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PEM Exam Topics > Trauma/Resusc > Flashcards

Trauma/Resusc Flashcards

1
Q

Factors associated with survival from cardiac arrest

A
  • Witnessed arrest
  • Shockable rhythm
  • Short period
  • Age: older (ado)
  • Reversible causes
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2
Q

List the Hs and Ts need to consider in resusc/arrest

A
  • Hypo/hyper-kalemia
  • Hypoglycemia
  • Hypovolemia
  • Hypothermia
  • Hypoxia
  • H - acidosis
  • Thrombosis - stroke, MI
  • Tamponade
  • Tension pneumothorax
  • Toxin
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3
Q

S/S of cervical spine injury ?

A
  1. Abnormal motor examination (paresis, paralysis, flaccidity, ataxia, spasticity, rectal tone)
  2. Abnormal sensory examination (pain, sensation, temperature, paresthesias, anal wink)
  3. Altered mental status
  4. Neck pain
  5. Torticollis
  6. Limitation ROM
  7. Neck muscle spasm
  8. Abnormal or absent reflexes
  9. Clonus without rigidity
  10. Diaphragmatic breathing without retractions
  11. Spinal (neurogenic) shock (hypotension with bradycardia)
  12. Priapism
  13. Decreased bladder function
  14. Fecal retention
  15. Unexplained ileus
  16. Autonomic hyperreflexia
  17. Blood pressure variability with flushing and sweating
  18. Poikilothermia
  19. Hypothermia or hyperthermia
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4
Q

4 lines on lateral C-Spine imaging?

A
  1. Anterior verterbal line
  2. Posterior vertberal line
  3. Spinolaminar line
  4. Spinous process line
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5
Q

ABCs of C-Spine XR evaluation

(Fleisher)

A
  1. Alignment:
    1. Lordotic curves
    2. Gross malignment, subluxation
    3. Look at lines:
      1. Ant , Post Vertb line, Spinolaminalar, Spinous tips
  2. Bones
    1. Fractures
    2. Ant + Post Vertebral columns
    3. Ossification centers
  3. Cartilage
    1. Intervertebral disc spaces
      1. up to 3mm could be normal (ossification centers render normal anterior sloping)
  4. Soft Tissue spaces
    1. Prevertebral spaces, predental space
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6
Q

How to differentiate C-Spine pseudosubluxation from traumatic injury?

A

Swischuk Line:

A line is drawn from the cortex of the spinous process of C1 to the cortex of the spinous process of C3. Relationship of the line to cortex of the spinous process of C2 is noted. If the line is situated more than 2 mm anterior to the cortex of the spinous process

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7
Q

What is a Jefferson Fracture?

A

Burst fracture of C1 lateral mass

  • Axial Load: compress bw occipital condyles and C2 mass)
  • >1mm displacement of C1 lateral mass from C2
  • rarely have neuro impairment since does not compress SC
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8
Q

What is Hangman Fracture?

A

traumatic spondylolisthesis of C2

  • hyperextension injury
  • # of posterior elements of C2
  • May lead to anterior subluxation of C2 on C3
    *
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9
Q

What is Pseudo-Jefferson?

A
  • 90% of children at 2yo and normalizes by 4-6 yo.
  • Has radiographic appearance of a Jefferson fracture
  • Because of increased growth of the atlas (C1) compared with the axis (C2) and radiolucent cartilage artifact.
  • This disorder can present with unilateral or bilateral lateral mass offset.
  • If a Jefferson fracture is suspected by radiographic findings and mechanism of injury in children younger than 4 years, a CT scan may be necessary to further elucidate the suspected injury

(Fleisher)

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10
Q

AtlantoAxial Subluxation

A
  • Between C1 and C2
  • Secondary to transverse ligament rupture or a fractured dens
    • (younger > more likely Dens #)
  • XR: widened predental (periodontoid, atlantodental interval) space on a lateral radiograph
    • Normal predental space: <5 mm (children) compared with < 3 mm in adults.
  • Classification (rotational): Type I,II,II,IV based on type and mm displacement
  • Neuro symptoms: when >7-10mm
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11
Q

Cervical Distraction Injury

  • Mechanism of injury?
  • How to assess
  • Complication?
A
  • Rapid Acceleration-Deceleration injury (MVC, shaking.NAI)
  • XR: Need 2 measurements: atlanto-occipital & C1-C2 interspinous distance
    • Atlanto-occipital: should not be >5mm
    • C1-2 interspinous: should not be >10mm
    • Sun’s Ratio: should not be >2.5 (C1-C2:C2:C3)
  • Neuro deficits may develop from direct spinal damage or associated carotid or vertebral artery injury.
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12
Q

Spinal Cord Syndromes:

Central Cord

Anterior cord

Hemi-section

Complete transection

A
  • Central cord syndrome
    • motor + sensory function
    • impairment of the UL > LL
  • Anterior cord syndrome
    • ischemia of the cord in regions serviced by the anterior vertebral artery.
    • Loss of motor function + sensation of pain and temperature
      • preservation of proprioception, fine touch, and vibratory sense
  • Hemi-section of the cord (Brown-Séquard syndrome),
    • ipsilateral motor + propio/vibr deficit with contralateral deficits in pain and temperature
  • Complete transection of the spinal cord
    • Absence of both motor and sensory function distal to the level of the lesion
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13
Q

SCIWORA

Typically what age group?

A

<8 yo

(Fleischer)

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14
Q

Clinical signs of TRA

A
  1. Differential pulses between arms or arms/legs
  2. Thoracic ecchymosis
  3. Thoracic and back tenderness
  4. Paraplegia
  5. Anuria

Also

  1. Hypotension
  2. ++blood loss from CT
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15
Q

XR findings of TRA

A
  • widened mediastinum
  • blurred aortic knob
  • pleural cap
  • tracheal or nasogastric tube deviation
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16
Q

Fleishers says ED thoracotomy recommended for who:

A

Thoracic trauma and:

  1. Penetrating > blunt
  2. patients who had VS in the field but cardiac arrest on transport or in the ED,
  3. Patients who remain hemodynamically unstable despite appropriate resuscitation after thoracic trauma,
  4. if a thoracic or trauma surgeon is available within approximately 45 minutes.
17
Q

3 injuries (blunt abdo) that can present LATE

A

(i) pancreatic pseudocyst
(ii) duodenal hematoma
(iii) hematobilia.

(fleischers)

18
Q

Classes of antiarrythmics, mechanism, and examples

A
  1. Class I : Na-channel blocker
    1. Ia: Procainamide
    2. Ib: Lidocaine
    3. Ic: Flecainide
  2. Class II: Beta-blocker – propranolol, esmolol
  3. Class III: K-ch blocker – Amiodarone , Sotalol
  4. Class IV: Ca ch blocker – Verapamil, Diltiazam
19
Q

Pressors:

1) Mechanism of Action (receptor)
2) Action (funciton)

A
  1. Epinephrine
    1. Low Dose: beta adrenergic affects:
      1. Beta 1: vasodilation
      2. Beta 2: Contractility + HR
    2. High Dose: alpha adrenergic + beta
      1. Vasoconstriction (a)–> SVR
      2. Inotrope (contract) (b1) –> incr Stroke Volume
      3. Chronotrope (b1)–> incr HR
  2. Noreepinephrine: Alpha
    1. Vasoconstriction (a++) –> SVR
    2. Inotrope/Chronotrope (b)–> SV
  3. Dopamine
    1. alpha and beta
    2. Inotrope + Vasoconstriction
  4. Milrinone
    1. Phosphodiasterase inhibitor
    2. Inotrope + vasodilator
  5. Phenylephrine
    1. Vasoconstriction (alpha) –> SVR
20
Q

Injuries associated with Car vs Pedestrian (peds)

A

Waddel’s triad:

1) Femur fracture
2) Ipsilateral abdo/thoracic injury
3) Contralateral head injury

21
Q

What is Beck’s triad ?

A

Tamponade!

1) Muffled heart sounds
2) hypotension
3) distended jugular veins

22
Q

Areas of mandibular #

A
  1. Body
  2. Symphysis
  3. Alveolar process
  4. Angle
  5. Ramus
  6. Condylar process
  7. Coronoid process
23
Q

CATCH2 rule

A
  • W – Worsening Headache
  • I – Irritability
  • G – GCS <15 2 hours after the injury
  • S – Suspected open/depressed skull #
  • S – Skull # (basal)
  • D – Dangerous mechanism (MVC, fall >3ft or 5 stairs, bike accident without helmet)
  • H – Hematoma (boggy)
  • 2: Vomiting > 4 episodes >20min apart
24
Q

PECARN head CT rule

A
  • CT:
    • AMS, palpable skull #
    • GCS <15, AMS, signs basilar skull # /palpable skull #
  • Obs vs CT
    • <2: Non-frontal hematoma, LOC>5s, severe mechanism , behavior change
    • >2: LOC, vomiting, severe mech, severe HA
  • LOW RISK (ie no CT):
    • <2yo:
      • normal MS, no scalp haematoma (except frontal), no LOC or LOC< 5 s, non-severe mechanism, no palpable skull fracture, and acting normally
    • >2 yo:
      • normal MS, no LOC, no V, non-severe mechanism, no signs of basilar skull fracture, and no severe HA

PEM Exam Topics (18 decks)

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