Chapter 15 - Trauma Flashcards by Liam Knott

What is the first peak of trauma death? causes

0-30 minutes.

Heart/aorta
brain/brainstem/spinal cord
cannot save these patients

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What is the second peak of trauma death? causes

30 minutes- 4 hours.

# 1 head injury
# 2 hemorrhage
Golden hour, rapid assessment

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What is the 3rd peak of trauma death?

days to weaks

multisystem organ failure
sepsis

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What percentage of trauma is blunt?

80%

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What is the most commonly injured organ in blunt trauma?

Liver (some say spleen)

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What is the formula for kinetic energy?

1/2 MV^2

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What is the LD50 fall height?

4 stories

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At what point of blood loss is blood pressure effected?

30%

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What is the most commonly injured organ in penetrating trauma?

Small bowel (some say liver)

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What is the most common cause of long term death with trauma?

Sepsis

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What is the most common cause of upper airway obstruction and how is it alleviated?

Tongue, jaw thrust (ohhhh yeaaaa)

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What injuries to seat belts cause?

small bowel perfs
lumbar spine fxs
Sternal fxs

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What site is best for cutdown access?

Saphenous vein

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When is a DPL positive?

> 10cc blood
100k RBC’s
-food particles, bile, bacteria
500cc WBC

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If a pelvic fx is present, where must DPL be performed?

Supraumbilical

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What does a DPL miss?

Retroperitoneal hematoma

Contained hematomas

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Where does a FAST look for blood?

perihepatic fossa
Pelvis
Pericardium

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What are flaws with FAST?

Operator Dependent (fuckin Belsky)
Obesity
May not detect fluid <50-80
Misses retroperitoneal bleed and hollow viscous injury

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CT after blunt trauma needed for what?

Abdominal Pain
Need for General Anasthesia
closed head injury
intoxicants
paraplegia
distracting injury
Hematuria

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What does a CT scan of blunt trauma miss?

hollow viscous injury

- retroperitoneal bleed

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These patients need a laparotomy after blunt trauma:

Peritonitis
evisceration
(+) DPL
clinical deterioration
uncrontrolled hemorrhage
free air
diaphragm injury
intraperitoneal bladder injury
specific renal, pancreas, biliary tract injury

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When does abdominal compartment syndrome happen?

massive fluid resuscitation
trauma
abdominal surgery

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Bladder pressures of what indicate abdominal compartment syndrome?

> 25-30

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What is the final common pathway for decreased cardiac output in abdominal compartment syndrome?

ICV compression

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What causes decreased urine output in abdominal compartment syndrome?

Compressed renal vein

What is tx for abdominal compartment syndrome?

decompressive laparotomy

When do you use a pneumatic antishock garment?

- SBP <50 without thoracic injury | - release one compartment at a time after reaching ED

When do catecholamines peak after trauma?

24-48 hours

Along with catecholamines, what rises after trauma?

-ADH -ACTH -Glucagon Fight or flight response

What blood type is a universal donor? Why? Rh can and cannot go to who?

- O, does not contain A or B antigens - Males can get Rh positive - prepubescent and child bearing age females must get Rh negative

Type specific, non-screened, non-crossmatched blood can be given safely with what side effects?

effects from antibodies to minor antigens

Glasgow coma score Motor

``` 6 follows commands 5 localizes pain 4 withdraws from pain 3 flexion with pain 2 extension with pain 1 no response ```

Glasgow coma score verbal

``` 5 oriented 4 confused 3 inappropriate words 2 incomprehensible sounds 1 no response ```

Glasgow coma score eye opening

4 spontaneous 3 to command 2 to pain 1 no response

GCS that gets head CT, Intubation, ICP monitor

<= 8 ICP monitor

Epidural Hematoma caused by damage to what? What does head CT show? What is patient presentation? When do you operate?

- Arterial bleed from middle meningeal A - CT shows lens shape lenticular deformity - initial LOC, lucid interval, sudden deterioration - Operate for significant degeneration or mass effect shift >5mm

Subdural Hematoma caused by damage to what? Head CT shows? when do you operate?

- venous plexus tearing between dura and arachnoid - CT shows crescent deformity - operate for significant mass defect

Intracerebral hematomas usually where? When do they need operation?

- Usually frontal or temporal | - operate for significant mass effect

Cerebral contusions can be one of these 2 types

coup or contracoup

When do traumatic intraventricular hemorrhages need treatment?

ventriculostomy if causing hydrocephalus

When imaging is best for DAI?

MRI better than CT

how do you calculate cerebral perfusion pressure?

MAP minus ICP

What are signs of elevated ICP?

- decreased ventricular size - loss of sulci - loss of cisterns

When are ICP monitors needed?

- GCS

What is a normal ICP?

-10, >20 needs tx

What do you want the CPP to be?

>60

What is supportive therapy for increased ICP?

- sedation and paralysis - raise head of bed - relative hyperventilation - Na 140-150 - Serum Osm 295-310 - Manitol - Barbituate coma - ventriculostomy with CSF drainage - Phenytoin

When does ICP peak after injury?

48-72 hours

What does dilated pupil show?

Temporal pressure on SAME side (CNIII compression)

Raccoon eyes indicates what?

anterior fossa fx

Battle's sign shows what?

middle fossa fx - acute need exploration - delayed secondary to edema

Temporal skull fx can injure what cranial nerves?

VII and VIII

What is the most common site of facial nerve injury?

geniculate ganglion

when do skull fx need treatment?

8-10 mm or > depression - contaminated - persistent CSF leak

What is a Jefferson cervical fx?

- C1 burst - caused by axial loading - tx rigid collar

What is a hangman's fx?

-C2 distraction and extension -traction and halo

What are the 3 types of C2 odontoid fx?

I above base, stable II at base, unstable- need fusion or halo III extend to vertebral body-need fusion/halo

What can facet fractures or disocations cause? how do they happen?

cord injury | associated with hyperextension and rotation with ligamentous disruption

What is the anterior column or thoracolumbar spine?

anterior longitudinal ligament and 1/2 of vertebral body

What is the middle column of thoracolumbar spine?

Posterior 1/2 of vertebral body and posterior longitudinal ligament

What is the posterior column of the thoracolumbar spine?

facet joints, lamina, spinous processes, interspinous ligament

How many columns of thoracolumbar spine must be disrupted for fx to be considered unstable?

What are wedge fractures? stable or unstable?

anterior column only; stable

What are burst fractures? stable or unstable?

>1 column and usually require fusion

What structures are at risk after upright fall?

calcaneus lumbar wrist/forearm fractures

What are the indications for emergent surgical spine decompression?

- fx not reducible with distraction - acute anterior spinal syndrome - open fractures - soft tissue or bony compression of the cord - progressive neurological dysfunction

What skull fracture is most common cause of facial nerve injury?

temporal bone FX

What is type I Le Fort fx? tx?

- maxillary fx straight across ( - ) | - tx with reduction, stabilization, intramaxillary fixation, +/- circumzygomatic and orbital rim suspension wires

What is type II Le Fort fx? tx?

- Lateral to nasal bone, underneath eyes, diagonal toward maxilla ( / \ ) - tx with reduction, stabilization, intramaxillary fixation, +/- circumzygomatic and orbital rim suspension wires

What percentage of nasoethmoidal bone fx have CSF leak?

70%

What is a type III Le Fort Fx? tx?

Lateral orbital walls ( - - ) | -suspension wiring to stable frontal bone; may need external fixation

What are the 2 types of Nosebleeds? Tx?

- Anterior - Packing | - Posterior - balloon tamponade first, may need embolization of internal maxillary a or ethmoidal a

What is the #1 indicator of mandibular injury?

malocclusion

What is a tripod fx? what do you do?

zygomatic bone fx. May need ORIF for cosmesis

what are patients with maxillofacial fx at a high risk for?

cervical spine injury

Asymptomatic blunt neck trauma gets what?

Neck CT

Neck Zone I? penetrating injury gets what?

Clavicle to Cricoid - angiography - bronchoscopy - rigid esophagoscopy - barium swallow - may need pericardial window/sternotomy

Neck Zone II? penetrating injury gets what?

Cricoid to angle of the mandible | -Exploration in the OR

Neck Zone III? Penetrating injury gets what?

Angle of mandible to base of skull - Angio - Laryngoscopy - may need jaw subluxation/digastric SCM release/mastoid sinus resection to reach vascular injuries

What is the best method to evaluate esophageal injury?

rigid esophagoscopy and esophogram (95% of injuries found)

Contained esophageal injuries treated how?

observation

Non-contained injuries to esophagus treated how?

small, <24h old, stable- primary closure | -otherwise, spit fistula and drain leak with chest tube

What percentage of esophageal and hypoesophageal injuries leak?

20%. always drain

How do you approach esophageal injuries?

- Neck- left side - upper 2/3- right thoracotomy - lower 1/3- left thoracotomy

What are the sx of laryngeal fx?

crepitus, stridor, respiratory compromise

Tx for thyroid injuries?

control bleeding, drain

Tx recurrent laryngeal nerve injury?

repair or reimplant in cricoarytenoid muscle

What do fucking shot gun injuries to the neck need other than a pine box?

angiogram, neck CT, esophagus/tracheal evaluation.

Tx for vertebral artery injury?

ligate or embolize without sequelae

Common carotid bleeds?

can tx with ligation - 20% will stroke

When to placed, indications for thoracotomy?

>1500 initially >250cc/h for 3 h >2500cc for 24h >instability

If all blood from hemothorax not drained in _____hours, risk this

48 hours; fibrothorax, pulmonary entrapment, infected hemothorax

unresolved hemothorax after 2 tubes?

thorascopic or open drainage

How large does a sucking chest wound need to be to be significant?

>2/3 diameter of trachea | -cover wound with dressing that has tape on 2 sides

Tracheobronchial injury can be diagnosed by what?

worse oxygenation after chest tube placement

What side are bronchial injuries more common?

right

What kind of intubation may be needed for bronchial injuries?

mainstem to unaffected side

When would you do right thoracotomy for tracheobronchial injury?

right mainstem, tracheal, proximal left mainstem | -avoid aorta

When would you do left thoracotomy for tracheobronchial injury?

-distal left mainstem injuries

Chapter 15 - Trauma Flashcards

(99 cards)