Trauma management Flashcards
What is Newton’s first law?
Laws of Inertia
A body in motion remains in motion in a straight line unless acted upon by outside force.
What is Newton’s second law?
Acceleration is dependent on mass of the object and the force upon the object.
What is Newton’s Third law?
For every action there is an equal and opposite reaction.
What are the types of trauma?
Blunt and penetrating
How many feet per second can high velocity weapons fire?
> 2000 FPS
What 3 factors make up the trauma triad of death?
Hypothermia, acidosis, coagulopathy
What classes of hypovolemic shock calls for blood administration?
Class III and IV (3 &4)
What are some injury patterns in trauma?
Side impact
Front impact
Rear impact
Rollover
What is Kehr’s sign and when would you see it?
Splenic rupture secondary to rib fracture (referred pain)
Most of the time in a side impact collision
Which vertebrae are the most commonly injured in rear collision?
T12-L1
What is a chance fracture?
T12 fracture
What is a hangman’s fracture?
Fracture of the C2 vertebrae
What is a Jefferson’s fracture?
C1 fracture from axial loading
What type of spinal fracture is most common in an off-road vehicle accident?
Hangman’s fracture
What should you be concerned about with lap belt injuries?
Cullen’s sign and internal bleeding
How do children tend to fall?
Head first
How many feet is considered before being associated with severe injury?
15-20 feet or 3x standing height
What injury will you see for a (FOOSH) fall on out stretched hand injury?
Bilateral wrist fractures
What is the most commonly injured solid organ in blunt trauma?
Spleen rupture
What two signs will you see positive in a splenic rupture?
Kehr’s sign
Ballance’s Sign
What is Ballance’s sign?
Dullness to percussion to left flank, LUQ, and shifting dullness to percussion to the right flank caused by splenic rupture.
What is the most commonly injured solid organ in penetrating abdominal injuries?
Liver
What is the most commonly injured hollow organ in penetrating abdominal injuries?
Colon/Small intestine
What is the highest risk for an unstable pelvis fracture?
Massive hemorrhage (exsanguination)
What are the three different types of pelvic fractures?
Lateral pelvic fracture - rarely has life threatening bleeding
Open-book fracture - Anterior-posterior force
Vertical shear- Highest potential for massive bleeding
What may the patient present with if they have fat embolism caused by long bone or lower extremity fracture?
Respiratory distress, Petechial rash, Diffuse infiltrates, hypoxemia, confusion, Fever, Tachycardia
What are some contraindications for placement of a urinary catheter?
High riding or non palpable prostate
blood at the urethral meatus
Pelvic fracture
Blood in the labia/scrotum (Coopernail’s sign)
What does REBOA stand for?
Resuscitative Endovascular Balloon Occlusion of the Aorta.
What does REBOA do?
Works like an internal tourniquet to occlude blood flow from the aorta.
What size does an open chest wound need to be in order to be considered a sucking chest wound?
> 2/3 of the diameter of trachea
If you have a trauma patient that has an increase in PIP and Plateau pressure, what should you suspect?
Tension Pneumothorax
What are signs of Tension Pneumothorax?
Dyspnea, anxiety, JVD, Tachypnea, and tracheal deviation.
JVD and deviation are late signs
What are two approved sites for Needle decompression?
Between 2nd and 3rd intercostal mid clavicular line
5th intercostal space mid axillary line
How much blood loss is considered massive hemorrhage?
> 1500 ml or 1/3 of patient’s blood loss
What is the proper treatment for rib fractures?
Analgesic and NPPV
What is a flail chest?
2 or more ribs broken in 2 or more places
Paradoxical movement
Transport injured side down
If a trauma patient has a sunken hollow shaped abdomen and bowel sounds in chest, what would you suspect?
Traumatic diaphragmatic hernia
What is Kussmaul’s sign
Rise in venous pressure on inspiration spontaneous breathing patient. Seen in cardiac tamponade.
What are early and late signs of Cardiac Tamponade?
Early signs are pulsus paradoxus and tachycardia
Late signs are Becks Triad
What is Beck’s triad?
Muffled heart tones
Narrowed pulse pressures
JVD
How much blood accumulation around the heart lead to higher risk of mortatlity?
> 150 ml
What is Hamman’s crunch?
Crunching, rasping sounds synchronous with the heartbeat
Subcutaneous Emphysema
What electrolyte abnormality is a common finding in rhabdomylysis?
Hyperkalemia
What is rhabdomylysis?
The breakdown of muscle fibers that leads to the release of muscle fiber contents (myoglobin) into the blood stream.
What percentage of blood loss is typically when hypotension begins?
Starts at 30% blood loss
List 4 adverse reactions to blood transfusions?
Drop in blood pressure
Fever
Tachycardia
Pallor
Which blood products do not require Rh matching?
Platelets, Fresh frozen plasma and Cryoprecopitate.
What blood type is the universal recipient?
AB
Which blood type is the universal donor?
O
What are the symptoms and treatment for anaphylactic reaction to blood transfusion?
Hypotension, Urticaria, tachycardia
STOP transfusion
Epi, steroids and Benadryl
What are the symptoms and treatment for overload reaction to blood transfusion? (TACO)
Hypertension, distended neck veins
STOP transfusion
Administer Lasix
What are the symptoms and treatment for Hemolytic reaction to blood transfusion?
Palpitations, Abdominal/Back pain, Syncope, Sense of Doom.
Caused by ABO incompatibility
STOP the infusion
Keep urine output high (100 ml/hr)
What is the symptoms and treatment for Acute lung injury blood reactions? (TRALI)
Dyspnea, tachycardia, fever and cyanosis.
Caused by Leukocyte antibodies in plasma portion in blood.
Symptoms begin 1-6 hours after transfusion
LEADING CAUSE OF TRANFUSION DEATH
Stop transfusion
