trauma

Question 1

Hard Signs of Penetrating Neck Trauma

Answer 1

Expanding or pulsatile hematoma
Loss of airway
Stridor or hoarse voice
Audible bruit or palpable thrill
Massive subcutaneous emphysema
Wound bubbling
Shock refractory to resuscitation

Question 2

Soft signs of penetrating neck trauma

Answer 2

Mild hemoptysis
Dysphonia
Dysphagia
Subcut or mediastinal air, non-expanding hematoma

Question 3

Spinal Levels and Loss of Function

Answer 3

C2- occiput
C3 - Thyroid Cartilage
C4 - Breathing / Sternal notch
C5 - Shrugging / Below the clavicles
C6 - Elbow flexion / Thumb
C7 - Extension / middle finger
C8 -Finger Flexion

Question 4

Anterior Spinal Column Contents

Answer 4

Anterior: Anterior spinal ligament, ant vertebral body and disc

Question 5

Middle Spinal Column Contents

Answer 5

posterior annulus of disc, posterior vertebral wall, posterior longitudinal ligament, spinal cord, laminae and pedicles, articulating facets, transverse process, nerve roots, vertebral arteries and veins

Question 6

Posterior Spinal Column Contents

Answer 6

Posterior: spinous process, nuchal ligament, interspinous and supraspinous ligaments, and ligamentum flavum

Question 7

Corticospinal Tract Location and Function

Answer 7

Postero-lateral and anterior cord. Ipsilateral motor.

Question 8

Spinothalmic Tract Location and Function

Answer 8

Anterolateral. Pain and temperature.

Question 9

Posterior Columns Locations and Function

Answer 9

Posterior central. Light touch Vibration and proprioception ipsilateral.

Question 10

Canadian C-Spine Rule High Risk Features

Answer 10

1) Age > 65
2) High Energy Mechanism
- Fall > 3 ft, axial load, high speed MVC, ATVs, bicycle hit by car
3) Parasthesias in extremities

Question 11

Canadian C-Spine Low Risk Features

Answer 11

1) Ambulated at any point
2) Seated in ED
3) Simple rearend MVC
4) Delayed onset of neck pain
5) Absence on C-spine tenderness

Question 12

Canadian C-Spine Inclusion

Answer 12

GCS 15
Stable vital signs
Age > 16
No paralysis
No known vertebral disease
Previous c-spine surgery

Question 13

Canadian CT Head Inclusion

Answer 13

LOC, definite amnesia or witnessed disorientation in GCS 13-15
Age >= 16
No anticoags

Question 14

Canadian CT Head Rule High Risk

Answer 14

1) GCS < 15 @ 2 hrs
2) Suspected open or depressed #
3) Any sign basal skull #
4) Vomiting > 2 episodes
5) Age > 65

Question 15

Canadian CT Head Medium Risk

Answer 15

Amnesia > 30 minutes before impact
Dangerous mechanism

Question 16

Cervical Spine Injuries and Stability - Flexion

Answer 16

1) Wedge - Stable
2) Flexion Tear Drop - Anterior vertebral body teardrop with interspinous ligament disruption. VERY unstable
3) Clay Shoveler’s - Spinous process #. Stable
4) Subluxation - Atlantooccipital misalignment. Possibly unstable
5) Bilateral Facet Dislocation - Unstable
6) Anterior atlantoaxial dislocation w or w/o # - Unstable
7) A-A dislocation - stable
8) Odontoid # - Unstable
9) Fracture of transverse process - stable.

Question 17

C-Spine Injuries Flexion - Rotation

Answer 17

Unilateral Facet Dislocation - stable
Rotary A-A dislocation - unstable

Question 18

C-Spine Injuries Extension

Answer 18

Posterior Neural Arch (C1) - Unstable
Hangman’s (C2) - # of bilateral pars interarticularis
Extension teardrop - Unstable in extension
Proper A-A dislocation w or w/o # - unstable
All extension injuries unstable

Question 19

C-Spine Injuries Compression

Answer 19

Bursting - stable
Jefferson (C1) - Extremely unstable if ligamentous injury
Isolated # of articular pillar and vertebral body

Question 20

Types of Odontoid Fractures

Answer 20

Type 1: Uncommon - tip of the dens. Avulsion of alar ligaments
Type 2: Most common - Waist of the dens near the ligament insertion
Type 3: Base of dens into the body

Type go in order from superior to inferior

Question 21

Central Cord Syndrome Mechanism and Symptoms

Answer 21

Hyperextension in an already narrowed canal. ?Ligamentum flavum protrusion into cord and injures central portion of cord.
- Weakness more in upper than lower.
- Variable sensory changes

Question 22

Anterior Cord Syndrome

Answer 22

Hyperflexion injury with disc protrusion into anterior cord.
- Motor paralysis below level
- Pain affected, fine touch and prioprioception spared
- Worst prognosis of partial cord injuries

Question 23

Define Spinal Shock vs Neurogenic Shock

Answer 23

Spinal shock is reversible impairment of spinal cord injury - can lead to neurogenic shock. Often leads to loss of f’n below the level of the injury.

Neurogenic Shock: Uncontrolled parasympathetic activation in complete spinal cord injury above T6 (location of sympathetic chain), bradycardia and vasodilation. Can see priapism as well.

Question 24

Brown Sequard / Hemi Cord Syndrome

Answer 24

Penetrating injury or lateral masses fracture
Weakness or paralysis with contralateral loss of sensation.

Question 25

Myocardial Concussion

Answer 25

Think commotio cordis - blunt trauma during repol. Can lead to asystole or vfib. No structural damage.

Question 26

Myocardial Contusion

Answer 26

Chest trauma with heart compressed by sternum. ECG abnormalities, tachy, PVCs, heart block, ischemia, arrhythmia, trop elevation. - N ECG and N trop = rule out

Question 27

Rib Fractures

Answer 27

If 3 or more - Consider admission. Treat pain to avoid splinting and atelectasis

Question 28

WEST Guidelines for Traumatic Arrest

Answer 28

If no signs of life: Blunt > 10 min Penetrating > 15 min = Dead If < time limit Consider resuscitative thoracotomy

Question 29

Pneumothorax Mgmt

Answer 29

If small < 2cm to chest wall then conservative If > 3 cm chest tube.

Question 30

Signs of Tension Pneumo

Answer 30

Deviated Trachea Hypotension Tachycardia, tachypnea Altered LOC Hypoxia

Question 31

Indications for laparotomy following penetrating trauma

Answer 31

Evisceration Diaphragm injury Hemodynamic Instability Peritoneal signs OR: Intraperitoneal air Implement in situ Gastrointestinal hemorrhage

Question 32

Diaphragm Injury Assess

Answer 32

can be missed on CT If L thoracoabdo penetrating trauma - need thoracoscopy or laparoscopy with N CT.

Question 33

Indications for laparotomy after blunt trauma

Answer 33

Hemodynamic Instability with suspected abdomen injury Peritonitis (Unequivocal) Pneumoperitoneum Diaphragmatic injury GI bleeding

Question 34

If multisystem trauma, hemodynamic unstable, with unstable pelvis and N CXR - next steps

Answer 34

If FAST + : laparotomy with packing and fixation If FAST - : Usually* angiography embolization and pelvic fixation. THEN look for intraabdominal injury on CT +/- laparotomy

Question 35

If combined blunt head with lateralizing and blunt abdo trauma

Answer 35

BRAIN TRUMPS EVERYTING: - Consider CT head and craniotomy then laparotomy vs angiography with pelvic fixation

Question 36

Types of brain herniation

Answer 36

Subfalcine Transalar / transphenoidal Transtentorial uncal Central transtentorial Cerebellar Tonsillar Herniation Transcalvarial

Question 37

Tentorial (Uncal) Symptoms

Answer 37

3 nerve palsy - unilateral fixed, blown Contralateral hemiparesis Brain stem compression

Question 38

Subfalcine (midline shift) herniation Signs

Answer 38

Papilledema Contralateral leg paralysis

Question 39

Central (tentorial) herniation Signs

Answer 39

Pupils fixed, mid-dilated. Decerebrate posturing (Similar to transtent)

Question 40

Upward transtentorial signs

Answer 40

Hydrocephalus and increased ICP N/V, headache and ataxia Progressive LOC and brain stem reflexes Ataxia and dysarthria Respiratory irregularities

Question 41

Tonsillar Herniation Sign (cerebellar tonsil)

Answer 41

Acute hydrocephalus with impaired consciousness, headache vomiting, and meningismus, Dysconjugate gaze and nystagmus Death

Question 42

massive transfusion def'n

Answer 42

Massive transfusion has been defined as transfusion of ≥10 units of whole blood (WB) or packed red blood cells (pRBCs) in 24 hours, ≥3 units of pRBCs in one hour, or ≥4 blood components in 30 minutes

Question 43

risks / adverse events of massive transfusion

Answer 43

coagulopathy

Question 44

Zone 1 Neck Anatomy

Answer 44

Base of neck to cricoid cartilage - Prox carotid artery - Vertebral artery - Subclavian - Mediastinal vessels - Apices of lungs - Esophagus - Trachea - Thyroid - Thoracic Duct - Spinal Cord

Question 45

Zone 2 Neck Anatomy

Answer 45

Base of cricoid to angle of jaw - Carotid artery - Vertebral artery - Larynx - Pharynx - Jugular Vein - Esophagus - Trachea - Vagus Nerve - Recurrent Laryngeal Nerve - Spinal Cord