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Senoir 21-2 > Truama Truama Truama > Flashcards

Truama Truama Truama Flashcards

1
Q

Top three causes of death following trauma

A

Head injury
Chest injury
Major vascular injury

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2
Q

What was the trauma act of 1990

A

U.S. Congress passed the Trauma Care Systems Planning and Development Act

Designated Trauma centers are certified based on their commitment of personnel & resources to maintain readiness to treat critically injured patients

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3
Q

TYpe 1 vs type 2 RR failure

A

Type 1 respiratory failure
->Hypoxia without hypercapnia
Conditions that affect oxygenation but not necessarily ventilation
-> PNA, PE
Treatment focuses on optimizing oxygenation

 Type 2 respiratory failure
-> Hypoxia with hypercapnia
 Conditions that affect ventilation
 COPD
-> Treatment focuses on optimizing oxygenation & supporting ventilation
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4
Q

7 P’s of RSI

A 
Preparation
Pre-oxygenation
Pre-treatment
Paralysis with Induction!!
Protection and Positioning
Placement of the tube/proof 
Post intubation management
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5
Q

How many breaths do you need for pre ox for RSI

A

Administer 100% oxygen for 3 minutes, using a NRB mask supplied with 15 L/min of oxygen

(Or 8 vital capacity breaths)

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6
Q

CAn children less than 12 get cric?

A

NO!

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7
Q

MC surgical site infection with Vanc resistance

A

Enterococcus fasciem

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8
Q

What is the BMZ

A

complex region of the extracellular matrix

Connects basal cells of epidermis with papillary dermis
->interdigitate with epidermal projections – “rete ridges”

significant role in burn wound healing

epithelialized wounds undergo blistering until:
->the anchoring structures of the BMZ mature

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9
Q

Burn Calc (9s)

A

Head 9

Front Torso: 18
Back: 18
Arms: 9 each

Legs 18 each

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10
Q

Deep vs superficial partial thickness burns

A

Superficial partial-thickness:
Typically pink, moist, and painful
Heal within 2 to 3 weeks, without scarring or functional impairment

Deep partial-thickness:
Extend into the reticular layer of the dermis
Typically a mottled pink-and-white, dry, and variably painful.

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11
Q

Prognosis of deep partial thickness burns

A

If they do not become infected,
typically heal in 3-8 weeks, with severe scarring, contraction, & loss of function

If a partial-thickness burn has not healed by 3 weeks,
surgical excision and skin grafting may be required

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12
Q

Do ABX help Burns?

A

All topical antibiotics retard wound healing

should be used only on deep second- or third-degree burns or wounds

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13
Q

MGMT for Superficial burns to the face

A

can be treated open with an antibacterial ointment

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14
Q

Systemic antibiotic prophylaxis

plays no role in the management of acute burn wounds

A
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15
Q

Cream for Burns to the ears

A

Sulfamylon
For burns to the ears. Prone to chondritis.
Painful topical

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16
Q

Best type of gradt for the face, neck and hands

A

Full thickness sheet graft

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17
Q

define burn shock

A

both a hypovolemic and a cellular shock

decreased cardiac output, increased extracellular fluid, decreased plasma volume, and oliguria

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18
Q

How do we decrease catabolism in burn pts

A

Controlled use of a beta-blocker has been shown to decrease catabolism

insulin, growth hormones, and testosterone analogues
shown to both decrease catabolism and increase anabolism

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19
Q

What kind of necrosis do acids and alkaline burns cause

A

Acids- coagulation necrosis

Alkaline- liquefaction necrosis

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20
Q

Tx for chemical burns

A

Remove clothing from burned area
Irrigate with copious amounts of running water
Elevate and dress
Splint in position of function

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21
Q

MGMT for chord biting burns

A

Normally no surgery/debridement needed immediately
Splint to avoid contracture
Reconstruction of the mouth after healed

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22
Q

Partial thickness burns greater than _____ should be sent to a burn center

A

10 %

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23
Q

What does ADC VAN DIS MAL mean

A

Admit
Dx
Condition

Vitals
Activity
Nursing orders

Diet
IVF
Special Tests

Meds
Allergies
Labs

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24
Q

3 stages of wound healing

A

inflammation, migration/proliferation, and maturation

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25
Q

Wound healing: 80% of original tensile strength is reached by 6-8 weeks

A
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26
Q

Healing time for abrasions

A

If left to heal by secondary intention -

should close within 7 to 14 days

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27
Q

When should we remoce debris from abrasions

A

traumatic tattooing if not debrided within 24-48 hours

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28
Q

Healing approach for punctures

A

They are typically left open,
treated with wound care,
and allowed to heal by secondary intention

Secondary closure reduces the risk of infection !

generally yields excellent aesthetic results

If Uncomplicated cellulitis
->Oral antibiotics

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29
Q

Healing MGMT for lacerations

A

Can be closed primarily
Ensure wound bed is clean

Close within 6-8 hours

Face may be left open for up to 24 hours

Do not close if debris left in wound or not HDS, If contamination then 2nd intention

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30
Q

Time frame to do fasciotomies in crush injuries

A

fasciotomies should be performed within 6 hours

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31
Q

Tx of Rhabdo and Renal failure in crush injuries

A

If an elevated serum CK, intravascular volume is stabilized, and urine flow is confirmed,

a forced mannitol-alkaline diuresis should be initiated
-prophylaxis against hyperkalemia and acute renal failure

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32
Q

If someone is bitten

What image must we order

A

X-rays must be obtained and wounds explored to evaluate for fractures or open joint injuries

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33
Q

Mgmt for bite If a joint capsule has been violated

A

the joint must be thoroughly cleaned

heal by secondary intention or delayed primary closure

Rabies prophylaxis treatment

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34
Q

What solutions should be used for wound irrigation

A

Only nontoxic solutions should be used for wound irrigation

Avoid irrigation with an antibiotic solution

Strong antiseptics should not be placed directly into the wound
->toxic to the tissues and impede healing

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35
Q

How does 2ndary intention work

A

Wound closure occurs by
granulation of the wound base,
contraction from the wound edges,
and reepithelialization

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36
Q

In any wound where cellulitis starts

Treat with

A

Oral ABX

37
Q

MC agent of surgical site infections

A

S. Aureus

38
Q

What is the threshold to start antimicrobianas ABX in chronic wounds

A

the wound should show signs of contracture and secondary wound closure within 2 weeks.

If not - Quantitative anaerobic and aerobic bacterial wound tissue culture

Topical antimicrobial treatment is recommended

systemic antibiotics are not effective

39
Q

Excessive cautery of the superficial scalp can lead to…

A

Alopecia

40
Q

Can you use active drains over skull fxs?

A

NEVER!

41
Q

layers of the scalp from superficial to deep

A

Acronym SCALP from outside in

Skin
Connective tissue
(galea) Aponeurosa
Loose areolar tissue
Pericranium
42
Q

Complications of basilar skull fxs

A

Vascular – epidural hematoma

CN deficits – III, IV, V

CSF leak – concern for meningitis

43
Q

What is 2ndary brain injury

A

Secondary brain injury is the sequelae of primary brain injury.

First responders can intervene to reduce secondary brain injury by managing:

  • Hypoxia
  • Hypotension ->decreased cerebral blood flow
  • Increased Intra-Cranial Pressure (ICP)
  • Hyper or hypo-glycemia
  • Seizures
44
Q

Motor score less than 4?

A

Intubate

45
Q

spontaneous hyperventilation (causing PaCO2 < 26 mm Hg)…

A

Immediately intubate

46
Q

Indications for a ICP bolt

A

Indicated in all salvageable patients
with a GCS score of less than or equal to 8 (between 3-8)
with an abnormal head CT scan

47
Q

Normal pupils should be within _____mm

A

1

48
Q

NML pupil size in adults

A

Less than 4mm

49
Q

Hyphema in head injury think

A

TBI

50
Q

LAB eval for LOC

A

CBC
CoAgstudies
BMP/ CMP

ABG

Tox

Blood and CSF Cx

Thyroid Funtion and B12 assay

51
Q

After structural lesions have been excluded, ____ should be performed in most patients with altered consciousness

A

EEG

52
Q

Loss of grey white delineation on CT

Think

A

Cerebral edema

53
Q

Artery asssoc with Epidural Hematoma

A

Middle Meningeal

54
Q

Sodium goals in Head trauma

A

Na+ goals of 145 to 155 mEq/l

55
Q

Rx to use in ICP to manage shock

A

Phenylephrine

56
Q

Labs when giving mannitol

A

Serial measurements of serum sodium, serum osmolality, and renal function

57
Q

Seizure prophylaxis in head truama

A

Levetiracetam (Keppra) for 7 days

58
Q

Rx for Agitaion in head truama

A

Propofol + Fentanyl

Propofol better outcome than using Benzos + narcotic

59
Q

Role of barbituates in ICP

A

Barbiturates - reserved for refractory elevated ICP

60
Q

What causes cerebral salt wasting following a TBI

A

attributable to the release of brain natriuretic peptide

a potent vasodilator and natriuretic that is elevated in serum during the acute phase of TBI

61
Q

Approach to penetrating abdominal trauma

A

May need surgery to evaluate for hollow organ injury

Exploratory laparotomy- open procedure

Exploratory laparoscopy- minimally invasive

62
Q

Stable pt with a penetrating abdominal trauma =

A

Diagnostic Laparoscopy

63
Q

Indications for Ex lap in Blount trauma

A

peritonitis, ongoing intra-abdominal hemorrhage, and the presence of other known associated injuries

64
Q

Penetrating injury to the abdomen + shock =

A

Ex lap

65
Q

Is peritonitis after blunt abdominal trauma common?

A

NO !

Indicates: rupture of a hollow organ - duodenum, bladder, intestine, or gallbladder; pancreatic injury; presence of retroperitoneal blood

66
Q

How does a hollow viscus organs injury look like on CT

A

May show “fat stranding”, pneumoperitoneum and free fluid as sequelae of hollow viscous organ injury

67
Q

2 indications that make you think there may be a hollow viscus injury

A

The “seat-belt” sign
->more than doubled relative risk of small bowel injury

Flexion-distraction fractures of the spine (Chance fractures)
->suspicion for associated hollow viscus injury.

68
Q

What can be done to decompress the stomach before Ex lap

A

Insert NG/OG tube to decompress stomach and avoid aspiration

69
Q

What is the prevailing therapeutic strategy for blunt trauma

A

Conservative MGMT

70
Q

Solid organ injury with evidence of active bleeding in the abdomen

A

Angiography

Must be stable

71
Q

In a liver injury, Evidence of RUQ fluid collections or clinical deterioration =

A

CT to exclude a biloma, an abscess, necrosis, or hematoma

72
Q

Post Dc imaging for Liver injury pts

A

4 to 8 weeks after injury

high-grade injuries should be reimaged at 3 months prior to return to contact sports

73
Q

Prevailing Strategy to manage Spleen injuries

A

nonoperative management (NOM) has become the prevailing strategy for blunt splenic trauma

74
Q 
direct blow to the epigastrium
Or
bicycle handlebar to the epigastrium
Or
the steering wheel or a motor cycle handle bar is involved

+abdominal, back, or flank pain

Think

A

High Index of suspicion for Duodenal/ Panc Trauma

75
Q

Retroperitoneal air, free intraperitoneal air, or obliteration of the psoas shadow

Think

A

Duodenal Rupture

76
Q

Indications to perform a RUG

A

Blood at meatus
Scrotal hematoma
Blood on gloved finger after DRE (Rectal)
High riding prostate

Do not place bladder catheter if urethra injury suspected

77
Q

If the FAST is negative In hemodynamically unstable patients with Pelvic trauma

Assume

A

pelvis is the source of the bleeding

Send to CT if stable, to evaluate

Arterial: angiographic embolization is necessary

Venous: operative placement of an external fixation device

78
Q

Define Abdominal compartment syndrome

A

Post surgery -> increased fluid-> Results in increased peak airway pressures, decreased cardiac output, increased systemic vascular resistance

If the abdomen is closed,
->evaluate frequently for acidosis, decreased urine out put and increased lactate

79
Q

Differnce between a Jackson Pratt and a Penrose Drain

A

Jackson Pratt drain :

  • Grenade shaped vacuum container
  • Closed system under suction

Penrose drain

  • Rubber/latex drain
  • Prevents wound healing and allows serous drainage
  • Open and not under suction
80
Q

Triangle of safety for Chest tubes

A

Medial border- pectoralis muscle
Lateral border- latissimus dorsi
Inferior border- 4-5th intercostal space

81
Q

Criteria to remove a chest tube

A

No air leak on water seal
<200ml drainage in 24 hours
No PTX

82
Q

Hard sings for penetrating neck injuries

A 
Crepitus 
Hoarse
Bloody Cough/ saliva 
Dyspnea
Drool 
Stridor 
EXANDING HEMATOMA! 
HOTN
83
Q

if a rectal injury is suspected – perform Sigmoidoscopy

A
84
Q

Hards signs of arterial injuries

A

external bleeding, an expanding/pulsatile hematoma, absent distal pulses, a palpable thrill, an audible bruit, or signs of distal ischemia

85
Q

Pelvic fx with no evidence of bleeding and the patient remains unstable

A

should be considered for external pelvic fixation and preperitoneal pelvic packing in the OR
followed by angioembolization

86
Q

A GCS score lower than 9 and a lateralizing neurologic examination

A

indicate a significant risk that emergency craniotomy will be needed

CT scan of the head if hemodynamic stability permits

87
Q

Gold standard to eval Vascualar Cerebral Injuries from blunt truama

A

CTA of the neck is considered the gold standard for initial screening

88
Q

For patients with a concerning MOI or inconclusive findings on CT
a small amount of free fluid, mesenteric or bowel wall thickening=

A

Serial physical examinations are performed,

and amylase levels are checked

89
Q

MGMT of blunt renal injury

A

Bed rest - until the urine becomes grossly clear

Foley catheter - until can void spontaneously

Consider Follow-up CT at 48 to 72 hours

Senoir 21-2 (77 decks)

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