traumatic emergencies Flashcards
what are the three zones associated with penetrating trauma to the head and neck ?
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)
what is the best imaging modality used to detect thoracic aorta injury ?
CT aortogram
if a patient is suspected to have aortic injury but is unstable what is the best imaging modality ?
TEE
at what TEWS score can we start worrying about life threatening conditions ?
TEWS 7 orr more , patient needs to attend to the resuscitation room
what is the tetanus prophylaxis for an immunocompromised patient ?
give the patient human immunoglobulin
what are the signs of aortic transection ?
widened mediastinum
left haemothorax
tracheal deviation to the right
what is the mechanism of injury associated with aortic transection ?
high speed deceleration injuries
what is the best way of airway management in an apneic patient with potential for cervical spine injury ?
orotracheal intubation
if not successful then percutaneous cricothyroidotomy
trauma to the face how should the airway be preserved ?
criciothyroidotomy or tracheostomy
what is the firrst line management for sucking chest wounds in open pneumothorax ?
close the hole by any means possible
then insert a chest tube
what is the presentation of tension pneumothorax ?
1- tracheal deviation away from the affected side
2- absent breath sounds
3- subcutaneous emphysema
what is the management of tension pneumothorax ?
large bore needle in the 5th intercostal space midaxillary line
chest penetrating injury with blood stained nasogastric aspiration suggests ?
esophageal injury
what imaging modality is the best to rule out oesophageal injury ?
esophagram with dye
if the chest wall moves paradoxically with respiration what is this a sign of ?
flail chest
what should be performed first when a patient presents with a flail chest ?
thoracocentesis to rule out tension pneumothorax or haemothorax
what is the management of hemothorax with bleeding more than 200ml/h ?
perform a thoracotomy
if the bleeding is less than that then we can consider autotransfusion
if there is massive bleeding causing the hemothorax what is the most likely artery to be injured ?
internal thoracic or intercostal arteries
what is the management of a patient presenting with a gunshot wound and is haemodynamically unstable ?
exploratory laparotomy
what is the best management for a patient with multiple gunshot wounds to the abdomen ?
open the abdomen and use a large richardson retractor to compress the abdominal aorta against the vertebral column
what procedure should be avoided in patients with midfacial trauma ?
tube
what physical findings increase the suspicion of traumatic rupture of the aorta ?
1- asymmetry of upper extremity blood pressure
2- chest wall contusion
3- intrascapular pain
4- intrascapular murmur
what is the most definitive test for aortic injury ?
aortogram
what is the cause of cardiac tamponade after blunt injury ?
coronary artery laceration
what is the next best step in management in a haemodynamically unstable patient with a pelvic fracture ?
external fixation of the pelvis
what is the most appropriate step in management in a pregnant patient who withstanded blunt trauma which induced hypovolemia?
displace the uterus to the left ( first step )
what are the indications for immediate intubation and ventilation following a head injury or multiple injuries ?
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
what is the first priority in the management of a case of severe head injury with open fracture of shaft of femur ?
intubation
what is the presentation of a sucking chest wound ?
rushing sound heard on inspiration
other name for sucking chest wound ?
open pneumothorax
what is the best management once flail chest. has been confirmed ?
endotracheal intubation
what are the initial effects of elevated intracranial pressure ?
bradycardia and hypertension
oxygenation that does not improve after chest tube insertion is a sign of ?
tracheobronchial injury
what is the best management for penetrating injury of the bowel with contamination ?
removal of the necrotic tissue
proximally perform a ccolostomy
digitally perform a mucous fistula
what is the management for injury sustained to each area of the head ?
zone 1 - angiography , thoracoscopy and esophagoscopy
zone 2 - surgical exploration
zone 3 - angiography and larngoscopy
what are the different types of fractures associated with spine trauma ?
C1- jefferson ( axial loading )
C2 - hangman ( distraction and extension )
C2 - odontoid fractue
what cervical spine views are needed to make sure that there is no injury ?
AP view
lateral view
odontoid view
when should ab be taken in relation to operations of penetrating abdominal injuries ?
pre op
what is the indication for the use of arteriography ?
blush seen on CT
diagnosis of renal artery thrombosis
what are the signs associated with urethral injury ?
floating prostate sign
hematuria
bleeding at the meatus
what is the other term used to describe blush seen on CT ?
active contrast extravasation
what is the management of blunt liver injuries ?
non. operative management only in stable patients
what are the three zones associated with abdominal injuries ?
zone 1 - middle retroperitoneal
zone 2 - lateral retroperitoneal
zone 3 - pelvi retroperitoneal
what is the management of hematomas found in the zones of the retroperitoneum ?
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
what is the most appropriate test used to exclude duodenal perforation ?
gastrografin
what postoperative complication is associated with long bones and pelvic fractures ?
fat embolism
