trauma trigger Flashcards
mannitol is used for what
increased ICP
open fx abx
rocephin
ruptured abdominal viscus abx
unasyn or zosyn
vaginal/rectal lacerations ABX
unasyn or zosyn
why can children <6 mo old have respiratory failure with midface trauma?
they are obligate nasal breathers
Initial approach to trauma patient acronym
S - s/s
A - allergies
M - medications
P - past medical hx
L - last oral intake
E - events leading up to presentation
what is given to a trauma patient with hypotension
1 L NS bolus and 1L blood products
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?
normal BP with tachycardia
(this is supposed to be compensated shock from hemorrhage)
what injury are infants/neonates at a higher risk for in trauma than other populations?
significant intracranial injury
there are lower incidences of vertebral fractures in what population? why?
pediatric population
increased flexibility = decreased vertebral fractures
intrathoracic injury without external signs of trauma are present in who? why?
peds, becuase chest wall is more compliant and not as protetive
are rib fractures common in peds? why/why not? what might they suggest?
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.
indications for CT for abdominal and GU trauma
suspicious MOI
tenderness on exam (wtf? just from hannahs quizlet idk)
seat belt sign
distention
vomiting
>50 RBC on UA in blunt trauma
what might an anterior ring pelvic fracture indicate
urethral or bladder injury
what are s/s of impending brain herniation? what would you want to maintain during this time?
severe HA w vomiting
HTN w brady/tachycardia
papilledema
(from UTD, dont come at me)
maintain a PaCO2 of 30-35
what should be obtained in almost every geriatric (65+ via google) head injury and C spine injury
CT brain - head injury
CT c spine - c spine injury
“liberal use of CT head” - HB quizlet
what is the workup for a geriatric pt with abdominal trauma
stable = CT
untable or + FAST = OR
MCC injury in geriatric population?
falls
what complication is common in the geriatric population that should make you cautious of fluid rescucitation
fluid overload
how much fluid volume can you lose before shock s/s are present
up to 30-35%
why are pregnant patients at higher risk for hemorrhage during trauma
uterus displaces other organs so increased risk with any penetrating upper abdominal injury
MCC of abdominal hemorrhage
spleen (im assuming rupture)
MCC of pregnancy complications
prreterm labor and abruption of placenta
what is the presentation of an abruption of the placenta
- abdominal pain
- vaginal bleeding
- uterine contractions
- signs of DIC (petechiae, hematemesis, hemturia, bruising)
what do you assume may be needed in all fetal-maternal hemorrhages
rhogam! (if mom is RH-)
should you change the type of imaging used in pregnancy traumas? if so, what and how
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”
what would you see under microscope on a pt w amniotic rupture
ferning and higher than normal vaginal pH
what typically causes fetal bradycardia
fetal hypoxia secondary to maternal hypotension, respiratory compromise or placental abruption
if a pregnant pt had blunt force trauma and they are >20 weeks gestation what must be done
4-6 hrs of fetal monitoring
what should you avoid (if possible i assume) in pregnancy even in the presence of hypotensive/neurogenic shock. why?
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”
what position should pregnant pts be put in after a traumatic event, why?
left lateral decubitus to prevent hypotension
what is coup v countrecoup vs coup-countrecoup
- coup - directly under point of force
- countercoup - on opposite side of force
- coup countercoup - both
who are coup-countercoup injuries more common in
elderly due to atrophy
what is the difference between fractures of the skull (lets say isolated and linear) that are depressed vs nondepressed
depressed - admission w neurosurgery consult and abx
nondepressed - none
MC CT finding in pts with moderate/severe TBI?
subarachnoid hemorrhage
what is a hemothorax? how would you DX and Tx it?
- blood in the pleural cavity
- DX: FAST exam and CXR
- Tx: thoracostomy
How would you diagnose and tx a pneumothorax?
Dx: auscultate, CXR, eFAST, CT
Tx: if small (<1.0cm and confined to upper chest) then none.
if large = thoracostomy
what type of rupture is an epidural hematoma vs a subdural hematoma
epidural = arterial (bleeds out FAST!!!!)
subdural = venous
LOC followed by lucidity followed by more LOC is associated with what ? what else might you find on exam?
epidural hematoma
may see fixed & dilated pupil on side of lesion
CT shows a biconvex lense in the temporal aspect of the skull
epidural hematoma
brian atrophy puts pts at increased risk of what conditions
subdural hematoma and coup-countercoup injuries
CT shows hyperdense lesion that crosses suture lines
subdural hematoma CT
what should you keep MAP above in head trauma
80
what would you give to a pt who is seizing after a head injury
IV lorazepam and fosphophenytoin
tx of basilar skull fracture, penetrating injuries or open skull fractures
admit to neuro and give rocephin!!
what are the disposition plans for patients w head injury? (home criteria, ED criteria, Admit criteria)
- 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
neurogenic vs spinal shock
neurogenic: loss of sympathetic innervation leading to bradycardia and hypotension
spinal: temporary loss or depression of spinal reflex activity below a spinal cord injury
what is the NEXUS Criteria for C spine imaging
- AMS
- midline cervical tenderness or step off
- intoxication
- neuro deficits
- severe distracting injury
when can you clinically clear C spine
- negative NEXUS scan
- ROM greater than 45 degrees BIL w no pain
if a patient has a cervical spine injury, what should you scan
the entire spine
when can you clinically clear thoracic and lumbar spine
- negative NEXUS
- assess sensation in all extremities
- assess motor fxn in all extremities
what should you order w maxillofacial trauma
CT of facial bones
abx for sinus traumas
keflex, augmentin, clinda
just one of em!
