Trauma part 2 Flashcards
Indications to transfer to trauma center: physiology abnormalities ?
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
Trimodal distribution of trauma death: First peak - environment ?
Prehospital
Trimodal distribution of trauma death: First peak - Injuries ?
Devastating head and vascular injuries
Trimodal distribution of trauma death: First peak - Approaches to reduce mortality ?
comprehensive injury prevention program
safe road construction
seat belt, helmet, airbag, drunk driving laws
handgun control
violence prevention
Trimodal distribution of trauma death: Second peak - environment ?
Minutes to hours after ED arrival
Trimodal distribution of trauma death: Second peak - Injuries ?
Major head, chest, abd. injuries
Trimodal distribution of trauma death: Second peak - Approaches to reduce mortality ?
Rapid transport to app. hospital, prompt resuscitation and ID of injuries needing surgery
Trimodal distribution of trauma death: Third peak - Environment ?
ICU
Trimodal distribution of trauma death: Third peak - Injuries ?
Systemic inflammatory response Syndrome (SIRS)
sepsis
multiorgan failure
Trimodal distribution of trauma death: Third peak - Approaches to reduce mortality ?
Evidence-based resuscitation practices
Skull fracture general
H and P ?
Skull depression
Possible opening
Basilar skull fracture
H and P ?
Battle sign - behind the ears
raccoon eyes
CSF otorrhea or rhinorrhea
Hemotympanum
Vertigo
decreased hearing or deafness
seventh nerve palsy - facial droop
Brain herniation: Uncal H and P ?
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 **
Brain herniation: Central transtentorial H and P ?
bilateral pinpoint pupils,
bilateral Babinski’s signs,
increased muscle tone
Brain herniation: Cerebellotonsillar H and P ?
pinpoint pupils,
flaccid paralysis
sudden death
Intracerebral hemorrhage H and P ?
May evolve slowly
Occur at site of trauma (coup) OR
Opposite side (contre coup)
Subarachnoid hemorrhage
H and P ?
headache
photophobia, and
meningeal signs ( neck stiffness, irritation of CSF)
Epidural hematoma
H and P ?
Temporal injury
loss of consciousness or altered sensorium
followed by a lucid interval
subsequent rapid neurologic demise
Subdural hematoma
H and P ?
Brains with extensive atrophy Higher risk
Elderly and Alcoholics
Subdural hematoma types ?
Acute— <2 weeks, usually immediate
Subacute– slower presentation
Chronic— > 2 weeks
Diffuse axonal injury
common causes ?
Blunt trauma - MVA
Shaken Baby syndrome
Penetrating trauma
H and P ?
Seen on exam
Head trauma DS ?
CT head
if indicated
CT indications: NO criteria - GCS 15 ?
h/a
vomiting
> 60 y.o.
intoxication
antegrade amnesia
trauma above clavicles
Seizure
- *more conservative is NO
- *
CT indications: Canadian criteria - GCS 13-15 ?
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
- *
High risk for children: CT scan ?
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
- *
Intermediate risk for intracranial hemorrhage for children: Obsevere 4-6 hrs OR CT scan ?
Vomiting 3-4 times
LOC < 1min
resolved lethargy or irritability
caretaker concern about behavior
skull fx
- *intermediate - talk to mom, document discussion
- *
Intermediate risk for skull fx. for children: Obsevere 4-6 hrs OR CT scan OR skull radiographs ?
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
- *
Low risk for children: No imaging?
low risk mechanism
asxs.
NL PE
> 2 h since injury
older age
- *low risk - justified in not getting any imaging
- *
children general information from kramer ?
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.
CT head potential findings ?
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
Subdural hematoma
CT findings ?
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
Epidural hematoma CT findings ?
biconvex (football shaped)
typically in the temporal region
**stops at suture lines
MC temporal cause middle meningeal artery
Diffuse axonal injury CT findings ?
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
