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ACP Term 2 Study > Trauma Slides > Flashcards

Trauma Slides Flashcards

1
Q

What are the 5 stages of a motor vehicle collision?

A
  1. Deceleration of vehicle
  2. Deceleration of occupants
  3. Deceleration of organs
  4. Secondary Collisions (other objects in vehicle)
  5. Additional Impacts (car involved in subsequent impacts)
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2
Q

Which contributes more to kinetic energy, mass or velocity?

A

velocity!

KE = M/2V2

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3
Q

Give examples of anatomical restraints and mobile organs which may be involved in deceleration injuries

A

Anatomical Restraints

  • Skull
  • Sternum
  • Ribcage
  • Spine
  • Pelvis

Mobile Organs

  • Brain
  • Heart
  • Liver
  • Spleen
  • Kidneys
  • Intestines
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4
Q

Where are spinal injuries due to shear forces likely to arise in deceleration trauma

A

At junctions between mobile and non-mobile areras

ex: C7/T1 or T12/L1

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5
Q

List three ways in which aortic rupture occurs in deceleration trauma

A
  1. Shear forces
  2. Hydrostatic Forces (water hammer effect)
  3. Bony compression
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6
Q

What is a bucket handle injury of the intestine

A

Free floating section of bowel, severed from mesentery due to deceleration trauma

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7
Q

How does brain tissue respond to compressive forces?

A

It doesn’t! Brain tissue does not compress, but it does swell afterwards

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8
Q

What are the two common injury patterns to front seat occupants in MVI? What injuries are commonly seen?

A

Down and under

  • Slide under dash
  • Transfer of energy through femurs to pelvis
  • Impact chest on steering column
  • Rotation of torso

Up and over

  • Go over dash
  • Head impacts windshield
  • Steering wheel impacts chest, abdomen, and pelvis
  • Risk of ejection
  • Anterior neck impacts steering wheel
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9
Q

List three findings on examination of the front compartment of a vehicle which may give clues to potential injury patterns

A
  • Deformed windscreen/front of vehicle
  • Deformed dashboard
  • Deformed steering column
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10
Q

List possible injuries associated with a deformed front of vehicle or windshield

A
  • Traumatic brain injury
  • Cervical spinal injury
  • Injury to trachea/larynx/pharynx/ hyoid
  • Soft tissue and bony injury to face
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11
Q

List possible injuries associated with a deformed steering wheel/column

A
  • Injury to trachea/larynx/pharynx/ hyoid
  • Fractures- Ribs, sternum, clavicle
  • Flail chest
  • Myocardial/pulmonary contusion
  • Cardiac tamponade
  • Pneumothorax/hemothorax
  • Aortic tear/rupture
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12
Q

List possible injuries associated with a deformed dashboard

A
  • Rupture of abdominal organs
  • Fracture or dislocation of patella
  • Femur fracture
  • Pelvis fracture
  • Hip dislocation
  • Tib/fib fracture
  • Spinal fracture due to hyperflexion
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13
Q

Lateral impacts to vehicles are associated with ________ (more/less) serious injuries to occupants. Why?

A

MORE!

Fewer safety features = faster acceleration/deceleration

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14
Q

Describe the pattern of injury when an adult pedestrian is struck by a vehicle of normal size.

A
  1. Vehicle’s bumper impacts lower limbs
  2. Pedestrian strikes vehicle’s bonnet
  3. Pedestrian thrown from bonnet to ground
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15
Q

Describe the pattern of injury when an pediatric pedestrian is struck by a vehicle of normal size.

A
  1. Vehicles bumper impacts pelvis/femur
  2. Chest/abdo hit grill or low on bonnet
  3. Head strikes bonnet then ground
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16
Q

What is Waddell’s triad?

A

The triad of injury patterns seen in pediatric ped struck situations

  1. Vehicles bumper impacts pelvis/femur
    • Fractured femoral shaft
  2. Chest/abdo hit grill or low on bonnet
    • Intrathoracic/abdominal injuries
  3. Head strikes bonnet then ground
    • Contralateral head injury
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17
Q

What five factors should be considered when assessing a fall from height?

A
  1. Height of fall
  2. Orientation on landing
  3. Area of impact
  4. Surface of impact
  5. Physical condition of the patient (pre-existing)
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18
Q

Children tend to fall _________ (head/feet) first while adults fall ________first

A

Children = head first

Adults = feet first

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19
Q

What are four physical factors of a patient which may exacerbate injuries from a fall from height?

A
  • Osteoporosis
  • Conditions resulting in enlarged organs
  • Coagulopathy
  • Young children
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20
Q

What are the four main injury mechanisms in blasts?

A
  • Primary injury
    • Caused by pressure shockwave
  • Secondary injury
    • Struck by flying debris
  • Tertiary injury
    • Being thrown into other objects
  • Other injuries
    • random other things associated with blasts
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21
Q

What are the meningeal layers and regions where intracranial bleeding can occur?

A
  • Epidural Space (between Dura and skull)
    • Dura Mater
  • Subdural Space (between Dura and arachnoid)
    • Arachnoid Mater
  • Subarachnoid Space (between Arachnoid and Pia)
    • Pia Mater
  • Intracerebral/intraparenchymal/vestibular (within brain matter or ventricles)
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22
Q

What is the Monro-Kellie doctrine?

A
  • Cranium is a fixed-volume container of:
    • brain
    • blood
    • csf
  • Increasing pressure forces one (or more) of the three out
    • usually starts with CSF, then blood, then brain.
    • Hydrocephalus removes this compensatory mechanism
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23
Q

What form of bleeding (arterial or venous) is associated with each kind of intracranial bleeding following trauma?

A
  • Epidural = Arterial
  • Subdural = Venous
  • Subarachnoid = Usually venous in trauma, arterial if spontaneous
  • Intracerebral = either or both
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24
Q

Which form of ICH is most salvageable if caught on time and managed appropriately?

A

epidural hemorrhage

On the other hand, cataastrophic if not caught/managed early. Brain death within 1-2h if left untreated

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25
Q

Which form of ICH is associated with blow to the temporal region with immediate LOC, followed by a lucid period?

A

Epidural hematoma/hemorrhage

Indicates rupture of middle meningeal artery. Prompt identification is absolutely essential or brain death occurs within 1-2h

26
Q

Cerebral contusion bost commonly occurs in which lobe?

A

Frontal

27
Q

The Babinski reflex ____ (is/is not) a reliable indicator of injury in the field

A

is not!

28
Q

Which of the GCS categories (E,V, or M) is highest yield in assessing TBI?

A

Motor

29
Q

What are SBP and MAP targets for TBI management?

A

SBP > 110mm Hg, MAP >80mm Hg

Slides state SBP>90 mm Hg, Figures above from CPGs

30
Q

Describe best practice principles for TBI management

A
  • Anticipate airway deterioration
  • Anticipate for seizures
  • Avoid hypotension (SBP >110, MAP >80)
  • Keep normothermic
  • High flow oxygen SpO2 >94%
  • Maintain EtCO2 30-35 mmHg, do not hyperventilate
  • Head of bed at 30 degrees!!
  • Loose neck ties!!
31
Q

What is Cushing’s triad?

A
  • Dysregulation of the sympathetic and parasympathetic impulses in severe brain injury (hypoxia, increased ICP)
  • Characterized by: Hypertension, Bradycardia and apnea (some literature states irregular breathing)
32
Q

What are the classes of lefort fractures?

A
  • I: “floating palate” speak no evil
    • ​involvement of the lateral bony margin of the nasal opening
  • II: “Pyramidal” see no evil
    • ​involvement of inferior orbital rim
  • III: “Craniofacial dissociation” hear no evil
    • ​invariably involve the zygomatic arch, or cheek bone
33
Q

What are the 3 neck zones in penetrating neck trauma?

A
  • Zone 3: above the angle of the mandible
  • Zone 2: cricoid cartilage up to angle of mandible
  • Zone 1: below the cricoid cartilage
34
Q

Which neck zone houses the laryngeal structures?

A

Zone 2

35
Q

Which neck zone contains the trachea, lung apices, and common carotid artery?

A

Zone 1

36
Q

What is a fundamental difference between the C1/C2 junction and other vertebral joints?

A

there is no intervertebral disc at C1/C2 (atlanto-axial junction)

37
Q

What is the transverse ligament of the spine, and what is the significance of injuries to it?

A

joins C1 to C2

Transverse ligament injury leads to highly unstable antlanto-axial junction. SCI is likely

38
Q

Is anterior cord syndrome or posterior cord syndrome more common?

A

anterior cord injury

the posterior cord is well protected

39
Q

What is the most common form of incomplete spinal cord injury syndrome (anterior, posterior, central, brown-sequard)

A

Central!

40
Q

Where are the primary ascending and descending white matter tracts located in the spinal cord?

A

All white matter tracts are superficial, while grey matter is deep

  • Ascending (sensory) tracts are dorsal, lateral, AND ventral
  • Descending (motor) tracts are primarily ventral and lateral

easiest to remember the only exception: there are no descending/motor tracts in the posterior/dorsal spinal cord. They are all ventral or lateral

41
Q

Briefly describe anterior cord syndrome:

A

incomplete SCI

  • Vibration and proprioception are preserved at all levels
  • Ipsilateral motor impairment below injury
  • Ciontralateral pain/temperature sensation loss below injury
42
Q

Briefly describe central cord syndrome:

A

Most common incomplete SCI

  • mostly affects motor skills below injury, sensation is spared
  • weakness is more pronounced in upper limbs
  • Loss of bladder function leads to urine retention!
43
Q

Briefly describe Brown-Sequard syndrome

A

Fully lateralized incomplete SCI (i.e. injury to one side of the spinal cord)

  • Contra-lateral loss of pain and temperature
  • Ipsilateral motor, proprioception and vibration loss
  • All below the injury
44
Q

What level of injury is typically associated with autonomic dysreflexia?

A

cervical or high thoracic (down to T6)

45
Q

How much blood can fill each of the following compartments before a significant tamponade (enough to halt bleeding) occurs?

  • pleural cavities
  • abdominal cavity
  • pelvic cavity
A
  • pleural cavities
    • 1.5L each
  • abdominal cavity
    • 5L
  • pelvic cavity
    • 6L
46
Q

What are the three components of the trauma triad of death?

A
  • Hypothermia
  • Coagulopathy
  • Acidosis
47
Q

What is the 90,90,9 rule of TBI?

A

For each of the following, mortality doubles:

  • Hypotension <90mmHg
  • Hypoxemia <90% SpO2
  • DLOC
48
Q

What are considered low voltage vs. high votlage electrical injuries?

A
  • Low: <500V
  • High: >500V
49
Q

Describe the rule of 9s for estimating BSA in adult burns

A
  • Head = 9%
  • Anterior torso = 18%
    • Anterior Thorax = 9%
    • Anterior abdomen = 9%
  • Posterior torso = 18%
    • Posterior thorax = 9%
    • Posterior abdomen = 9%
  • Each leg = 18%
    • Anterior/posterior = 9% each
  • Each arm = 9%
  • Genitals = 1%
50
Q

The leading preventable cause of death in trauma is:

A

hemorrhage/bleeding

51
Q

What are the four types of shock most commonly seen in trauma?

A
  • Hypovolemic/hemorrhagic
    • Bleeding
  • Obstructive
    • Pneumo/hemothorax
    • Tamponade
  • Distributive
    • Neurogenic/spinal
  • Cardiogenic
    • Arrhythmia
    • Direct myocardial injury
52
Q

How is spinal shock different from neurogenic shock?

A

Spinal shock is NOT SHOCK! It is loss of function below the level of injury in acute SCI

Neurogenic shock is a distributive shock state caused by loss of sympathetic innervation and may be a result of spinal shock

53
Q

What are classic signs of neurogenic shock?

A
  • Bradycardia
  • Hypotension
  • Warm, flushed, well-perfused skin
  • Hx suggestive of SCI
54
Q

Are vital signs changes in severe hemorrhage reliable indicators of shock progression?

A

NO!

It’s not just kids that compensate well! Treating to vital signs targets only leads to under-resuscitation in 50% of patients.

55
Q

What are reasonable SBP and MAP targets in trauma (not including suspected TBI)

A

SBP 80-90mmHg, MAP >65

56
Q

What two processes contribute to traumatic coagulopathy?

A
  • acute coagulopathy of trauma (TC)
    • Loss of blood, platelets, clotting factors
    • Metabolic derangement
  • resuscitation-induced coagulopathy (IC)
    • Injudicious fluid admin
    • Iatrogenic hypothermia
57
Q

What is ACoTS?

A

Acute Coagulopathy of Trauma-Shock

Early coagulopathy following trauma, seems to have a lot to do with early hyper-fibrinolysis and factor consumption

58
Q

What are the pillars of reducing ACoTS in trauma patients?

A
  • Permissive hypotension / judicious fluid resuscitation
  • Prevention of hypothermia
  • Administration of TXA EARLY!
59
Q

Is Fentanyl administration in trauma associated with hypotension?

A

NO!!!!!!!!!

NO!!!!!!!!!!!!!!

NO! NO! NO!

Kill this myth. Fentanyl is not morphine. No evidence of significant iatrogenic harm from fentanyl admin in trauma. Don’t force your patients to suffer!

60
Q

Why is ketamine dosing reduced in patients with a shock index >1?

A

Because Ketamine is more likely to cause hypotension in these patients

  • Ketamine is only hemodynamically stable because it stimulates endogenous catecholamine release*
  • Patients with shock index >1 are already releasing all the catecholamines that they can. Ketamine can not stimulate more release. The result is hypotension caused by the CNS-depressant effects of ketamine*
61
Q

What is an NCTH?

A

Non-compressible traumatic hemorrhage

e.g. junctional, abdominal, thoracic bleeding

62
Q

What is the best fluid for resuscitation of trauma patients?

A

Blood!

Get thee to a hospital, or call for a friendly blood delivery

ACP Term 2 Study (15 decks)

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