Trauma Flashcards

Question

Signs of basilar skull fractures?

Answer 1

**Periorbital ecchymosis** (Raccoon eyes) **CSF from the nose (rhinorrhoea) or ear (otorrhea)** **Retro auricular ecchymosis** (Battle’s sign)

Answer 2

Relatively uncommon, approx. 0.5% of patients with brain injuries **Biconvex shape**- push adherent dura away from the inner aspect of the skull Often at the temporal or temporoparietal region from tear to middle meningeal artery Classically **a lucid interval** from the time of injury to neurological deterioration _Treatment_: **Surgical evacuation**

Answer 3

More common than extradural Conform to contours of the brain, crescent-shaped or curved, (think sUbdural = cUrved) Often result from the shearing of bridging blood vessels of the cerebral cortex May be: - **Acute** - symptoms within 48 hours - **Subacute** - symptoms within 3-14days - **Chronic** - symptoms after 2 weeks or longer _Treatment_: **Craniotomy and clot evacuation to reduce the mass effect**

Answer 4

Resuscitation Rapid Diagnosis of brain lesion Prevention of secondary brain insults

Answer 5

Antiplatelet agents – **give platelets** Warfarin - **FFP, vitamin K, prothrombin complex concentrate** Heparin - **protamine sulfate** Direct thrombin inhibitors (dabigatran) -**idarucizumab**

Answer 6

GCS = 3 Non - reactive pupils Absent brainstem reflexes e.g. oculocephalic, gag reflex, corneal reflex No ventilatory effort Absence of confounding factors e.g. hypothermia, drug or alcohol intoxication Consider organ donation with family

Answer 7

Supervision for 48 hours Tell to return if: - Confusion - Drowsiness - Seizures - LOC - Visual disturbance - Headaches - Vomiting

Answer 8

_Potential types of injury_ - Laryngeal injury - Posterior dislocation of the clavicular head - Penetrating trauma from knives or bullets _Causes_ - Swelling - Bleeding - Vomitus

Answer 9

“One-way valve” leak occurs from the lung or through the chest wall => Air is forced into the pleural space with no escape, collapsing the affected lung => mediastinum is displaced to the opposite side leading to: o Decreased venous return ➔ Reduced cardiac output o Compression of the opposite lung o Obstructive shock may result

Answer 10

The most common cause is **mechanical ventilation in patients with lung injury** Also as a result of simple pneumothorax following penetrating or blunt trauma

Answer 11

Tracheal deviation AWAY from the side of the injury Unilateral absence of breath sounds Elevated hemithorax without respiratory movement Hyperresonant to percussion Neck vein distension Cyanosis (late manifestation)

Answer 12

CLINICAL DIAGNOSIS➔ DO NOT WAIT FOR RADIOLOGICAL CONFIRMATION **Insert Large bore cannula into 5th intercostal space, slightly anterior to the mid-axillary line** - Beware cannula may kink, or chest wall may be too thick to effectively reach the pleural space - Continuously reassess - Finger thoracostomy may be performed if needle decompression is unsuccessful **Chest drain insertion is mandatory after needle or finger decompression**

Answer 13

Opening in the chest wall that is ≥2/3 the diameter of the trachea, air passes preferentially through the chest wall defect with each inspiration Effective ventilation is thereby impaired ➔ Hypoxia and hypercarbia

Answer 14

Penetrating or blunt trauma that disrupts the systemic or hilar vessels Can compromise respiratory efforts by compressing the lung and preventing adequate oxygenation and ventilation

Answer 15

Establish large calibre intravenous lines Infuse crystalloid, give blood as soon as possible Chest drain insertion (28-32 French) and drainage of haemothora: - 5th intercostal space - Anterior to the mid-axillary line

Answer 16

Immediate return of 1500 mL or more of blood Initial output <1500ml, but continued loss of >200ml/hr for 2-4 hrs Incomplete evacuation of blood from the chest Persistent need for blood transfusion Penetrating anterior chest wounds medial to the nipple line and posterior wounds medial to the scapula

Answer 17

**Beck's Triad** - Distended Neck Veins - Muffled Heart Sounds - Hypovolemia **Kussmaul’s Sign**: A rise in venous pressure with inspiration when breathing spontaneously **Pulseless electrical activity (PEA) on ECG** in a trauma patient in cardiac arrest may indicate cardiac tamponade

Answer 18

eFAST can effectively identify cardiac tamponade or pericardial effusion - 90-95% accurate - Beware ➔ concomitant haemothorax may result in both false positive or negative

Answer 19

**IV fluid** will improve cardiac output transiently while preparations are made for surgery If surgical intervention is not possible, **pericardiocentesis** can be therapeutic, but it does not constitute definitive treatment for cardiac tamponade.

Answer 20

**Hypovolemic**: Pulseless electrical activity (PEA) on ECG **“True” cardiac arrest** (Ventricular fibrillation, Asystole)

Answer 21

Severe Hypoxia Tension Pneumothorax Profound Hypovolemia Cardiac Tamponade Cardiac Herniation Severe Myocardial Contusion

Answer 22

Start CPR ABC Management 2 X Large-bore IV cannulas (Intraosseous if unable to get IV) Secure airway with an endotracheal tube Administer mechanical ventilation with 100% oxygen (Monitor ECG and oxygen saturation) To alleviate potential tension pneumothorax perform bilateral finger or tube thoracostomies Rapid fluid (ideally blood) resuscitation Administer epinephrine (1 mg) if ventricular fibrillation is present resuscitative thoracotomy may be required if there is no return of spontaneous circulation (ROSC)

Answer 23

Simple pneumothorax Haemothorax Rib Fractures, Flail Chest and Pulmonary Contusion Blunt Cardiac Injury Traumatic Aortic Disruption Traumatic Aortic Disruption Blunt Oesophageal Rupture

Answer 24

_Signs: - Decreased air entry to the affected side - Hyperresonance - Tachypnoea - No tracheal deviation (no tension) - Dyspnoea _Investigations_: - Upright expiratory chest x ray - CT THorax

Answer 25

_Causes:_ Laceration of the lung, great vessels, an intercostal vessel, or an internal mammary artery from penetrating or blunt trauma _Signs_: - Decreased chest wall movement - Penetrating injuries evident - Decrease air entry to the affected side - Dullness to percussion on the affected side - Typically no signs of shock as not massive (<1500ml)

Answer 26

**Flail Chest** - Two or more adjacent ribs fractured in two or more places - can also occur when there is a costochondral separation of a single rib from the thorax **Pulmonary Contusion** - most common potentially lethal chest injury - Children have far more compliant chest walls than adults and may suffer contusions and other internal chest injuries without overlying rib fractures **Observation of abnormal respiratory motion and palpation of crepitus from rib or cartilage fractures can aid diagnosis**

Answer 27

Chest X-ray may suggest multiple rib fracture If flail chest suspected, CT Thorax is indicated Analgesia: IV or PO Opioids given locally (Paravertebral or serratus anterior nerve blocks) avoids respiratory depression of opioids Humidified oxygen Adequate ventilation Cautious fluid resuscitation

Answer 28

Patients with significant hypoxia (**PaO2 < 60 mm Hg or SaO2 < 90%**) on room air may require intubation and ventilation within the first hour after injury

Answer 29

Widened mediastinum Obliteration of the aortic knob Deviation of Trachea to the RIGHT Depression of LEFT mainstem bronchus Elevation of RIGHT mainstem bronchus Obliteration of space between pulmonary artery and aorta Deviation of Esophagus (nasogastric tube) to the RIGHT Left Hemothorax Fractures of 1st or 2nd rib or scapula **If an aortic injury is suspected ➔ CT aortogram**

Answer 30

**Cullen’s sign** = ecchymosis of the peri-umbilical area **Grey-Turner’s sign** = ecchymosis of the flank

Answer 31

Lap belt sign = 30% chance of mesenteric or intestinal injury

Answer 32

**Focused Assessment with Sonography for Trauma (FAST)** - The main aim of a FAST scan is to identify intra-abdominal free fluid (assumed to be haemoperitoneum in the context of trauma). - Takes up to 500mls of free fluid for the FAST to be positive – if initially negative but high suspicion for intraabdominal injury/haemorrhage consider repeat examination after a period of time.

Answer 33

Defines the severity of organ injury and potential for nonoperative management Detects severity and source of haemoperitoneum rather than just presence/absence Often able to detect active bleeding Ability to assess retroperitoneum and vertebral column Ability to concurrently scan other areas (e.g. brain, thorax) Negative imaging generally good indicator of the absence of clinically significant injury

Answer 34

Insensitive for mesenteric, bowel, and pancreatic duct injuries IV contrast required – potential for allergic reactions High cost Difficult to obtain/potentially unobtainable in haemodynamically unstable patients Radiation exposure

Answer 35

**Local wound exploration**: Involvement of the abdominal fascia is considered a positive result. **Erect CXR**: Subdiaphragmatic free air is indicative of peritoneal perforation; however, a normal examination does not rule it out. **FAST (Focused Assessment with Sonography for Trauma)**: The presence of free fluid in the abdomen is indicative of peritoneal perforation/intraperitoneal organ injury, however, a normal examination does not rule it out. **CT abdomen** is highly sensitive. The major advantage of CT is the ability to diagnose the injured organ(s) and to quantify the severity of injuries.

Trauma Flashcards

(67 cards)