Traumatic Emergencies Flashcards by Jacob Quin

What is a good pneumonic for what to examine after a traumatic event?

A (airway

C (cardiovascular)
R (respiratory)
A (abdomen)
S (spine)
H (head)

P (pelvis)
L (limbs)
A (peripheral arteries)
N (peripheral nerves)

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Where are the landmarks for an AFAST ultrasound scan?

Caudal to the xiphoid
R/L flanks
Cranial to pelvis

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Where are the landmarks for a TFAST ultrasound scan?

7th-9th dorsolateral ribs (thorocostomy sites)

5th-6th right and left ventrolateral thoracic wall (pericardiocentesis sites)

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What is a glide sign and what does absence of this indicate?

A glide sign is the normal gliding of the lung against the thoracic wall
Absence indicates pneumothorax
A deviated glide sign indicates thoracic trauma

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What are the most common thoracic injuries noted on radiographs?

Pneumothorax
Pulmonary contusions
Rib fractures
Pleural fluid
Pneumomediastinum
Diaphragmatic hernia
Sternal fracture

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How can you externally stabilze a flail chest?

Perform a local block 2-3 rib spaces caudal to affected rib and affected ribs
Using plastic or aluminum external spints, use a non-absorbable suture around the rib dorsal and ventral to fragment

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What radiographic signs are noted with with pulmonary contusions?

Interstitial or alveolar lung pattern

Interstitial pattern may be localized to one lung lobe

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What treatment is needed for mild cases of pulmonary contusions?

Mild cage rest and confinement

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What treatment is needed for moderate or severe cases of pulmonary contusions?

Treat for shock
Monitor blood gases
Intermittent positive-pressure ventilation

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How should a ruptured urinary bladder be addressed in the cat and the dog?

Cat: should be surgically corrected immediately

Dog: place urinary catheter
Correct once patient is stabilized

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Why is running a PCV/ TS important for blood and abdominal cavity?

If the PCV of abdominal fluid is increasing > 5% from original value, can be indicative of intraperitoneal hemorrhage

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What test can be performed to look for uroperitoneum?

Comparing peritoneal fluid creatinine or potassium to the blood

Ratio of 2:1 abdominal to blood creatinine indicates ruptured bladder

Ratio of 1.4:1 abdominal to blood potassium indicates ruptured bladder

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What is a Cullen sign

Ecchymoses around the inguinum - indicated intraabdominal hemorrhage

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What should be inspected with abdominal radiographs after trauma?

Free air
Ground glass appearance (indicates fluid)
Place and shape of organs
Integrity of diaphragm and abdominal wall
Retroperitoneal space –> hemorrhage in this regions shows a psoas sign/ depressed colon

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When is a diaphragmatic hernia a surgical emergency?

When organ entrapment leading to necrosis is seen

Respiratory distress

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How can you stablize a patient with abdominal hemorrhage prior to surgical correction?

Place compression bandages on hind limbs and pelvis

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How long should a blood transfusion take?

~ 4 hours with strict monitoring for reactions

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What is seen with Schiff-Sherrington posture in dogs and what does this indicate?

Extensor rigidity of forelimbs
Flaccid paraplegia of hindlimbs
Intact spinal reflexes caudal to the lesion

Indicates severe spinal trauma

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What treatment should be administered for spinal trauma?

Owners should keep patients immobilized and muzzled prior to arrival
Pain control (e.g. fentanyl for rapid check)
Steroids given with 8 hours
GI protectants as ulcers increase with spinal trauma

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What history may be seen with pneumothorax?

Respiratory distress and anxiety

+/- trauma

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What physical exam signs are noted with pneumothorax?

Dyspnea +/- open mouth breathing
Crepitation
Decreased lung sounds
Hyperresonance with chest percussion

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What radiograph signs are noted with pneumothorax?

Heart elevated from sternum
Retracted lung lobes
Pulmonary contusions
Hemothorax
Pneumediastinum

What is the prognosis with pneumothorax?

Guarded

What is a tension pneumothorax?

Emergency with signs including:
Barrel chest
Cyanosis
Open-mouth breathing
Shock
Shallow and rapid breathing

Perform thoracocentesis immediately

What wrap material do cats tend to tolerate better than bandage material?

Plastic wrap

What is the most common type of hernia secondary to trauma?

Diaphragmatic

What other situations occur along with diaphragmatic hernias?

``` Hypovolemic shock Flail chest Rib fractures Pulmonary contusions Pulmonary edema Traumatic myocarditis ```

What region of the diaprhagm is most commonly affected

Ventrolateral musculature

What physical exam findings are noted with diaphragmatic hernias?

``` Sitting with elbows abducted Abdomen feels empty Has trouble lying down Heart sounds muffled GI sounds ausculted in chest ```

What radiograph findings are noted with diaphragmatic hernias?

Loss of diaphragm detail Bowel loops in thoracic cavity Fractured ribs Pulmonary contusions

What organs are most commonly herniated into the diaphragm?

``` Liver Small intestine Stomach Spleen Omentum ```

When is a diaphragmatic hernia considered an emergency?

Respiratory distress Hypovolemic shock Bowel strangulation

How should the diaphragm be closed?

Simple continuous pattern with 2-0 PDS | Do not freshen the edges

What additional diagnostic should be performed with degloving injuries?

Radiographs to monitor for deeper lesions

What is the preferred lavaging fluid?

LRS as this provides least damage to fibroblasts

How often should bandages be changed with degloving injuries?

Daily until exudate decreases Then every other day until granulation tissue forms Then every third day until healing is noted

Why should radiographs be performed with bite wounds?

External wounds are tip of the iceberg

What are good anesthetic drugs for cardiovascular-compromised patients?

Oxy/hydromorphone and diazepam IV Hydro and midazolam IV Diazepam and ketamine

What should be done after placing a Penrose drain?

Bandaging it to prevent environmental contamination

What is the difference between low and high-velocity firearm wounds?

Low-velocity may be stuck in the soft tissue High-velocity can penetrate bone in a large dog

What is the difference between exit and entry wounds?

Exit wounds are larger than entry wounds

What diagnostics should be performed with gun shot wound?

Radiographs of the surrounding area to assess for damage

What must be done if a projectile is shot at the eye?

The projectile must removed and rads of globe should be taken

What legal issues are important with projectile injuries?

Take pictures of event Radiographs Write down communications Wrap tape around forceps to prevent damage to bullet, wrap bullet in facial tissues, write pet's name, ID number, date, site it was taken from, and initials of all who were present during this being removed

What is a critical fracture?

``` An emergency where immediate surgery is needed to keep the life or purpose of the bone in place Examples include: Skull fractures Spine fractures Open fractures Displacements ```

What is a semi-critical fracture?

``` Fractures that may cause discomfort if not addressed soon E.G Growth plate fractures Femoral head/ shoulder/ elbow luxations Mid/ distral humeral fracture Pelvic fracture Os penis fractures ```

What is a non-critical fracture?

``` Fractures that are not emergent E.G Greenstick fractures Scapular or pelvic fractures Closed long bone diaphyseal fractures ```

When should a splint not be used?

On humerial, femoral, or pelvic fractures

When is an amputation indicated?

``` Severe trauma Neoplasia Ischemic necrosis Severe infection unresponsive to therapy Paralysis Congenital defects Severe arthritis ```

Why should you avoid the base of the tail for amputation?

Cutting too close to the tail base can interfere with the perineal nerve, causing incontinence

How can a hip luxation be treated in dogs? Cats?

Reduce the luxation, apply an Ehmer sling, let sit for 2-12 days. If no correction, will need surgical correction Cats need surgical correction

What is important about elbow luxations?

Need to be reduced within 2 days or these become very difficult to correct

What directions do the bones of the elbow deviate in elbow luxations?

Radius and ulna deviate laterally | Anconeus luxated caudolaterally

What should be told to a client over the phone when suspicion of dehiscence is noted?

Tell them to place a wrap on the affected area, allow them to carry the patient into the hospital to not place any additional stress to the affected area