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Surgery > Trauma Management > Flashcards

Trauma Management Flashcards

1
Q

Cause of death immediately after trauma

A

Severe head injury (mc)

Transection of great vessels

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2
Q

Cause of death within 1 hour of injury

A 
Airway obstruction 
Tracheobronchial injury 
Open pneumothorax
Tension pneumothorax
Acute circulatory failure
Hemothorax 
Cardiac tamponade
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3
Q

Color coding red in triage means

A

Urgent intervention

Airway obstruction
Tracheobronchial injury 
Open pneumothorax
Tension pneumothorax
Acute circulatory failure
Hemothorax 
Cardiac tamponade
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4
Q

Death after days following trauma can be due to

A

Delayed head injury

Sepsis

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5
Q

What is Golden hour and platinum minutes following trauma

A

1 hr following trauma

1st 10 min after trauma - Platinum minutes

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6
Q

What is multiple and mass casuality event

A

Multiple casuality event when number of injured don’t overwhelm medical facilities

Mass casuality event when it overwhelms medical facilities

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7
Q

Color coding of triage

Principle of triage

A 
Red
Yellow
Green 
Black 
Principle - to save as many as pt possible in little time
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8
Q

Yellow
Green
Black category of triage include

A

Yellow- admitted and stabilised
Fracture and moderate head injury

Green walking wounded
Minor bruise laceration

Black dead bodies, moribund pt

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9
Q

Principle of ATLS

A

A airway
B breathing
C circulation
D disability mgt

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10
Q

Advanced cardiac life support principle

A

CAB
Circulation
Airway
Breathing

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11
Q

Principle of trauma management during war fields

A

cABCD

c - control exsanguinating hemorrhage

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12
Q

Before arriving hospital information collected from ambulance driver and pt

A 
Driver 
M mech of injury
I  injury
S sign and symptoms
T treatment given 
Patient 
A allergy
M medical condition
P past history
L last meal 
E event leading to trauma
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13
Q

Secondary survey in ATLS is done for and how

A

Done to search for all injury
By log roll to see back injury
Minimum 4 people
In limb fracture 5 people required

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14
Q

Ist step of ATLS

A

Cervical spine stabilisation

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15
Q

How to transfer pt of cervical spine injury

A

Done on hard board
Supine position strap head thorax pelvis
Prone position- done in unconscious pt to prevent aspiration

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16
Q

Criteria used to assess C spine injury

A

Nexus criteria
Canadian C spine rule
American Spinal Injury Association impairment scale

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17
Q

When to use hard Philadelphia collar and image Cervical spine acc to nexus criteria

A 
N neuro deficit
E alcohol intoxication
X extremely distracting injury
U unable to give history
S spinal tenderness

If any feature present both above mentioned steps have to performed

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18
Q

Danger sign during airway assessment

What if danger sign are present

A

Unable to speak
Comatose pt
Pt with GCS less than equal to 8
Non purposeful movement

If present intubation orotracheal /nasotracheal

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19
Q

Emergency mgt due to failure of orotracheal intubation

Definitive mgt

A

Emergency Needle cricothyroidotomy

Definitive tracheostomy

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20
Q

3rd to 5th ribs are most commonly fractured during

A

CPR

21
Q

Most uncommon rib fracture

A

1st rib

22
Q

Most common cause of death in blunt thoracic trauma

A

Tracheo bronchial injury

23
Q

Most common cause of death in penetrating thoracic trauma

A

Pulmonary laceration leading to hemothorax

24
Q

Most common site of rupture of thoracic aorta

A

Distal to ligamentum arteriosum

25
Q

Strapping is management of rib fracture

T/F

A

False

Adequate analgesia is mgt

26
Q 
Rta 
Pulse 100/min
BP 90
O2 84
RR 22
Decrease breath sounds on right and hyper resonant note on percussion
Diagnosis
A 
Tachycardia
Hypotension
Low 02 
Hyperventilating
 Hyper resonant- pneumothorax with unstable vitals
Diagnosis Tension Pneumothorax
27
Q

55yr old male breathless vitals stable

Decrease breath sounds on right side and hyper resonant note on percussion

A

Simple pneumothorax

28
Q 
PR 110/min
BP 90 
Distend neck vein 
Muffled heart sounds
Triad? 
Diagnosis?
A

Beck triad

Cardiac tamponade

29
Q

Cardiac tamponade is a ______ diagnosis supported with ____

A

Clinical diagnosis supported with FAST/EFAST

30
Q

Cardiac tamponade is an indication for emergency room thoracotomy
T or F

A

False

It is indication for emergency thoracotomy

31
Q 
Correlate Injury with neck trauma zone
Pt sustain injury below cricoid
Most exposed zone
Most surgically accessible zone
Injury to base of skull
A

Zone 1
2
2
3

32
Q

Intercostal block to insert chest tube should be given along ?

A

Lower border of rib as neurovascular bundle runs here

33
Q

Where are chest tubes inserted

A 
Inserted in triangle of safety
Boundaries
Ant - ant axillary fold
Post -post axillary fold
Apex axilla 
Base 5th intercostal space
34
Q

To determine correct position of chest tube investigation

A

Chest xray in which all holes of tubes are inside thoracic cavity

35
Q

Indication of a normally functioning tube

A

Oscillation of fluid with breathing

36
Q

When to remove chest tubes

A

Lung expands and breath sounds are presen
Output less than 100cc in 24hrs
At peak of inspiration when pt holds breath

37
Q

Most common thoracic trauma in adults

A

Rib fracture

38
Q

If first rib is fractured suspect injury of

A

Subclavian vessel
Brachial plexus
Apex of lungs

39
Q

flail chest
Def
Mc cause of death in flail chest
Mgt

A

ATLS def - fracture of 2 or more consecutive ribs at 2 or more places

Pulmonary contusion mc cause of death

Mgt analgesic and oxygenation
If pO2 less than 60 - IPPV if it fails surgical correction

40
Q

What is tension pneumothorax and its difference from simple pneumothorax

A

Tension pneumothorax - pneumothorax with rapid hemodynamic compromise
Simple no hemodynamic compromise

41
Q

Most common cause of tension pneumothorax

A

Pulmonary laceration
Others -
Tracheo bronchial injury
Open pneumothorax

42
Q

What is sucking wound on chest wall

A

Open pneumothorax where wound is 2/3 circumference of trachea
One way valve is formed

43
Q

Pathogenesis of tension pneumothorax

A

Air accumulation causes lung collapse of same side
Hyperinflation of opposite side
Mediastinal shift causes compression over heart
Hemodynamic changes

44
Q

Clinical feature of pneumothorax

A

Respiratory rate increase
Heart rate increases stroke volume decrease = CO decrease
JVP increase
Percussion- hyper resonant

45
Q

eFast sign of tension pneumothorax

A

Stratosphere sign
Bar code sign
Sea shore sign

46
Q

Emergency needle thoracocentesis is done for

Site of this procedure

A

Pneumothorax
In adult 5 th intercostal space in mid axillary line
In children 2nd ICS in mid clavicular line

47
Q

What is hemothorax

source of blood

A

Accumulation of blood in pleural space

Intercostal vessels

48
Q

Indication for emergency thoracotomy

A

Output more than 1.5 litre blood at time of ICT Insertion

More than 200cc/hr for 3 consecutive hrs

49
Q

Indication for emergency room thoracotomy

A

Open cardiac massage
Massive air leak
Massive bleeding

Surgery (5 decks)

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