Royal College: Emergency Medicine > Trauma > Flashcards

Trauma Flashcards

This deck covers Chapters 33-41 in Rosens, compromising all of trauma. (103 cards)

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1
Q

List 5 predictors of mortality in penetrating head injury.

A
  1. Low GCS
  2. Unreactive pupils
  3. Missile crossed midline
  4. Missile through ventricles
  5. Missile in posterior fossa
  6. High velocity weapon
  7. Self-inflicted
  8. Secondary injury
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2
Q

Outline management of high ICP in children.

A
  • HOB at 30 degrees
  • Head midline without tight C-collar
  • Hyperosmolar
  • Mannitol 1 g/kg
  • HTS 3 mL/kg
  • Hyperventilate (30-35 mmHg for acute change)
  • Intubation
  • Paralysis
  • Phenobarbital 10 mg/kg
  • Decompressive craniectomy
  • Avoid fever
  • Maintain euvolemia
  • Treat seizure
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3
Q

Outline the pathophysiology of compartment syndrome.

A
  • Tissue pressure increases above capillary pressure
  • Damage causes edema, further increasing pressure
  • Rarely does pressure exceed arterial pressure
  • Pulses present until late
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4
Q

List 5 injuries associated with seat-belt signs.

A
  1. Chance fracture
  2. Ruptured diaphragm
  3. Intestinal injury
  4. Mesenteric laceration
  5. Abdominal aortic dissection
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5
Q

What is your MAP target during spinal paralysis?

A

MAP >85 mmHg

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6
Q

List 5 complications of chest tube insertion.

A
  1. Infection
  2. Intercostal artery injury
  3. Hemothorax
  4. Pulmonary injury
  5. Bronchopleural fistula
  6. Intra-abdominal placement
  7. Failure to re-expand PTX
  8. Re-expansion pulmonary edema
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7
Q

List 6 hard signs of ARTERIAL injury.

A
  1. Bruit/Thrill
  2. Pulsatile bleeding
  3. Expanding hematoma
  4. Loss of distal pulses
  5. Cyanosis/temperature differences
  6. P’s of arterial insufficiency
  7. Pain on passive stretch
  8. Pulseless
  9. Paresthesias
  10. Pallor
  11. Paralysis
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8
Q

List 5 procedures you can do after a thoracotomy.

A
  1. Twist hilum
  2. Deliver the heart
  3. Repair heart laceration
  4. Clamp aorta
  5. Open cardiac massage
  6. Internal defibrillation
  7. Intracardiac epinephrine
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9
Q

What 2 things are necessary to rule out blunt cardiac injury?

What do you do if one is abnormal?

A
  1. Negative troponin
  2. Normal ECG

If either AbN, need 24h monitoring ;

If hypotensive, increasing trop, or AbN ECG, get echo

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10
Q

Name 6 indications for laparotomy after PENETRATING trauma.

A
  1. Evisceration
  2. Peritonitis
  3. Diaphragm injury
  4. Massive GIB
  5. Knife insitu
  6. Free air on imaging
  7. Hypotension
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11
Q

Outline the CT Head rule.

A

Avoid Driving if you Get Super Smashed And Vomit

Medium Risk (for injury)

  • Amnesia >30m before impact
  • Dangerous mechanism (peds struck, ejected, fall >3ft)

High Risk (for NSx intervention)

  • GCS <15 at 2h
  • Suspected open/depressed skull fracture
  • Signs of basilar fracture
  • Age >65
  • Vomiting >=2 times
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12
Q

What is the shock index? What number predicts MTP?

A

SI = HR/BP

  • SI >1.0 predicts MTP
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13
Q

Describe the Ellis classification system.

A

Ellis I

  • Enamel chipped

Ellis II

  • Dentin exposed
  • Pain
  • Cover with calcium hydroxide paste

Ellis III

  • Pulp exposed
  • Need ABx for pulpitis (Amox/Clinda)
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14
Q

List 6 advantages and 4 disadvantages of CT for abdominal trauma patients.

A

Advantages

  1. Non-invasive
  2. Sensitive for solid organ injury
  3. Sensitive for active bleeding
  4. Sensitive for GU tract injuries
  5. Evaluates retroperitoneum and spine
  6. Easily extends to include thorax/pelvis

Disadvantages

  1. Radiation exposure
  2. Contrast exposure
  3. Expensive
  4. Insensitive for pancreas/diaphragm/bowel/mesentery
  5. Leaving the ED to get scan
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15
Q

Define and differentiate the following:

  • Caput succedaneum
  • Subgaleal hematoma
  • Cephalohematoma
A
  • Caput succedaneum
  • Hematoma in connective tissue layer
  • Moves across suture lines
  • Subgaleal hematoma
  • Hematoma in loose areolar tissue
  • Cephalohematoma
  • Hematoma under periosteum
  • Does NOT cross suture lines
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16
Q

List 5 C-spine injuries sustained via a FLEXION mechanism.

A

AA-FOB

  1. Atlanto-axial dislocation
  2. Atlanto-occipital dislocation
  3. Flexion teardrop
  4. Odontoid fractures
  5. Bilateral facet fracture/dislocation
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17
Q

List 7 ANATOMIC differences between adults and children relevant to trauma.

A
  1. Relatively larger head = more head injury
  2. Thinner skull = more head injury
  3. Anterior placement of liver/spleen = more injury
  4. Less muscle/fat to protect truncal organs
  5. Tachycardia w/ normal BP may represent shock in kids
  6. Kidneys less protected by ribs in kids
  7. Chest wall more elastic = lung injury without rib injury
  8. Salter-Harris ortho fracture patterns
  9. Tenuous spinal cord blood supply = more SCIWORA
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18
Q

List 6 clinical findings consistent with basilar skull fracture.

A
  1. Raccoon eyes
  2. Battle Sign
  3. Rhinorrhea
  4. Otorrhea
  5. Hemotympanum (behind TM)
  6. Blood in ear canal
  7. CN7 palsy
  8. CN8 palsy
  9. Tinnitus
  10. Nystagmus
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19
Q

List and describe 5 herniation syndromes.

A
  1. Uncal Herniation
    * Medial temporal lobe through the tentorium
    * Ipsilateral blown pupil, contralateral hemiparesis
  2. Central Transtentorial
    * Supratentorial herniation down
    * Coma, Pinpoint pupils, Bilateral paralysis, Rigid
  3. Subfalcine (MCC)
    * Cingulate gyrus under falx cerebri
    * H/A, contralateral leg weakness
  4. Transcalvarial
    * Out of head
  5. Upward Transtentorial
    * Cerebellum up
    * N/V, Coma, Pinpoint pupils, downward gaze
  6. Cerebellotonsillar
    * Cerebellar tonsils through foramen magnum
    * Coma, Pinpoint pupils, Bilateral paralysis, Apnea
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20
Q

What is your CPP target in severe head injury?

A

60 mmHg

<50 increases mortality

>70 increases ARDS

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21
Q

List 4 indications for prolonged (24h) tocography following minor/moderate trauma.

A
  1. 3+ contractions per hour
  2. Uterine tenderness after 4h
  3. Vaginal bleeding
  4. Membrane rupture
  5. Abnormal 4h monitoring
  6. Serious maternal injury
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22
Q

List 7 ANATOMIC differences between adults and children relevant to AIRWAY management.

A
  1. Larger head
  2. Larger tongue
  3. Larger tonsils
  4. Dynamic airway collapse with respiration
  5. Anterior larynx
  6. Larger/floppy epiglottis
  7. Narrowest at cricoid
  8. Shorter trachea
  9. Smaller airways
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23
Q

What are the anatomic borders of the ‘cardiac box’?

A
  • Clavicles
  • Nipples
  • Costal Margin
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24
Q

List 5 stable C-spine fractures.

A
  1. Wedge fracture
  2. Clay Shoveler’s fracture
  3. Transverse process fracture
  4. Unilateral facet dislocation
  5. Burst fracture
  6. Isolated fracture of articular pillar/body
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25
List 5 management steps to deal with **esophageal injury**.
1. Monitored setting 2. NPO 3. NG under endoscopy 4. IV ABx 5. GenSx/Thoracics consult
26
What are the 4 ACS guidelines regarding the presence of a surgeon in **trauma resuscitation**?
Trauma surgeon should be present **within 15 minutes** if: 1. sBP \<90 2. Intubated 3. GSW to neck, chest, abdo/pelvis 4. GCS \<8
27
How do you estimate the size of the following in **pediatric trauma**? * ETT size * ETT depth * Chest tube * NG/OG tube * Foley * Femoral line
* ETT size = 3.5 + (Age/4) * ETT depth = 12 + (Age/2) * Chest tube = ETT size x4 * NG/OG tube = ETT size x2 * Foley = ETT size x2 * Femoral line * 3 kg = 3F * 3-10 kg = 4F * 10-20 kg = 5F * \>20 kg = 6F
28
Outline the **kidney injury classification system**.
1. Simple contusions/hematomas 2. Parenchymal injury \<1cm depth 3. Parenchymal injury \>1cm depth 4. Lac through cortex/medulla/collecting system or contained vasc injury 5. Shattered - shatter kidney or avulsed hilum
29
What are our BP targets in severe TBI as per the **Brain Trauma Foundation**?
sBP \>100 mmHg if age 50-69 sBP \>110 mmHg otherwise
30
How do you determine if there is pseudosubluxation of C2 on C3 in **pediatric C-spine injury**?
**Line of Swischuk** * Line from ant. cortical margin of C1 spinous process to C3 * Distance of ant. cortical margin of C2 from line: * \<2 mm = normal * \>2 mm = subluxation
31
Name 3 types of **cerebral edema** and their mechanism.
1. **Cerebral** * Too much water/sodium imbalance 2. **Vasogenic** * BBB failure 3. **Cytotoxic** * Cellular pump failure
32
What are the 5 **Nexus Criteria** to identify low-risk C-spine injury?
**F-MAID** 1. No **F**ocal deficits 2. No **M**idline pain 3. **A**lert 4. No **I**ntoxication 5. No **D**istracting injury
33
What are 8 indications for seizure prophylaxis in **severe TBI**?
1. Depressed skull fracture 2. Paralyzed patient 3. Seizure at time of injury 4. Seizure in ED 5. Penetrating trauma 6. GCS 8 7. SDH 8. EDH 9. ICH 10. Prior seizure disorder
34
List 3 inclusion and 8 exclusion criteria for the **CT Head rules**.
**Inclusion** 1. Minor HI (Disoriented, Amnestic, LoC) 2. GCS \>=13 3. Trauma within 24h **Exclusion** 1. Minimal head injury 2. Age \<16 3. GCS \<13 4. Non-trauma 5. Penetrating trauma 6. Neuro deficit 7. Polytrauma 8. Pregnant 9. Seizure 10. Intoxication 11. On OAC
35
List 4 indications for **OR thoracotomy** based on hemothorax output/clinical scenario.
1. Initial drainage \>20 cc/kg (~1.5L) 2. Persistent bleeding \>7 cc/kg/hr (~500 cc/hr) 3. Increasing hemothorax on CXR 4. Hypotension despite blood and no other bleeding 5. Patient decompensates after resuscitation
36
Name the 5 layers of the **scalp**.
**SCALP** * **S**kin * **C**onnective tissue * **A**poneurosis * **L**oose connective tissue * **P**eriosteum
37
List 8 PHYSIOLOGIC changes of **normal aging**.
* **CNS** * Decreased vision/hearing * Decreased proprioception/balance * Cognitive impairment and dementia * Brain atrophy = bridging vein tears with trauma * **Cardiac** * Decreased contractility * Decreased sympathetic response * Often medications suppress cardiac physiology * **Respiratory** * Decreased FEV1 and Vital Capacity * Decreased compliance * Respiratory muscle weakness * Brittle chest wall * **GI** * Pain perception altered = abdo exam unreliable * **MSK** * Joint disease * Osteoporosis * Weak muscles * **Derm** * Frail, brittle skin tears easily
38
What are the **anatomic borders** of the anterior and posterior triangle of the neck?
**Anterior** * SCM * Mandible * Midline **Posterior** * SCM * Clavicle * Trap
39
What is the "**Injury Triangle**"?
* Host (Patient) * Agent (Energy) * Vector (Environment) This is also part of the Haddon Matrix: * Pre-event * Event * Post-event
40
Outline a clinical pathway for **REBOA use**. (How/When do you think about using it and where)
**Indictation** * sBP \<90 * Partial/non-responder to blood **Contraindication** * CXR shows possible aortic dissection **Procedure** * Access femoral vessels * FAST + --\> Zone I REBOA * FAST - and no pelvic # --\> Zone 1 REBOA * FAST - and Pelvic # --\> Zone 3 REBOA
41
Give three uses for **REBOA**.
1. Isolated pelvic hemorrhage (Zone III) 2. Junctional vascular injury (Zone III) 3. Intra-abdominal hemorrhage (Zone I)
42
Differentiate the adult and pediatric **GCS scales**.
**Motor** * Same **Eyes** * Same **Voice** * \<2yr = none/grunts/irritable/consolable/coos * 2-5yr = none/grunts/irritable/inapprop./approp. * \>5yr = same as adult
43
Describe the classification of **odontoid fractures**.
**Type 1** * Tip, above transverse ligaments * Stable **Type 2** * Tip, below transverse ligaments * Unstable **Type 3** * Extension into body of C2 * Unstable
44
Differentiate **spinal and neurogenic shock**.
**Spinal Shock** * Concussive dysfunction of the spinal cord * Flaccid paralysis * Absent bulbocavernosus reflex (recovered when back) **Neurogenic Shock** * Functional sympathectomy * Hypotension * Bradycardia * Above T6 to cause hemodynamic changes
45
List 5 risk factors for **blunt cerebrovascular injury**.
1. LeFort II/III injury 2. Basilar skull fracture 3. C1-C3 fracture 4. GCS \<6 5. Near hanging with anoxia 6. Clothesline injury
46
What is the **ABC score** and what is it used for?
2+ Predicts massive transfusion * HR \>120 bpm * BP \<90 mmHg * + FAST * Penetrating mechanism
47
Outline the **PECARN rule**.
* **Kid is \<2 years old** * CT if: * Altered * GCS \<15 * Palpable skull fracture * Observe if: * Non-frontal scalp hematoma * LOC \>5s * Severe mechanism * AbN behaviour as per parents * Otherwise no CT * **Kid is \>2 years old** * CT if: * Altered * GCS \<15 * Basilar skull fracture * Observe if: * LOC * Vomiting * Severe mechanism * Severe headache * Otherwise no CT
48
List 5 hard and 5 soft signs of **penetrating NECK trauma**.
**Hard - (CASBAH-D)** 1. **C**erebral ischemia 2. **A**irway obstruction 3. **S**hock 4. **B**ruit/thrill 5. **A**ctive Severe Bleeding 6. **H**ematoma expanding 7. **D**ecreased/absent radial pulse **Soft (ODD CNS FH)** 1. **O**ropharyngeal blood 2. **D**yspnea 3. **D**ysphonia/Dysphagia 4. **C**hest tube air leak 5. **N**on-expanding hematoma 6. **S**ubQ air 7. **F**ocal neurologic deficits 8. **H**ematemesis/Hemoptysis
49
List 4 risk factors for **re-expansion pulmonary edema**.
1. Younger 2. Duration of PTX (\>3d) 3. Removal of \>1.5L 4. Suction 5. Bronchial obstruction
50
How long do you fetal monitor a pregnant woman for after **mild/moderate trauma**?
4 hours, unless abnormal All viable pregnancies (24+ weeks)
51
List 6 of the common causes of **esophageal perforation**.
1. Iatrogenic 2. Foreign body 3. Caustic injury 4. Trauma 5. Vomiting (Boerhaave's) 6. Post-op anastomotic failure
52
Outline the anatomy and deficits in the following **cord syndromes**: * Central cord syndrome * Brown-Sequard syndrome * Anterior cord syndrome
**Central Cord Syndrome** * Mechanism: hyperextension, lig. flavum buckles in * Motor: motor \> sensory * Sensory: distal \> proximal, arm \> leg **Brown-Sequard syndrome** * Mechanism: hemisection, usually penetrating trauma * Motor: ipsilateral hemiparesis * Sensory: ipsilateral proprio, contralateral pain/temp **Anterior Cord Syndrome** * Mechanism: AAA, EVAR, Hyperflexion * Motor: bilateral paralysis * Sensory: intact proprio/touch, bilateral pain/temp loss
53
List 6 advantages and 4 disadvantages of ultrasound in **abdominal trauma**.
**Advantages** 1. Bedside 2. Non-invasive 3. Quick 4. Cheap 5. Serial exams 6. Sensitive for blood 7. Also can assess PTX 8. No radiation exposure **Disadvantages** * Operator dependent * Insensitive for solid organ injury/bowel/diaphragm * Difficult in agitated/obese patients * False-negative rate with pelvic fractures
54
List 3 primary and 5 secondary indications for **lateral canthotomy** in the ED.
**DIP A CONE** **Primary** 1. **D**ecreased VA 2. **I**OP \>40 3. **P**roptosis **Secondary** 1. **A**fferent pupillary defect (RAPD) 2. **C**herry red macula 3. **O**phthalmoplegia 4. **N**erve pallor 5. **E**ye pain
55
Name 3 changes to lung mechanics in pregnancy relevant to **intubation**.
1. Decreased FRC * Small reserve = quickly desat 2. Increased O2 demand 3. Increased minute ventilation * Respiratory alkalosis LES more relaxed due to progesterone, so higher risk of aspiration with intubation
56
What are two ways to diagnose a **bladder rupture**?
1. Retrograde cystography * KUB, Foley, Contrast in, KUB 2. Retrograde CT cystography
57
List 5 risk factors for **falls in the elderly**.
1. Mobility impairment 2. Balance impairment 3. Cognitive impairment 4. Visual impairment 5. Functional impairment 6. Postural hypotension 7. Polypharmacy 8. Weakness
58
Describe the **LeFort classification system**.
**LeFort I** * Across the maxilla horizontally, above teeth **LeFort II** * Pyramidal from nasal bridge to bilateral maxilla **LeFort III** * Across nasal bridge, through orbit, and out at B/L zygoma
59
What are the clinical features of **laryngotracheal injury**?
* Bubbling from wound * Massive subq air * Crepitus over larynx * Dysphonia * Dyspnea * Stridor * Hemoptysis
60
What is **Kernohan's Notch Syndrome**?
False localization during uncal herniation where uncus causes contralateral midbrain compression and IPSILATERAL hemiparesis
61
Which of PECARN, CATCH, and CHALICE is the **best**?
* **PECARN (Best)** * Sens = 100% * Spec = 62% * **CATCH** * Sens = 91% * Spec = 44% * **CHALICE** * Sens = 84% * Spec = 85% * \*CATCH2 is new and equivalent to PECARN * Added recurrent vomiting (4+ times)
62
List 5 exclusion criteria in the **Canadian C-spine rule**.
1. Non-traumatic 2. GCS \<15 3. Unstable 4. Age \<16 5. Paralysis 6. Known vertebral disease 7. Previous C-spine surgery
63
What is the **volume** of the below fluids given in pediatric trauma? * Crystalloid * Blood * FFP * Platelets * Cryoprecipitate
* Crystalloid = 20 cc/kg * Blood = 10 cc/kg * FFP = 15 cc/kg * Platelets = 10 cc/kg * Cyroprecipitate = 0.2 bag/kg
64
List 5 reasons why you would involve ophthalmology in an **eyelid repair**.
1. Through tarsal plate 2. Through septum 3. Involves lacrimal system 4. Involves canthal tendons 5. Involves lid margin 6. Soft tissue loss
65
List 5 signs or symptoms of **BCVI**.
1. Arterial hemorrhage from neck/nose/mouth 2. Cervical bruit w/ age \<50 3. Expanding cervical hematoma 4. Focal neuro deficit 5. Neuro exam incongruent with CT Head 6. Stroke on CT Head
66
Name 6 unstable **C-spine fractures**.
**Jefferson** **B**it **O**ff **A** **Hangman's** **T**humb 1. **Jefferson** fracture (C1 burst) 2. **B**ilateral facet dislocation 3. **O**dontoid fracture (Type 2 or 3) 4. **A**ny fracture/dislocation combo 5. **Hangman's** fracture (C2 arch) 6. **T**eardrop (Anterior flexion)
67
Describe the **anatomic zones** of the neck. List 3 unique structures in each.
**Zone 1** * Sternal notch to the cricoid cartilage **Zone 2** * Cricoid cartilage to angle of mandible **Zone 3** * Angle of mandible to occiput
68
How do you calculate and interpret an **ABI**?
**Ankle-Brachial Index** * Take BP in ankle / arm * \>1.3 = non-compressible arteries (calcium, DM, ESRD) * 1 = normal * \<0.9 = abnormal * \<0.6 = intermittent claudication * \<0.3 = resting ischemic pain * \<0.2 = gangrene
69
What are 5 signs/symptoms of **increased ICP** in INFANTS?
1. Irritable 2. Persistent emesis 3. Altered LOC 4. Split sutures 5. Bulging fontanelle 6. "Setting Sun" - bilateral downward gaze, can't look up
70
List 8 indications for **tube thoracostomy**.
1. Pneumothorax - traumatic 2. Pneumothorax - moderate/large 3. Pneumothorax - symptomatic 4. Pneumothorax - tension 5. Pneumothorax - bilateral 6. Pneumothorax - increasing w/ conservative tx 7. Pneumothorax - recurs after CT removal 8. Hemothorax 9. Chylothorax 10. Empyema 11. Post-cardiac surgery 12. Traumatic cardiac arrest 13. Patient requires GA 14. Patient requires intubation
71
What is the best way to diagnose a **suspected esophageal injury** in neck trauma?
Contrast esophagography (gastrograffin) AND Flexible endoscopy
72
What is the test of choice for **urethral injury** in the setting of pelvic trauma? How do you perform this?
**Retrograde Urethrogram** 1. KUB x-ray 2. Slowly instill 60 cc contrast over 60 seconds 3. KUB x-ray during last 10 seconds Partial disruption = extravasate but bladder fills Complete disruption = extravasate but bladder empty
73
Outline the '**Graduated Return to Play**' protocol.
1. No activity 2. Light exercise 3. Sport-specific exercise 4. Non-contact drills 5. Full-contact practice 6. Return to play
74
What must you rule out in a kid with a significant **flexion/extension neck injury**? How do you do that?
**Atlantooccipital Dislocation** * Power's Ratio * Basion to anterior side of posterior arch C1 * Opisthion to posterior side of anterior arch C1 * \>1 = your head fell off...inside
75
Describe 5 **hemodynamic changes** in pregnancy relevant to trauma.
1. HR increases 2. BP decreases in 1st/2nd trimester 3. CO increases in 2nd trimester onward 4. CVP decreases throughout pregnancy 5. Blood volume increases (more plasma than HCT)
76
List 4 **alterations in physiology** during pregnancy that may worsen bleeding.
1. Increased CO 2. Increased blood flow to vulnerable uterus 3. Venous congestion in pelvis 4. Increased peripheral venous pressure in legs
77
Outline where you'd exam the body for the following levels of the sensory **ASIA exam**: * C5 * C6 * C7 * C8 * T1 * T4 * T10 * L2 * L3 * L4 * L5 * S1
* C5 - sergeants patch * C6 - D1 * C7 - D3 * C8 - D5 * T1 - inner upper arm * T4 - nipples * T10 - umbilicus * L2 - inguinal canal * L3 - medial knee * L4 - medial malleolus * L5 - lateral malleolus * S1 - lateral heel
78
Define a **flail chest**. How does it alter respiratory mechanics? List 4 management techniques.
**Flail Chest** * 3+ ribs fractured at 2+ spots each **Mechanics** * Inspiration causes flail segment to sink in **Management** 1. PPV 2. Pain management 3. Physiotherapy 4. Surgical fixation of ribs
79
List 7 methods of **lower ICP**.
1. HOB at 30 degrees 2. Remove C-spine collar 3. Hyperosmolar therapy 4. Hyperventilate 5. Intubate, Paralyze 6. Barbiturate coma 7. EVD 8. Decompressive craniectomy
80
List 8 ANATOMIC **differences** between the adult and child C-spine.
1. Fulcrum at C2/3 in toddlers and C5/6 in age 8-12 2. Larger head = more flex/ext injuries 3. Large occiput = flexed neck when supine 4. Ligamentous injuries more common 5. Flatter, more horizontal facet joints 6. Incomplete ossification 7. Growth plates can mimic fractures 8. Pre-odontoid space larger in kids * \<8yo = 5mm, \>8yo = \<3mm 9. Pseudosubluxation of C2 on C3 in kids age 8-12 10. Prevertebral space varies with respiration
81
List 10 findings on CXR for **aortic dissection**.
1. Wide mediastinum (\>6cm on PA, \>8cm on AP) 2. Obscured aortic knob 3. Loss of AP window 4. Left pleural effusion 5. Left pleural cap 6. Calcium sign 7. Wide paratracheal stripe 8. Displaced NG to right 9. Displaced trachea to right 10. Depressed left mainstem bronchus
82
Describe the **Canadian C-Spine rule**.
**High Risk (PAD) - if yes, then image** * **P**aresthesia * **A**ge \>65 * **D**angerous Mechanism * Axial load, fall \>3ft, High-speed MVC, Motorcycle **Low Risk (SANDS) - if any no, image** * Sitting * Ambulatory * No midline pain * Delayed onset * Simple rear-end MVC
83
List 6 soft signs of **ARTERIAL injury**.
1. Weak pulse 2. Delayed cap refill 3. Peripheral nerve injury 4. Severe hemorrhage in field 5. Hypotension 6. Non-pulsatile hematoma
84
List **physiologic and pathologic factors** that promote cerebral vasoconstriction vs vasodilation.
**Vasoconstriction** * Hypocarbia * Hypertension * Alkalosis **Vasodilation** * Hypoxia * Hypercarbia * Hypotension * Acidosis
85
List 8 indications for **intubation** with flail chest.
1. GCS \<8 2. Respiratory fatigue 3. RR \>35 or \<8 4. PaO2 \<60 at 50% oxygen 5. PaCO2 \>55 at 50% oxygen 6. A-a gradient \>450 7. Shock 8. Other injuries requiring surgery
86
What does **REBOA** stand for? Define each zone.
**Resuscitative Endovascular Balloon Occlusion of the Aorta** **Zone 1** * Left subclavian to celiac trunk **Zone 2** * Celiac trunk to infrarenal **Zone 3** * Infrarenal to bifurcation
87
List 4 options for diagnosing **popliteal artery injury** following knee dislocation
1. ABI + PE (NPV 100% if normal) 2. U/S 3. CT 4. Angiography 5. OR
88
Name 5 indications for **laparotomy** after BLUNT trauma.
1. Hypotension 2. Peritonitis 3. Free air 4. Diaphragmatic injury 5. Massive GIB Same as penetrating, except no knife insitu or evisceration
89
List 4 clinical features of **orbital blowout fracture**.
1. Enopthalmos 2. Diplopia * Entrapment of inferior rectus 3. V2 paresthesia 4. Step-off deformity
90
What is "**Waddle's Triad**"?
Injury pattern from pedestrian vs. car: 1. **Fracture of tib/fib or femur** * From bumper of car 2. **Truncal injury** * After landing on hood/ground 3. **Craniofacial injury** * After thrown off car, onto ground
91
What are the 4 steps involved in the **field triage trauma scheme**?
1. **Vitals + GCS** * GCS \<14, sBP \<90, RR \<10 or \>29 2. **Anatomy** * Penetrating, Paralyzed, Severe limb, Flail chest 3. **Mechanism** * Fall \>2 stories, Motorcycle, High-speed MVC 4. **Special circumstance** * Pediatric, Geriatric, other
92
List 3 **C-spine injuries** sustained via an EXTENSION mechanism.
**HEP** 1. **H**angman's 2. **E**xtension Teardrop 3. **P**osterior arch of C1
93
List 5 **contraindications** for REBOA use.
1. Age \>70 2. PEA \>10 minutes 3. Significant comorbidities 4. Aortic dissection 5. Cardiac arrest from causes other than hemorrhage 6. Femoral vessels unidentifiable by U/S
94
How do you reduce a **TMJ dislocation**?
1. Thumbs in buccal grooves bilaterally 2. Push down 3. Push back
95
Regarding kidney trauma, what were the findings of the **Mee et al. study**?
**Landmark Trial (1989)** * Renal lacerations are repairable * CT was the test of choice * Decreased use of retrograde urinary studies Clinically significant blunt renal injuries have: * Gross hematuria * Microscopic hematuria and shock * Mechanism was sudden deceleration
96
What are the mandatory reporting guidelines relevant to **trauma**?
* GSWs * Driving impairment * Child abuse * Elder abuse in LTC
97
What 7 signs/symptoms of **increased ICP** in CHILDREN?
1. Headache 2. Stiff neck 3. Photophobia 4. Altered LOC 5. Persistent vomiting 6. CN palsy 7. Papilledema 8. Cushings (HTN, Bradycardia, Hypoventilation) 9. Posturing
98
List 4 requirements to perform **local wound exploration** following penetrating trauma.
1. Stable 2. No peritonitis 3. No evisceration 4. Anterior abdomen
99
Outline the **motor component** of the ASIA exam.
* C5 - elbow flexors * C6 - wrist extensors * C7 - elbow extensors * C8 - finger flexors * T1 - finger abduction/adduction * L2 - hip flexors * L3 - knee extensors * L4 - ankle dorsiflexion * L5 - great toe extensors * S1 - ankle plantar flexors
100
What recent study looked at **blood transfusion** in trauma? Summarize it.
**PROPRR** * Multicenter RCT * Non-inferiority of 1:1:2 vs 1:1:1 in severe trauma patients * Outcome = mortality at 1 day and 1 month * Conclusion = no difference
101
List 8 DDx for **esophageal perforation**.
1. Spontaneous pneumomediastinum 2. Thoracic aortic aneurysm 3. ACS 4. PE 5. Pneumonia 6. PUD 7. Pancreatitis 8. Cholecystitis 9. Mesenteric thrombus
102
List 4 causes of false-positive and 4 causes of false-negative in **FAST**.
**False Positive** 1. Ascites 2. Renal fat 3. Pericardial fat 4. Pleural effusion 5. User inexperience **False Negative** 1. Early bleed 2. Retroperitoneal bleed 3. Pelvic fracture 4. Prior surgeries causing loculation 5. User inexperience
103
What are the indications for **ED thoracotomy**?
**Rosen's** * Penetrating * Arrest at any point with signs of life in field * sBP \<50 despite resuscitation * Shock + Tamponade * Blunt * Arrest in the ED * Air embolism **West** * Penetrating * \<15 min CPR * Blunt * \<10 min CPR * Profound refractory shock **East** * Penetrating * Pulseless with signs of life in thorax injury (strong) * Pulseless without signs of life in thorax injury (cond) * Blunt * Pulseless with signs of life in thorax injury (cond)
Royal College: Emergency Medicine
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