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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
Sucking chest wound immediate intervention?
Occlusive dressing
26
Trouble shooting asymmetric or absent breath sounds in intubated pt?
Partially withdraw endotracheal tube from right mainstem bronchus or reintubate
27
If there are no breath sounds and massive hemothorax or vascular injury suspected reflex?
Thoracotomy or video-assisted thoracic surgery to control bleed source
28
Output Values indicative of massive hemothorax or vascular injury w/in chest?
Initial chest tube output >1000mL Or >200mL/h
29
Primary survey - circulation eval includes?
``` Any external bleeds LOC skin color Peripheral pulses HR and pulse pressure ```
30
Pulse pressure calculated how?
SBP - DBP
31
Correlating hemorrage class I to S/S?
``` Vol loss- up to 750mL % loss- up to 15% HR- <100 BP- NL PP- NL or INC ```
32
Correlating hemorrage class II to S/S?
``` Vol loss- 750-1500mL % loss- 15-30% HR- 100-120 BP- NL PP- decreased ```
33
Correlating hemorrage class III to S/S?
``` Vol loss- 1500-2000mL % loss- 30-40% HR- 120-140 BP- decreased PP- decreased ```
34
Correlating hemorrage class IV to S/S?
``` Vol loss- >2000 % loss- 40% HR- >140 BP- decreased PP- decreased ```
35
Class II hemorrhage may easily evolve to
Profound hypoperfusion and decompensated shock if not recgonized early
36
What can mask early hemodynamic inducators of shock?
B-blks
37
Immediate interventions during circulation portion of primary survey?
Two LRG bore IV lines (18 gauge or larger) -infuse LR or NS Labs (esp T/S XM)
38
Unstable pts w/ difficult peripheral veins of UE reflex to?
``` Central venous access -subclavian -int jugular -femoral vein OR Access w/ an IO ```
39
How can you maximize flow rates when giving fluids?
Use pressure bag
40
Rapid infusion of 2L of crystalloids (LR/NS) for HOTN pt w/out surgery indication req?
Reassessment after infusion
41
No improvement of circulation after 2L crystalloid reflex to?
TXF type O-blood | O= if female of childbearing age
42
Pts req massive TXF generally will also req?
Urgent surgery to control bleed
43
What two conditions will contribute to coagulopathy?
Acidosis | Hypothermia
44
After ABCs are addressed and stabilized perform?
``` Focused neuro eval Assess LOC Pupillary size/reactivity Motor Fx GCS Measure blood glucose Consider intoxicants ```
45
Pts w/ AMS or GCS <15 and a corresponding MOI have what until R/O?
Head injury
46
Resusing Brain injured pts req?
Maintaining - NL cerebral perfusion - euglycemia (GLU) Avoid hyperventilate 1st 24hr after injury when cerebral blood flow critically reduced
47
Is prph hyperventilation indicated for brain injuries?
No - may reduce ICP but at expense of cerebral v-con and hypoperfusion
48
Last portion of primary survey what is next?
``` Logroll pt (maintain c-spine) Check posterior side Palpate spinous process Rectal exam Check perineum ```
49
Purpose of rectal exam during
ID gross rectal bleeds or | Loss of rectal tone = spinal injury
50
Specific injury - severe head injury
TBI - rapid neuro status | Defer procedures until head CT
51
Intubation req w/ a c-spine stabilization procedure?
Remove c-spine Keep in-line immobilization during intubation Reapply c-spine after intubation.
52
Tension pneumothorax immediate TXT is?
Needle decompression > thorcostomy (dont delay for imaging)
53
Cardiac tamponade is ass/w what type of trauma?
2% of penetrating trauma (rarely blunt)
54
Pathophys of cardiac tamponade
``` 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
Amounf of blood req to increase intracardial pressure?
65-100mL
56
How is cardiac tamponade Dx (SOC)?
FAST exam
57
S/S of cardiac tamponade?
``` 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
Narrow pulse pressure + elevated CVP is assumed?
Cardiac tamponade until R/O
59
Cardiac tamponade ID'd w/ FAST reflex to?
Pericardiocentesis (U/S guided)
60
Unstable pts w/ cardiac tamponade that may not survive OR transfer req?
ED thoracotomy
61
Penetrating trauma w/ ABD TTP, distention, and HOTN req?
Immediate transport to OR for emergent exploratory laparotomy.
62
Penetrating gunshot wound to the ABD management?
Emergent exploratory laparotomy (NOT U/S or CT)
63
ED thoracotomy is strongly recommended for pts w/?
Penetrating chest trauma w/ witnessed signs of life during transport AND cardiac electrical activity upon arrival.
64
ED thoracotomy indication for penetrating thoracic trauma, CPR(pulseless) w/out signs of life?
No further resus efforts
65
ED thoracotomy indication for blunt trauma, CPR(pulseless) w/ myocardial electrical activity?
No further resus efforts
66
Secondary is essentially?
Rapid but thoroug head-to-toe exam for injuries
67
DO NOT start secondary survey until?
Basix Fx corrected (ABCs, disability, exposure) and resuscitation initiated.
68
How to control scalp lacerations during secondary survey?
Control beleeding w/ plastic Raney clips or staples
69
Secondary survey includes eval?
``` 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
Urinary cath cleared for placement if?
Prostate is normal and no blood found at urethral meatus
71
Meatal blood or prostate displacement suggests?
Urethral injury
72
Urethral injury suspected > reflex?
Retrograde urethrography before inserting Foley cath
73
Vaginal bleeding reflex?
Manual and speculum exam | -possible vaginal laceration w/ possible pelvic Fx
74
Extremity eval includes?
Inspect for Fx, soft tissue injury, and peripheral pulses
75
Conditions requiring imaging to ID?
Injuries to - esophagus - diaphragm - sml bowel
76
MC missed injury is?
Orthopedic injuries > extremity XR PRN
77
Tertiary survey recommended if pt?
W/in 24hrs of Multisystem trauma to lessen missed injuries
78
Standard imaging for non-OR/CT pt after initial assessment?
Chest/Pelvic XR (can see blood volumes of HOTN/shock)
79
Pts w/ gunshot wounds to torso req?
Chest XR w/w/out ABD films depending one injury site
80
Extended FAST exam is for?
Identifying causes of HOTN/shock after primary survey Major intraperitoneal bleeding Pericardial tamponade Hemo/Pneumothorax
81
Definitive imaginf of ABD is?
CT w/ IV contrast
82
Obtunded pts or multisystem trauma may need?
Imaging of entire spine if MOI warrants it
83
W/ head CT also order?
cervical spine CT simultaneously
84
Chest/ABD CTs can be reconstucted to visualize?
thoracic/lumbar spines
85
Avoid CT imaging in?
Young pts w/ clinical indications that may be equivocal
86
Routine labs for trauma pt?
T/S, H/H, UA, ETOH, bHCG
87
AMS pts req what lab?
Check capillary blood glucose (check if Hx of DM too)
88
>55yo and a trauma pt order?
EKG, cardiac markers
89
Dispo of hemodynamic instable/ongoing bleeding?
Expedient transfer to OR or facility w/ capabilities
90
What is required of the HCP provider before transfering pt to another facility?
Rapid/thorough primary/secondary survey
91
During a transfer of a trauma what should come along w/ pt?
Chronological record of | -pts Vitals, Fluids infused, UO, GI output, neuro findings
92
What may not be readily apparent on initial CT?
Blunt ABD injuries involving pancreas or bowel
93
Admit/observation unit pts w/?
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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