trauma trigger

Question 1

mannitol is used for what

Answer 1

increased ICP

Question 2

open fx abx

Answer 2

rocephin

Question 3

ruptured abdominal viscus abx

Answer 3

unasyn or zosyn

Question 4

vaginal/rectal lacerations ABX

Answer 4

unasyn or zosyn

Question 5

why can children <6 mo old have respiratory failure with midface trauma?

Answer 5

they are obligate nasal breathers

Question 6

Initial approach to trauma patient acronym

Answer 6

S - s/s
A - allergies
M - medications
P - past medical hx
L - last oral intake
E - events leading up to presentation

Question 7

what is given to a trauma patient with hypotension

Answer 7

1 L NS bolus and 1L blood products

Question 8

If a child presents with blunt force trauma to the abdomen and you suspect they are bleeding out into their abdomen, what would you expect their vitals to look like?

Answer 8

normal BP with tachycardia

(this is supposed to be compensated shock from hemorrhage)

Question 9

what injury are infants/neonates at a higher risk for in trauma than other populations?

Answer 9

significant intracranial injury

Question 10

there are lower incidences of vertebral fractures in what population? why?

Answer 10

pediatric population

increased flexibility = decreased vertebral fractures

Question 11

intrathoracic injury without external signs of trauma are present in who? why?

Answer 11

peds, becuase chest wall is more compliant and not as protetive

Question 12

are rib fractures common in peds? why/why not? what might they suggest?

Answer 12

NO

sign of child abuse in the absence of a traumatic event. Especially if broken ribs are posterior. Ribs have increased compliance in pediatric patients, so unlikely to break w/o large force.

Question 13

indications for CT for abdominal and GU trauma

Answer 13

suspicious MOI
tenderness on exam (wtf? just from hannahs quizlet idk)
seat belt sign
distention
vomiting
>50 RBC on UA in blunt trauma

Question 14

what might an anterior ring pelvic fracture indicate

Answer 14

urethral or bladder injury

Question 15

what are s/s of impending brain herniation? what would you want to maintain during this time?

Answer 15

severe HA w vomiting
HTN w brady/tachycardia
papilledema
(from UTD, dont come at me)

maintain a PaCO2 of 30-35

Question 16

what should be obtained in almost every geriatric (65+ via google) head injury and C spine injury

Answer 16

CT brain - head injury
CT c spine - c spine injury

“liberal use of CT head” - HB quizlet

Question 17

what is the workup for a geriatric pt with abdominal trauma

Answer 17

stable = CT
untable or + FAST = OR

Question 18

MCC injury in geriatric population?

Answer 18

falls

Question 19

what complication is common in the geriatric population that should make you cautious of fluid rescucitation

Answer 19

fluid overload

Question 20

how much fluid volume can you lose before shock s/s are present

Answer 20

up to 30-35%

Question 21

why are pregnant patients at higher risk for hemorrhage during trauma

Answer 21

uterus displaces other organs so increased risk with any penetrating upper abdominal injury

Question 22

MCC of abdominal hemorrhage

Answer 22

spleen (im assuming rupture)

Question 23

MCC of pregnancy complications

Answer 23

prreterm labor and abruption of placenta

Question 24

what is the presentation of an abruption of the placenta

Answer 24

• abdominal pain
• vaginal bleeding
• uterine contractions
• signs of DIC (petechiae, hematemesis, hemturia, bruising)

Question 25

what do you assume may be needed in all fetal-maternal hemorrhages

Answer 25

rhogam! (if mom is RH-)

Question 26

should you change the type of imaging used in pregnancy traumas? if so, what and how

Answer 26

NO!!!

just cover the uterus and protect it as much as possible while using protocol imaging (card says “no imaging should be witheld but uterus should be protected”

Question 27

what would you see under microscope on a pt w amniotic rupture

Answer 27

ferning and higher than normal vaginal pH

Question 28

what typically causes fetal bradycardia

Answer 28

fetal hypoxia secondary to maternal hypotension, respiratory compromise or placental abruption

Question 29

if a pregnant pt had blunt force trauma and they are >20 weeks gestation what must be done

Answer 29

4-6 hrs of fetal monitoring

Question 30

what should you avoid (if possible i assume) in pregnancy even in the presence of hypotensive/neurogenic shock. why?

Answer 30

vasopressors.

decreases blood flow to the fetus

It did not say hypotensive/neurogenic shock i was just rtying to think of a way to ask this question haha. it just said “avoid vasopressors in pregnancy”

Question 31

what position should pregnant pts be put in after a traumatic event, why?

Answer 31

left lateral decubitus to prevent hypotension

Question 32

what is coup v countrecoup vs coup-countrecoup

Answer 32

1. coup - directly under point of force
2. countercoup - on opposite side of force
3. coup countercoup - both

Question 33

who are coup-countercoup injuries more common in

Answer 33

elderly due to atrophy

Question 34

what is the difference between fractures of the skull (lets say isolated and linear) that are depressed vs nondepressed

Answer 34

depressed - admission w neurosurgery consult and abx

nondepressed - none

Question 35

MC CT finding in pts with moderate/severe TBI?

Answer 35

subarachnoid hemorrhage

Question 36

what is a hemothorax? how would you DX and Tx it?

Answer 36

• blood in the pleural cavity
• DX: FAST exam and CXR
• Tx: thoracostomy

Question 37

How would you diagnose and tx a pneumothorax?

Answer 37

Dx: auscultate, CXR, eFAST, CT
Tx: if small (<1.0cm and confined to upper chest) then none.
if large = thoracostomy

Question 38

what type of rupture is an epidural hematoma vs a subdural hematoma

Answer 38

epidural = arterial (bleeds out FAST!!!!)
subdural = venous

Question 39

LOC followed by lucidity followed by more LOC is associated with what ? what else might you find on exam?

Answer 39

epidural hematoma

may see fixed & dilated pupil on side of lesion

Question 40

CT shows a biconvex lense in the temporal aspect of the skull

Answer 40

epidural hematoma

Question 41

brian atrophy puts pts at increased risk of what conditions

Answer 41

subdural hematoma and coup-countercoup injuries

Question 42

CT shows hyperdense lesion that crosses suture lines

Answer 42

subdural hematoma CT

Question 43

what should you keep MAP above in head trauma

Answer 43

80

Question 44

what would you give to a pt who is seizing after a head injury

Answer 44

IV lorazepam and fosphophenytoin

Question 45

tx of basilar skull fracture, penetrating injuries or open skull fractures

Answer 45

admit to neuro and give rocephin!!

Question 46

what are the disposition plans for patients w head injury? (home criteria, ED criteria, Admit criteria)

Answer 46

• home w reliable caretaker - GCS 15 w normal CT and norm serial neuro exams
• ED - GCS of 14 w normal CT
• Admit - anyone w abnormal CT or GCS <14

Question 47

neurogenic vs spinal shock

Answer 47

neurogenic: loss of sympathetic innervation leading to bradycardia and hypotension

spinal: temporary loss or depression of spinal reflex activity below a spinal cord injury

Question 48

what is the NEXUS Criteria for C spine imaging

Answer 48

• AMS
• midline cervical tenderness or step off
• intoxication
• neuro deficits
• severe distracting injury

Question 49

when can you clinically clear C spine

Answer 49

• negative NEXUS scan
• ROM greater than 45 degrees BIL w no pain

Question 50

if a patient has a cervical spine injury, what should you scan

Answer 50

the entire spine

Question 51

when can you clinically clear thoracic and lumbar spine

Answer 51

• negative NEXUS
• assess sensation in all extremities
• assess motor fxn in all extremities

Question 52

what should you order w maxillofacial trauma

Answer 52

CT of facial bones

Question 53

abx for sinus traumas

Answer 53

keflex, augmentin, clinda

just one of em!