trauma pestana Flashcards
3 indications that patient needs an airway
unconscious (GCS 8 or under. “under 8, intubate”)
breathing is noisy or gurgly
severe inhalation injury (e.g. breathing smoke)
use of what is mandatory in establishing airway for patient with subcutaneous emphysema in neck?
fiberoptic bronchoscope
subcutaneous emphysema in neck is a sign of major traumatic disruption of _________
tracheobronchial tree
but other d/dx are rupture of esophagus and tension pneumothorax
B/c of potential need for future laryngeal reconstruction, cricothyroidotomy is usually not done before age ___
12 y/o
2 things used to assess proper breathing
can hear breath sounds
pulse oximetry
volume replacement protocol for hemorrhagic shock (step 1, and the step 2 until….)
- about 2 L Ringer lactate (w/out sugar)
- packed RBCs, FFP, platelet packs in 1-1-1 ratio (aka replace whole blood), until urinary output reaches 0.5-2mL/kg/h, while not exceeding CVP 15 mmHg
preferred route of fluid recuscitation in trauma setting.
alternative?
alt for children < 6 y.o
preferred = 2 peripheral IV lines, 16 gauge
alt = percutaneous femoral vein catheter or saphenous vein cut downs
alt children<6y.o = intraosseus cannulation of proximal tibia
initial tx for septic shock. 2 drugs.
abx
steroid bolus
you dx septic shock and tx them accordingly. they respond well at first but then start to relapse. what do they actually have?
adrenal insufficiency
4 signs of fracture affecting base of skull. implication?
- raccoon eyes
- rhinorrhea
- otorrhea
- ecchymosis behind ear
indication is very severe head trauma so requires assessment of cervical spine -> CT scan of head AND neck. also avoid nasal endotracheal intubation
which cranial hematoma (epidural or subdural) has the lucid period?
acute epidural
on CT, epidural hematoma is _____ shaped.
subdural is ______ shaped
epidural - biconvex/lens shaped
subdural - semilunar/crescent shaped
if epidural hematoma is not treated, after lucid period what will happen (clinical picture)?
lapse back into coma, fixed dilated pupil, contralateral hemiparesis, decerebrate posture
emergency craniotomy is tx for acute epidural hematoma, but what is tx for acute subdural hematoma (if no deviation of midline structures)? (4)
- moniter ICP, avoid fluid overload and give mannitol or furosemide (as far as systemic MAP is not lowered)
- elevate head
- hyperventilate. goal PCO2 = 35
- hypothermia > sedation to lower brain O2 demand
what motor/sensory stuff in anterior cord syndrome?
loss of motor and pain and temp BILATERALLY distal.
vib and prop preserved
central cord syndrome. classic scenario? signs/sx?
elderly with forced hyperextension of neck (rear end collision)
paralysis and burning pain in upper extremities. lower extremities are usually pretty fine.
do what 2 things to treat rib fracture?
local nerve block
epidural catheter
in a hemothorax, when putting in chest tube, how much blood suggests it’s actually a systemic vessel that’s lacerated? (usually intercostal artery). tx?
1500+ ml initially, or 600+ ml in next 6 hours.
tx: video assisted thoracotomy to stop bleeding
in flail chest, the real problem is the underlying _____, which is very sensitive to ______.
tx?
contused lung. sensitive to fluid overload. thus tx is fluid restriction + diuretics. also monitor ABGs b/c of possible pulm dysfunction
since big trauma is required to get flail chest, what else must you check!!! if they have flail chest
check for traumatic transection of the aorta
myocardial contusion specific test
troponins
whereas post op MI is CKMB
traumatic rupture of diaphragm shows up with bowel in chest on right or left side?
next step?
LEFT side
evaluate w/ laproscopy -> surgical repair
pulmonary contusion has what 2 findings?
- deteriorating blood gases
2. “white out” of lungs on chest xray
what specific location does traumatic rupture of aorta occur?
junction of arch and descending aorta
