Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Medicine Lecture - Professor Kramer > Trauma part 2 > Flashcards

Trauma part 2 Flashcards

1
Q

Indications to transfer to trauma center: physiology abnormalities ?

A

Systolic blood pressure <90 mm Hg

Glasgow Coma Scale score <14

Inadequate airway or need for immediate intubation

Penetrating wound to head, neck, or torso

Gunshot wound to extremities proximal to elbow or knee

Extremity with neurovascular compromise

Amputation proximal to wrist or ankle

Central nervous system injury or paralysis

Flail chest

Suspected pelvic fracture
MVC with intrusion into passenger compartment >12 in.

MVC with major vehicular deformity >20 in.
Ejection from vehicle

MVC with entrapment or prolonged extrication of >20 min

Fall of >20 ft

MVC with fatality in same passenger compartment

Auto-pedestrian or auto-bicycle collision at >5 mph
Vehicular rollover

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Trimodal distribution of trauma death: First peak - environment ?

A

Prehospital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Trimodal distribution of trauma death: First peak - Injuries ?

A

Devastating head and vascular injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Trimodal distribution of trauma death: First peak - Approaches to reduce mortality ?

A

comprehensive injury prevention program

safe road construction

seat belt, helmet, airbag, drunk driving laws

handgun control

violence prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Trimodal distribution of trauma death: Second peak - environment ?

A

Minutes to hours after ED arrival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Trimodal distribution of trauma death: Second peak - Injuries ?

A

Major head, chest, abd. injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Trimodal distribution of trauma death: Second peak - Approaches to reduce mortality ?

A

Rapid transport to app. hospital, prompt resuscitation and ID of injuries needing surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Trimodal distribution of trauma death: Third peak - Environment ?

A

ICU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Trimodal distribution of trauma death: Third peak - Injuries ?

A

Systemic inflammatory response Syndrome (SIRS)

sepsis

multiorgan failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Trimodal distribution of trauma death: Third peak - Approaches to reduce mortality ?

A

Evidence-based resuscitation practices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Skull fracture general

H and P ?

A

Skull depression

Possible opening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Basilar skull fracture

H and P ?

A

Battle sign - behind the ears
raccoon eyes

CSF otorrhea or rhinorrhea

Hemotympanum

Vertigo

decreased hearing or deafness

seventh nerve palsy - facial droop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Brain herniation: Uncal H and P ?

A

fixed and dilated pupil due to unopposed sympathetic tone.

Further herniation compresses the pyramidal tract, which results in contralateral motor paralysis.

**pupil wide and other side they have weakness **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Brain herniation: Central transtentorial H and P ?

A

bilateral pinpoint pupils,

bilateral Babinski’s signs,

increased muscle tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Brain herniation: Cerebellotonsillar H and P ?

A

pinpoint pupils,

flaccid paralysis

sudden death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Intracerebral hemorrhage H and P ?

A

May evolve slowly

Occur at site of trauma (coup) OR

Opposite side (contre coup)

17
Q

Subarachnoid hemorrhage

H and P ?

A

headache

photophobia, and

meningeal signs ( neck stiffness, irritation of CSF)

18
Q

Epidural hematoma

H and P ?

A

Temporal injury

loss of consciousness or altered sensorium

followed by a lucid interval

subsequent rapid neurologic demise

19
Q

Subdural hematoma

H and P ?

A

Brains with extensive atrophy Higher risk

Elderly and Alcoholics

20
Q

Subdural hematoma types ?

A

Acute— <2 weeks, usually immediate

Subacute– slower presentation

Chronic— > 2 weeks

21
Q

Diffuse axonal injury

common causes ?

A

Blunt trauma - MVA

Shaken Baby syndrome

22
Q

Penetrating trauma

H and P ?

A

Seen on exam

23
Q

Head trauma DS ?

A

CT head

if indicated

24
Q

CT indications: NO criteria - GCS 15 ?

A

h/a

vomiting

> 60 y.o.

intoxication

antegrade amnesia

trauma above clavicles

Seizure

  • *more conservative is NO
  • *
25
Q

CT indications: Canadian criteria - GCS 13-15 ?

A

GCS <15 at 2 hours

suspected open or depressed skull fx.

sing of basilar skull fx.

vomiting ( many episodes)

Retrograde amnesia >30 min

dangerous mechanism

> 65 yo.

  • *add intoxication and seizures to canada
  • *
26
Q

High risk for children: CT scan ?

A

AMS

focal neuro deficit

acute skull fx.

basilar or depressed skull fx.

irritability

seizure

vomiting more than 5 times

LOC > 1 min

bulging fontanelle

  • *high - then CT
  • *
27
Q

Intermediate risk for intracranial hemorrhage for children: Obsevere 4-6 hrs OR CT scan ?

A

Vomiting 3-4 times

LOC < 1min

resolved lethargy or irritability

caretaker concern about behavior

skull fx

  • *intermediate - talk to mom, document discussion
  • *
28
Q

Intermediate risk for skull fx. for children: Obsevere 4-6 hrs OR CT scan OR skull radiographs ?

A

sig. mechanism - MVA

large, confrontal scalp hematoma

fall onto hard surface

unwitnessed trauma

vague hx.

signs and sxs. of head trauma

  • *intermediate - talk to mom, document discussion
  • *
29
Q

Low risk for children: No imaging?

A

low risk mechanism

asxs.

NL PE

> 2 h since injury

older age

  • *low risk - justified in not getting any imaging
  • *
30
Q

children general information from kramer ?

A

when kids are screaming and yelling then they are probably fine but if the kid is not interacting and being quiet etc. then they are the sickest person in the room.

31
Q

CT head potential findings ?

A

Skull fractures (not sutures)

Intracerebral hemorrhage - May take time to be seen

Subarachnoid hemorrhage - blood in the CSF

Epidural hematoma (biconvex, tempora region) - MMA

Subdural hematoma

Diffuse axonal injury

32
Q

Subdural hematoma

CT findings ?

A

crescent-shaped lesions that cross suture lines

Acute– hyperdense
rapid blood relieved in that area and it is bright white

Subacute– isodense

Chronic– hypodense
black

33
Q

Epidural hematoma CT findings ?

A

biconvex (football shaped)

typically in the temporal region

**stops at suture lines

MC temporal cause middle meningeal artery

34
Q

Diffuse axonal injury CT findings ?

A

May be normal

Classically, shows punctuate hemorrhagic injury along the grey-white junction of the cerebral cortex and within the deep structures of the brain

May also show loss of the grey matter–white matter interface

less differentiation from gyri and sulci

Clinical Medicine Lecture - Professor Kramer (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions