w/ c-spine
Insert oral/nasal AW - if inadequate resp effort

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11
Q

CI - Oral AW

A

Active gag reflex

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12
Q

CI - Nasal AW

A

Basilar skull Fx

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13
Q

C-spine is best performed w/?

A

Two-person stabilization

  • one > undivided attn to c-spine
  • two > mamages AW
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14
Q

Endotracheal intubation in is indicated when?

A

GCS - <8

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15
Q

Aids for intubation?

A

Video laryngoscopy for vocal cord visualization while minimizing cervical spine manipulation

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16
Q

If severe maxillofacial injury CI’s endotracheal intubation reflex to?

A

Cricothyroidotomy

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17
Q

Criteria for omitting cervical spine imaging

req image if any one is met

A 
NEXUS(none of following)
N- neuro focal deficits
E- evidence intoxication
X- distracting injury 
U- AMS
S- spinal TTP
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18
Q

W/ obtunded pt you must assume they have?

A

Cervical spine injury

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19
Q

Does XR/CT R/O cervical spine injury?

A

No - may be ligamentous injuries

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20
Q

SOC for initial cervical spine eval

A

CT

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21
Q

Next step after AW controlled?

A

Inspect, auscultate, palpate the thorax and neck for ABNL

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22
Q

Inspect, auscultate, palpate the thorax and neck for what?

A

-Deviated trachea (tension ptx)
-crepitus (ptx)
-Paradoxical chest (flail)
-sucking chest wound
-Fx sternum
-absent breath sounds
Simple/tension ptx
Massive hemothorax
Right stem intubation

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23
Q

Tension ptx immediate intervention?

A

Needle decompress (thoracostomy)

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24
Q

Hemopneumothorax immediate intervention?

A

Lrg-bore chest tube (36-F)

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25
Q

Sucking chest wound immediate intervention?

A

Occlusive dressing

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26
Q

Trouble shooting asymmetric or absent breath sounds in intubated pt?

A

Partially withdraw endotracheal tube from right mainstem bronchus or reintubate

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27
Q

If there are no breath sounds and massive hemothorax or vascular injury suspected reflex?

A

Thoracotomy or video-assisted thoracic surgery to control bleed source

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28
Q

Output Values indicative of massive hemothorax or vascular injury w/in chest?

A

Initial chest tube output >1000mL
Or
>200mL/h

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29
Q

Primary survey - circulation eval includes?

A 
Any external bleeds
LOC
skin color
Peripheral pulses
HR and pulse pressure
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30
Q

Pulse pressure calculated how?

A

SBP - DBP

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31
Q

Correlating hemorrage class I to S/S?

A 
Vol loss- up to 750mL
% loss- up to 15%
HR- <100
BP- NL
PP- NL or INC
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32
Q

Correlating hemorrage class II to S/S?

A 
Vol loss- 750-1500mL
% loss- 15-30%
HR- 100-120
BP- NL
PP- decreased
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33
Q

Correlating hemorrage class III to S/S?

A 
Vol loss- 1500-2000mL
% loss- 30-40%
HR- 120-140
BP- decreased
PP- decreased
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34
Q

Correlating hemorrage class IV to S/S?

A 
Vol loss- >2000
% loss- 40%
HR- >140
BP- decreased
PP- decreased
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35
Q

Class II hemorrhage may easily evolve to

A

Profound hypoperfusion and decompensated shock if not recgonized early

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36
Q

What can mask early hemodynamic inducators of shock?

A

B-blks

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37
Q

Immediate interventions during circulation portion of primary survey?

A

Two LRG bore IV lines (18 gauge or larger)
-infuse LR or NS
Labs (esp T/S XM)

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38
Q

Unstable pts w/ difficult peripheral veins of UE reflex to?

A 
Central venous access
-subclavian
-int jugular
-femoral vein
OR
Access w/ an IO
39
Q

How can you maximize flow rates when giving fluids?

A

Use pressure bag

40
Q

Rapid infusion of 2L of crystalloids (LR/NS) for HOTN pt w/out surgery indication req?

A

Reassessment after infusion

41
Q

No improvement of circulation after 2L crystalloid reflex to?

A

TXF type O-blood

O= if female of childbearing age

42
Q

Pts req massive TXF generally will also req?

A

Urgent surgery to control bleed

43
Q

What two conditions will contribute to coagulopathy?

A

Acidosis

Hypothermia

44
Q

After ABCs are addressed and stabilized perform?

A 
Focused neuro eval
Assess LOC
Pupillary size/reactivity
Motor Fx
GCS
Measure blood glucose
Consider intoxicants
45
Q

Pts w/ AMS or GCS <15 and a corresponding MOI have what until R/O?

A

Head injury

46
Q

Resusing Brain injured pts req?

A

Maintaining
- NL cerebral perfusion
- euglycemia (GLU)
Avoid hyperventilate 1st 24hr after injury when cerebral blood flow critically reduced

47
Q

Is prph hyperventilation indicated for brain injuries?

A

No - may reduce ICP but at expense of cerebral v-con and hypoperfusion

48
Q

Last portion of primary survey what is next?

A 
Logroll pt (maintain c-spine)
Check posterior side
Palpate spinous process
Rectal exam
Check perineum
49
Q

Purpose of rectal exam during

A

ID gross rectal bleeds or

Loss of rectal tone = spinal injury

50
Q

Specific injury - severe head injury

A

TBI - rapid neuro status

Defer procedures until head CT

51
Q

Intubation req w/ a c-spine stabilization procedure?

A

Remove c-spine
Keep in-line immobilization during intubation
Reapply c-spine after intubation.

52
Q

Tension pneumothorax immediate TXT is?

A

Needle decompression > thorcostomy (dont delay for imaging)

53
Q

Cardiac tamponade is ass/w what type of trauma?

A

2% of penetrating trauma (rarely blunt)

54
Q

Pathophys of cardiac tamponade

A 
Intracardial blood accumulation >
increased intrapericardial pressure >
decreased R/L vent filling pressures >
septum shifts to L-side >
further decreasing L ventricular filling/CO >
irreversible shock and death
55
Q

Amounf of blood req to increase intracardial pressure?

A

65-100mL

56
Q

How is cardiac tamponade Dx (SOC)?

A

FAST exam

57
Q

S/S of cardiac tamponade?

A 
Sometimes only S/S = Sinus tachycardia
Ominous S/S = HOTN > decompensation
Becks triad(muffled heart, HOTN, distended neck vein)
Narrow pulse pressure
Elevated CVP
58
Q

Narrow pulse pressure + elevated CVP is assumed?

A

Cardiac tamponade until R/O

59
Q

Cardiac tamponade ID’d w/ FAST reflex to?

A

Pericardiocentesis (U/S guided)

60
Q

Unstable pts w/ cardiac tamponade that may not survive OR transfer req?

A

ED thoracotomy

61
Q

Penetrating trauma w/ ABD TTP, distention, and HOTN req?

A

Immediate transport to OR for emergent exploratory laparotomy.

62
Q

Penetrating gunshot wound to the ABD management?

A

Emergent exploratory laparotomy (NOT U/S or CT)

63
Q

ED thoracotomy is strongly recommended for pts w/?

A

Penetrating chest trauma w/ witnessed signs of life during transport AND cardiac electrical activity upon arrival.

64
Q

ED thoracotomy indication for penetrating thoracic trauma, CPR(pulseless) w/out signs of life?

A

No further resus efforts

65
Q

ED thoracotomy indication for blunt trauma, CPR(pulseless) w/ myocardial electrical activity?

A

No further resus efforts

66
Q

Secondary is essentially?

A

Rapid but thoroug head-to-toe exam for injuries

67
Q

DO NOT start secondary survey until?

A

Basix Fx corrected (ABCs, disability, exposure) and resuscitation initiated.

68
Q

How to control scalp lacerations during secondary survey?

A

Control beleeding w/ plastic Raney clips or staples

69
Q

Secondary survey includes eval?

A 
Scalp
Tympanic membranes
RPT pupil exam
Facial trauma/basilar skull Fx > gastric tube via PO
RPT neck/thorax exam
Inspect urinary meatus, scrotum, perineum, vagina
Rectal exam (CI if pt is alert)
Extremities
Thorough neuro exam (M/S)
70
Q

Urinary cath cleared for placement if?

A

Prostate is normal and no blood found at urethral meatus

71
Q

Meatal blood or prostate displacement suggests?

A

Urethral injury

72
Q

Urethral injury suspected > reflex?

A

Retrograde urethrography before inserting Foley cath

73
Q

Vaginal bleeding reflex?

A

Manual and speculum exam

-possible vaginal laceration w/ possible pelvic Fx

74
Q

Extremity eval includes?

A

Inspect for Fx, soft tissue injury, and peripheral pulses

75
Q

Conditions requiring imaging to ID?

A

Injuries to

  • esophagus
  • diaphragm
  • sml bowel
76
Q

MC missed injury is?

A

Orthopedic injuries > extremity XR PRN

77
Q

Tertiary survey recommended if pt?

A

W/in 24hrs of Multisystem trauma to lessen missed injuries

78
Q

Standard imaging for non-OR/CT pt after initial assessment?

A

Chest/Pelvic XR (can see blood volumes of HOTN/shock)

79
Q

Pts w/ gunshot wounds to torso req?

A

Chest XR w/w/out ABD films depending one injury site

80
Q

Extended FAST exam is for?

A

Identifying causes of HOTN/shock after primary survey
Major intraperitoneal bleeding
Pericardial tamponade
Hemo/Pneumothorax

81
Q

Definitive imaginf of ABD is?

A

CT w/ IV contrast

82
Q

Obtunded pts or multisystem trauma may need?

A

Imaging of entire spine if MOI warrants it

83
Q

W/ head CT also order?

A

cervical spine CT simultaneously

84
Q

Chest/ABD CTs can be reconstucted to visualize?

A

thoracic/lumbar spines

85
Q

Avoid CT imaging in?

A

Young pts w/ clinical indications that may be equivocal

86
Q

Routine labs for trauma pt?

A

T/S, H/H, UA, ETOH, bHCG

87
Q

AMS pts req what lab?

A

Check capillary blood glucose (check if Hx of DM too)

88
Q

> 55yo and a trauma pt order?

A

EKG, cardiac markers

89
Q

Dispo of hemodynamic instable/ongoing bleeding?

A

Expedient transfer to OR or facility w/ capabilities

90
Q

What is required of the HCP provider before transfering pt to another facility?

A

Rapid/thorough primary/secondary survey

91
Q

During a transfer of a trauma what should come along w/ pt?

A

Chronological record of

-pts Vitals, Fluids infused, UO, GI output, neuro findings

92
Q

What may not be readily apparent on initial CT?

A

Blunt ABD injuries involving pancreas or bowel

93
Q

Admit/observation unit pts w/?

A

Closed head trauma w/ NL LOC and req RPT neuro

Risk of delayed PTX or Pulmonary contusion that req RPT CXR

Emed 4 (10 decks)

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