Chapter 15 - Trauma Flashcards by Ryan Cohen

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 is the most commonly injured organ in blunt trauma?

Liver (some say spleen)

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What is the LD50 fall height?

4 stories

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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 upper airway obstruction and how is it alleviated?

Tongue, jaw thrust (ohhhh yeaaaa)

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What site is best for cutdown access?

Saphenous vein

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

Supraumbilical

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Where does a FAST look for blood?

perihepatic fossa
Pelvis
Pericardium

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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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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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Bladder pressures of what indicate abdominal compartment syndrome?

> 25-30

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What causes decreased urine output in abdominal compartment syndrome?

Compressed renal vein

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When do you use a pneumatic antishock garment?

SBP <50 without thoracic injury

- release one compartment at a time after reaching ED

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Along with catecholamines, what rises after trauma?

-ADH
-ACTH
-Glucagon
Fight or flight response

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

effects from antibodies to minor antigens

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Glasgow coma score verbal

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

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GCS that gets head CT, Intubation, ICP monitor

<= 8 ICP monitor

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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

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Cerebral contusions can be one of these 2 types

coup or contracoup

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When imaging is best for DAI?

MRI better than CT

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What are signs of elevated ICP?

decreased ventricular size
loss of sulci
loss of cisterns

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What is a normal ICP?

-10, >20 needs tx

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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

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What does dilated pupil show?

Temporal pressure on SAME side (CNIII compression)

Battle's sign shows what?

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

What is the most common site of facial nerve injury?

geniculate ganglion

What is a Jefferson cervical fx?

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

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 is the anterior column or thoracolumbar spine?

anterior longitudinal ligament and 1/2 of vertebral body

What is the posterior column of the thoracolumbar spine?

facet joints, lamina, spinous processes, interspinous ligament

What are wedge fractures? stable or unstable?

anterior column only; stable

What structures are at risk after upright fall?

calcaneus lumbar wrist/forearm fractures

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

temporal bone FX

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 is a type III Le Fort Fx? tx?

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

What is the #1 indicator of mandibular injury?

malocclusion

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

cervical spine injury

Neck Zone I? penetrating injury gets what?

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

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

Contained esophageal injuries treated how?

observation

What percentage of esophageal and hypoesophageal injuries leak?

20%. always drain

What are the sx of laryngeal fx?

crepitus, stridor, respiratory compromise

Tx recurrent laryngeal nerve injury?

repair or reimplant in cricoarytenoid muscle

Tx for vertebral artery injury?

ligate or embolize without sequelae

When to placed, indications for thoracotomy?

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

unresolved hemothorax after 2 tubes?

thorascopic or open drainage

Tracheobronchial injury can be diagnosed by what?

worse oxygenation after chest tube placement

What kind of intubation may be needed for bronchial injuries?

mainstem to unaffected side

When would you do left thoracotomy for tracheobronchial injury?

-distal left mainstem injuries

When would you do right thoracotomy for tracheobronchial injury?

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

What side are bronchial injuries more common?

right

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

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

48 hours; fibrothorax, pulmonary entrapment, infected hemothorax

Common carotid bleeds?

can tx with ligation - 20% will stroke

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

angiogram, neck CT, esophagus/tracheal evaluation.

Tx for thyroid injuries?

control bleeding, drain

How do you approach esophageal injuries?

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

Non-contained injuries to esophagus treated how?

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

What is the best method to evaluate esophageal injury?

rigid esophagoscopy and esophogram (95% of injuries found)

Neck Zone II? penetrating injury gets what?

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

Asymptomatic blunt neck trauma gets what?

Neck CT

What is a tripod fx? what do you do?

zygomatic bone fx. May need ORIF for cosmesis

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 percentage of nasoethmoidal bone fx have CSF leak?

70%

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 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 are burst fractures? stable or unstable?

>1 column and usually require fusion

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

What is the middle column of thoracolumbar spine?

Posterior 1/2 of vertebral body and posterior longitudinal ligament

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

cord injury | associated with hyperextension and rotation with ligamentous disruption

What is a hangman's fx?

-C2 distraction and extension -traction and halo

when do skull fx need treatment?

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

Temporal skull fx can injure what cranial nerves?

VII and VIII

Raccoon eyes indicates what?

anterior fossa fx

When does ICP peak after injury?

48-72 hours

What do you want the CPP to be?

>60

When are ICP monitors needed?

- GCS = 8 | - suspected increased ICP and inability to follow clinical exam

how do you calculate cerebral perfusion pressure?

MAP minus ICP

When do traumatic intraventricular hemorrhages need treatment?

ventriculostomy if causing hydrocephalus

Intracerebral hematomas usually where? When do they need operation?

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

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

Glasgow coma score eye opening

4 spontaneous 3 to command 2 to pain 1 no response

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 ```

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

When do catecholamines peak after trauma?

24-48 hours

What is tx for abdominal compartment syndrome?

decompressive laparotomy

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

ICV compression

When does abdominal compartment syndrome happen?

- massive fluid resuscitation - trauma - abdominal surgery

What does a CT scan of blunt trauma miss?

- hollow viscous injury | - retroperitoneal bleed

What are flaws with FAST?

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

What does a DPL miss?

Retroperitoneal hematoma | Contained hematomas

When is a DPL positive?

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

What injuries to seat belts cause?

- small bowel perfs - lumbar spine fxs - Sternal fxs

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

Sepsis

At what point of blood loss is blood pressure effected?

30%

What is the formula for kinetic energy?

1/2 MV^2

What percentage of trauma is blunt?

80%

What is the first peak of trauma death? causes

0-30 minutes. - Heart/aorta - brain/brainstem/spinal cord - cannot save these patients

Chapter 15 - Trauma Flashcards

(99 cards)