Emergency Medicine > Trauma > Flashcards

Trauma Flashcards

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1
Q

components of trauma hx

A
  1. From pt, family, witnesses, or prehospital providers may provide important info
  2. Circumstances of injury (e.g., single-vehicle crash, fall from height, environmental exposure, smoke inhalation)
  3. Ingestion of intoxicants
  4. Preexisting medical conditions (DM, depression, cardiac disease, pregnancy)
  5. Meds (steroids, βB, anticoag) that may suggest certain patterns of injury or the physiologic response to injury.
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2
Q

4 mgmt/steps to trauma pt

A
  1. Primary survey
  2. Resuscitation
  3. Secondary Survey
  4. Definitive Care
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3
Q
  • Airway maintenance with C-spine protection
  • Breathing and ventilation
  • Circulation with hemorrhage control
  • Disability: neurological status
  • Exposure/environmental control

ABCs

which type of assessment is this

A

Primary Survey

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4
Q

during primary survery Identify yourself and ask patient for their name, what happened
if they can respond, what can you determine already?

A
  • no airway compromise (ability to speak clearly)
  • no breathing compromise (ability to generate air movement to speech)
  • no major decrease in level of consciousness (able to recall events)
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5
Q

mgmt for airway during primary survery?

A
  1. Suctioning/inspection for foreign bodies
  2. Facial, mandibular or tracheal laryngeal fractures
  3. Immobilize cervical spine
    - Assume cervical spine injury in pts
    with blunt trauma, altered LOC
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6
Q

breathing requires adequate function of what body parts?
how to determine if they have proper breathing?

A

lungs, chest wall, diaphragm

  1. Auscultate lungs to ensure gas flow
  2. Visual inspection/palpation of
  3. chest wall
  4. Inspect JVD, position of trachea
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7
Q

predominant cause of preventable deaths after injury

A

hemorrhage

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8
Q

how does altered LOC happen?

A

Decreased cerebral blood flow

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9
Q

Pts extremities are ashen grey pale, what does that mean?

A

hypovolemia

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10
Q

how to assess circulation? (4)

A
  1. LOC
  2. skin color
  3. pulse
  4. bleeding - ext vs int
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11
Q

pts pulse is rapid thready, what does that mean?

A

hypovolemia

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12
Q

mgmt for external hemorrhage?

A

Direct manual pressure
Tourniquets with caution

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13
Q

mgmt for internal hemorrhage

A
  • Chest, abdomen, retroperitoneum, pelvis, long bones
  • Once identified, splint application or immediate surgical intervention
  • Fluids/blood
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14
Q

When can you consider CNS origin for trauma?

A

After ABC ruled out →alcohol, hypoglycemia, narcotics ruled out

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15
Q

how to assess disability?

A

GCS

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16
Q

mgmt for resuscitation

A
  1. Airway
    - Jaw thrust chin tilt initially
    - If unconscious and no gag reflex: definitive airway - < 8, intubate
  2. Breathing - oxygen
  3. Circulation
    - Definitive bleed control & volume replacement: Fluids, blood products
    - Definitive: surgery, pelvic stabilization
    - 2 large bore IV
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17
Q

adjuncts/workup in primary survey

A
  1. EKG
  2. Urinary catheters
  3. Gastric catheters
  4. ABG
  5. Pulse Ox
  6. Blood pressure
  7. Xray
  8. FAST
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18
Q

Begins after primary survey, resuscitation began, and normalization of vital functions

A

Secondary survey
Do not move on until definitive treatment and normalization of vital functions

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19
Q

PE of secondary survey

A
  1. Head
    - Inspect ears and nose for cerebrospinal fluid leakage
    - Eyes: VA, pupillary size, conj hemorrhage, penetrating injury, contacts (remove before edema), dislocation of lens, ocular entrapment
    - Maxillofacial structures: palpate bony structures, intraoral exam, soft tissues, occlusion
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20
Q
  • Blood collects in the potential space between the skull and the dura mater
  • Convex, focal
  • Blunt trauma to the temporal or temporoparietal area with associated skull fracture and middle meningeal arterial disruption

what type of head trauma?

A

Epidural Hematoma

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21
Q

significant blunt head trauma with loss of consciousness or altered sensorium, followed by a lucid period and subsequent rapid neurologic demise

dx?
w/u? findings?
mgmt?

A
  • Epidural Hematoma
  • CT: biconvex (football-shaped) mass, MC temporal region
  • Maintain cerebral perfusion and oxygenation
  • Definitive Tx: Neurosurgery consult
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22
Q

highest risk for epidural hematoma?

A

Traumatic blows to temporal bone over the lateral aspect of the head

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23
Q

epidural hematoma
what SBP do you want to maintain for 50-69 y/o? 15-49? >70?

A

≥100 - 50-69 y/o
≥110 - 15-49 y/o or >70 years old

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24
Q
  • sudden acceleration-deceleration of brain parenchyma with subsequent tearing of the bridging dural veins.
  • formation between the dura mater and the arachnoid
  • Collect more slowly than epidural hematoma because of its venous origin.

dx?
who is more susceptible to develop this dx?

A
  • Subdural Hematoma
  • Brains with extensive atrophy (elderly, chronic alcoholics); < 2y/o
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25
classifications of subdural hematoma based on severity?
* Acute sx - within 14 days of injury. * >2 wks - chronic * No specific clinical syndrome associated with a subdural hematoma.
26
how may an acute case of subdural hematoma present?
immediately after severe trauma, and often the patient is unconscious
27
what pts may result in vague complaints or mental status changes with subdural hematoma?
In the elderly or in alcoholics
28
f/u (+findings) and mgmt for subdural hematoma?
* CT scan: hyperdense, crescent-shaped lesions that cross suture lines - Subacute subdural hematomas are isodense and are more difficult to identify. * **Neurosurgery Consult** * **surgical repair for acute/subacute**; Chronic can sometimes be managed w/o surgery depending on severity of sx 1. Acute - Craniotomy if: Symptomatic, Fixed/dilated pupils; Bleed >10mm, Midline shift >5mm; GCS ↓ ≥ 2 from onset of injury - If surgery: Antithrombotic management - No surgery: Observe & repeat CT at 6-8hrs 2. Chronic - Urgent surgery if: Worsening condition, Herniation, Bleed >10mm, Midline shift >5mm; Burr Holes
29
PE & mgmt for cervical spine and neck trauma?
* **C collar** * Inspection: Seat belt mark; C-spine tenderness; Subcutaneous emphysema; Tracheal deviation * Palpate and auscultate carotid arteries * **admit; Spine precautions, stabilize injuries, Monitor for rsp or neuro deterioration**
30
mgmt for neck penetration injuries (zones)? | C-spine & neck
* **zone II** - surgical exploration * **zone I & III** - further evaluation.
31
what structures are in zone 1 of the neck? (8)
clavicles to cricoid cartilage * proximal carotid vertebral arteries * major thoracic vessels * superior mediastinum * lungs * esophagus * tachea * thoracic duct * spinal cord
32
zone 2 structures of the neck (6)
cricoid cartilage to the angle of mandible * carotid and vertebral arteries * jugular veins * esophagus * trach * larynx * spinal cord
33
zone 3 structures of the neck (3)
angle of mandible and base of skull * distal carotid and verterbal art * pharynx * spinal cord
34
Patients with neck trauma are at increased risk for requiring a ?
* **surgical cricothyrotomy** d/t disruption of laryngotracheal anatomy * extensive airway injuries - surgical airway
35
soft signs of tissue zones of penetration (9)
- HoTN n field - Hx of arterial bleeding - Unexplained bradycardia - Non-expanding large hematoma - Apical capping on CXR - Stridor, hoarseness - Vocal cord paralysis - SubQ emphysema - Facial Nerve injury
35
what is the proximate cause of death in most penetrating neck injury victims.
Exsanguination: Massive bleeding from trauma kills more rapidly than an unstable airway.
36
hard signs of neck injury?
* **vascular**: unresponsive shock to fluids, active art bleeding, pulse deficit, pulsatile/expanding hematoma, thrill/bruit * **laryngotracheal**: stridor, hemoptysis, dysphonia, air/bubbling in wound, obstruction
37
dx and tx for spinal cord injuries?
1. DX: CT or Cervical MRI 1. TX: neurosurgery consult, stabilization
38
* Results from **damage to corticospinal and spinothalamic pathways**, with _preservation of posterior column function_ * **Loss of motor, pain and temperature sensation _distal to the lesion_** * **Presevered vibration, position, and tactile sensation** * direct injury to this area of spinal cord
anterior cord syndrome
39
* **decr strength and (less severe) decr pain and temp sensation, MC UE** > LE * **Vibration and position sensation preserved**
central cord syndrome Involves central portion of the cord more than peripheral→ centrally located fibers of the corticospinal and spinothalamic tracts are affected.
40
Neural tracts providing function to the upper extremities are most ____ in position compared with the thoracic, LE, and sacral fibers that have a more ____ distribution
medial lateral
41
* Hemisection of the cord * **ipsilateral loss of motor function, proprioception, and vibratory sensation, and contralateral loss of pain and temperature sensation** * Penetrating injury dx?
Brown sequard
42
s/s of cauda equina?
Direct injuries to this region produce peripheral nerve injuries. 1. Bowel and/or bladder dysfunction, 1. Decreased anal sphincter tone, 1. “saddle anesthesia” (sensory deficit over the perineum, buttocks, and inner thighs), 1. Variable motor and sensory loss in the lower extremities, 1. Decreased lower extremity reflexes, and sciatica 1. Bladder retention comes first→then leads to overflow incontinence 1. Anal sphincter tone can be spared
43
mgmt for neuro complaints?
* Reevaluate GCS * Immobilization of entire spine until spinal injury excluded
44
mgmt for chest dx?
* Inspection: open pneumothorax; flail chest * Palpation: clavicles, ribs and sternum * Auscultation: high on anterior chest (pneumothorax); low on posterior chest (hemothorax)
45
Blood in the pleural cavity dx? w/u? tx?
Hemothorax DX: FAST exam, CXR TX: thoracostomy
46
Air outside lung in pleural cavity dx? w/u? tx?
pneumothorax DX: auscultate, CXR, eFAST, CT TX: if small, asx (< 1.0 cm wide, confined to upper third of chest) → none If larger, thoracostomy
47
Pleural pressure transferred to mediastinum Tachypneic, Tachycardic, Tracheal deviation, No breath sounds dx? tx?
Tension Pneumothorax Tx: needle decompression 4th AICS in midclavicular line above rib with angiocatheter →then thoracostomy
48
PE and w/u for abdomen dx?
* Inspection: bruising, MOI * Palpate for tenderness, involuntary guarding * FAST exam, CT
49
s/s of solid organ injuries? w/u? tx?
1. Bruising, Distention, Tenderness, Hypotension - Any blunt abd trauma w/ diffuse peritonitis / hemodynamically unstable = urgent laparotomy 2. DX: FAST, CT Scan 3. TX: Laparotomy
50
In blunt abdominal trauma, incidence of blunt bowel and mesenteric injuries is infrequent sx: from the combination of blood loss and peritoneal contamination by GI contents Hemorrhage from a mesenteric injury may be minimal and not be obvious on physical exam dx?
Hollow viscus injuries
51
PE/mgmt for perineum/rectum/vaginal trauma?
* Inspection: hematomas, lacerations, urethral bleeding * Rectal exam before placing catheter: presence of blood, high riding prostate, pelvic fracture, quality of sphincter tone * Vaginal exam: women with pelvic fractures need vaginal examination
52
PE for MSK trauma
* Inspection: contusions/deformities * Palpation: abnormal movements/tenderness * Pelvis: Ecchymosis; Mobility; Only perform one pelvic manipulation (can cause _bleeding_) * Impaired sensation/loss of voluntary contraction strength * Lumbar/thoracic spine-point tenderness
53
Mobility of pelvis with anterior to posterior pressure with heels of hands on anterior iliac spines can suggest ?
pelvic ring disruption
54
dx and tx for extremity fx?
DX: XR TX: splint, surgery If open fx, ABX
55
dissolution of skeletal muscle →leakage of muscle cell contents, myoglobin, sarcoplasmic proteins (creatine kinase, lactate dehydrogenase, aldolase, alanine, and aspartate aminotransferase), and electrolytes into the extracellular fluid and the circulation dx? w/u? tx?
Rhabdomyolysis DX: CK TX: fluids Can cause acute renal failure
56
trauma or impaired movement of muscles for long periods of time
crush syndrome
57
Swelling or bleeding occurs in compartment→increased pressure→disrupts nerves, vasculature, oxygen delivery MC: calf; Also occur in forearm, hands, feet 5 P's dx? w/u? tx?
Compartment syndrome DX: clinical, compartment pressures TX: fasciotomy
58
Concerning hx features of peds abuse
1. no history of trauma 1. changing important details of the history 1. explanations inconsistent with the injury or with the developmental stage of the child 1. discrepancies in the history provided by different caregivers 1. significant delay in seeking care
59
difference between accidental vs nonaccidental bruises in peds?
* **Accidental**: front of the body, over bony prominences, on the extremities, and on the forehead * **Nonaccidental**: torso, neck, and ears and the soft parts of the body such as the cheeks and the buttocks; clusters, to be on the back of the body, and to be symmetrical; larger and more numerous than accidental bruises.
60
most inflicted burns are caused by ?
immersion in hot tap water
61
signs of abusive peds burns?
glove and stocking distribution with a sharp line of demarcation between the burned and uninjured skin.
62
burns to the perineum and feet with ring-shaped sparing of the buttocks where the skin was in contact with the cooler surface MOA of this burn?
held seated in a tub of hot water
63
T/F: rib fractures are common in infants/young children?
**false** * rare in infants and young children * In the absence of severe trauma, a child with rib fractures has a 7 in 10 chance of having been abused * **Posterior rib fractures MC with _physical abuse_**
64
which fx is highly specific for child abuse? w/u? tx?
* Classic metaphyseal fractures: shear injuries to the immature ends of growing bones in infants caused by the rapid acceleration and deceleration associated with yanking or shaking * Dx: XR, CT if head or abdomen involvement * TX: stabilize, CPS involvement Constant reevaluation Once stabilized-disposition patient Surgery, admission, home, transfer
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