trauma trigger COPY USE THIS ONE 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
who are coup-countercoup injuries more common in
elderly due to atrophy
what is the difference between tx of fractures of the skull (lets say isolated and linear) that are depressed vs nondepressed
depressed - admission w neurosurgery consult and abx
nondepressed - none
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
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
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 is contained in the 2nd zone of the neck
mid carotid/vertebral arteries, jugular veins, esophagus, c spine larynx, and trachea.
cricoid cartilage to angle of mandible
what types of traumas do bowel injuries typically present with? How might a different type of trauma cause bowel injury?
typical - penetrating trauma
different - decelerating trauma that causes mesenteric tear or blow out injury of the antimesenteric border.
what type of trauma are duodenal injuries most associated with
high speed vertical or horizontal deceleration
what type of trauma are pancreatic injuries most assocaited with
rapid deceleration or crush injuries
tx of humerus fx
sling, splint, analgesia
management of olecranon fx
long arm posterior splint w ortho fu
management of radial head fx
sling and fu w ortho
management of forearm fx
- nondisplaced - sugartong splint and ortho f/u
- displaced: reduce and ortho f/u
what are s/s of a hip fracture and how do you treat it
- grain pain and shortening of the affected leg
- immobilize, pain control, inline traction, monitor for blood loss, ORIF
manmagement of femoral shaft fractures
ORIF
how fast does CPK rise post muscle injury? when does it peak
2-12 hours
1-3 days peak
