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senior clerkship lectures > traumatic emergencies > Flashcards

traumatic emergencies Flashcards

1
Q

what are the three zones associated with penetrating trauma to the head and neck ?

A

zone 1 - clavicle to cricoid - thoracic outlet
zone 2 - cricoid to the angle of the mandible
zone 3 - angle of the mandible to the skull base ( above hyoid)

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2
Q

what is the best imaging modality used to detect thoracic aorta injury ?

A

CT aortogram

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3
Q

if a patient is suspected to have aortic injury but is unstable what is the best imaging modality ?

A

TEE

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4
Q

at what TEWS score can we start worrying about life threatening conditions ?

A

TEWS 7 orr more , patient needs to attend to the resuscitation room

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5
Q

what is the tetanus prophylaxis for an immunocompromised patient ?

A

give the patient human immunoglobulin

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6
Q

what are the signs of aortic transection ?

A

widened mediastinum
left haemothorax
tracheal deviation to the right

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7
Q

what is the mechanism of injury associated with aortic transection ?

A

high speed deceleration injuries

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8
Q

what is the best way of airway management in an apneic patient with potential for cervical spine injury ?

A

orotracheal intubation
if not successful then percutaneous cricothyroidotomy

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9
Q

trauma to the face how should the airway be preserved ?

A

criciothyroidotomy or tracheostomy

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10
Q

what is the firrst line management for sucking chest wounds in open pneumothorax ?

A

close the hole by any means possible
then insert a chest tube

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11
Q

what is the presentation of tension pneumothorax ?

A

1- tracheal deviation away from the affected side
2- absent breath sounds
3- subcutaneous emphysema

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12
Q

what is the management of tension pneumothorax ?

A

large bore needle in the 5th intercostal space midaxillary line

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13
Q

chest penetrating injury with blood stained nasogastric aspiration suggests ?

A

esophageal injury

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14
Q

what imaging modality is the best to rule out oesophageal injury ?

A

esophagram with dye

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15
Q

if the chest wall moves paradoxically with respiration what is this a sign of ?

A

flail chest

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16
Q

what should be performed first when a patient presents with a flail chest ?

A

thoracocentesis to rule out tension pneumothorax or haemothorax

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17
Q

what is the management of hemothorax with bleeding more than 200ml/h ?

A

perform a thoracotomy
if the bleeding is less than that then we can consider autotransfusion

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18
Q

if there is massive bleeding causing the hemothorax what is the most likely artery to be injured ?

A

internal thoracic or intercostal arteries

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19
Q

what is the management of a patient presenting with a gunshot wound and is haemodynamically unstable ?

A

exploratory laparotomy

20
Q

what is the best management for a patient with multiple gunshot wounds to the abdomen ?

A

open the abdomen and use a large richardson retractor to compress the abdominal aorta against the vertebral column

21
Q

what procedure should be avoided in patients with midfacial trauma ?

A

tube

22
Q

what physical findings increase the suspicion of traumatic rupture of the aorta ?

A

1- asymmetry of upper extremity blood pressure
2- chest wall contusion
3- intrascapular pain
4- intrascapular murmur

23
Q

what is the most definitive test for aortic injury ?

A

aortogram

24
Q

what is the cause of cardiac tamponade after blunt injury ?

A

coronary artery laceration

25
Q

what is the next best step in management in a haemodynamically unstable patient with a pelvic fracture ?

A

external fixation of the pelvis

26
Q

what is the most appropriate step in management in a pregnant patient who withstanded blunt trauma which induced hypovolemia?

A

displace the uterus to the left ( first step )

27
Q

what are the indications for immediate intubation and ventilation following a head injury or multiple injuries ?

A

1- GCS below 8 , or a falling score
2- inability to maintain airway
3- facial trauma or bleeding into the airway 4- spontaneous hyperventilation
5- inadequate ventilation
6- seizures
7- extreme agitation

28
Q

what is the first priority in the management of a case of severe head injury with open fracture of shaft of femur ?

A

intubation

29
Q

what is the presentation of a sucking chest wound ?

A

rushing sound heard on inspiration

30
Q

other name for sucking chest wound ?

A

open pneumothorax

31
Q

what is the best management once flail chest. has been confirmed ?

A

endotracheal intubation

32
Q

what are the initial effects of elevated intracranial pressure ?

A

bradycardia and hypertension

33
Q

oxygenation that does not improve after chest tube insertion is a sign of ?

A

tracheobronchial injury

34
Q

what is the best management for penetrating injury of the bowel with contamination ?

A

removal of the necrotic tissue

proximally perform a ccolostomy
digitally perform a mucous fistula

35
Q

what is the management for injury sustained to each area of the head ?

A

zone 1 - angiography , thoracoscopy and esophagoscopy
zone 2 - surgical exploration
zone 3 - angiography and larngoscopy

36
Q

what are the different types of fractures associated with spine trauma ?

A

C1- jefferson ( axial loading )
C2 - hangman ( distraction and extension )
C2 - odontoid fractue

37
Q

what cervical spine views are needed to make sure that there is no injury ?

A

AP view
lateral view
odontoid view

38
Q

when should ab be taken in relation to operations of penetrating abdominal injuries ?

A

pre op

39
Q

what is the indication for the use of arteriography ?

A

blush seen on CT
diagnosis of renal artery thrombosis

40
Q

what are the signs associated with urethral injury ?

A

floating prostate sign
hematuria
bleeding at the meatus

41
Q

what is the other term used to describe blush seen on CT ?

A

active contrast extravasation

42
Q

what is the management of blunt liver injuries ?

A

non. operative management only in stable patients

43
Q

what are the three zones associated with abdominal injuries ?

A

zone 1 - middle retroperitoneal
zone 2 - lateral retroperitoneal
zone 3 - pelvi retroperitoneal

44
Q

what is the management of hematomas found in the zones of the retroperitoneum ?

A

zone 1 - treat as penetrating
zone 2 and 3 - do not open hematoma unless its pulsatile, expanding or ruptures

then exploration through a midline incision is indicated

45
Q

what is the most appropriate test used to exclude duodenal perforation ?

A

gastrografin

46
Q

what postoperative complication is associated with long bones and pelvic fractures ?

A

fat embolism

senior clerkship lectures (25 decks)

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