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Trauma 1
Surgery 2
| Question | Answer |
|---|---|
| Trauma PE: Head | Scalp lacerations, contusions. Skull fractures; rhinorrhea, otorrhea (CSF), hemotympanum, halo sx on bandage; visual acuity; pupil equality and reactivity. Facial fractures |
| Trauma PE: Neck | tracheal deviation; spinal tenderness or stepoffs (MAINTAIN MIDLINE IMMOBILIZATION DURING EXAM) |
| Trauma PE: Chest | clear and equal breath sounds, symmetric chest rise; rib and sternal fractures; clear heart sounds |
| Trauma PE: Abdomen | bowel sounds, distension, tenderness, contusions (e.g., seat-belts) |
| Trauma PE: Pelvis | instability on rocking; rectal exam (on everyone) for blood, sphincter tone, high-riding prostate; blood at urethral meatus |
| Trauma PE: Back | spinal tenderness or stepoffs; ecchymoses, lacerations (LOGROLL) |
| Trauma PE: Extremities | deformities, joint mobility, pulses, lacerations, contusions |
| Trauma PE: Neurologic | Glasgow Coma Scale (GCS); motor/sensory deficits |
| 3 reasons to intubate a trauma pt | Impaired level of consciousness, a mechanically compromised airway, or ventilatory problems |
| True/False: Dx tension PTX can be made by chest X-ray. | False |
| Tension PTX: Sx: | tracheal deviation (away from side of PTX), increased JVD, decreased breath sounds, tympany to percussion, hypotension. |
| Tension PTX: Rx: | needle decompression followed by chest tube insertion |
| Beck’s Triad (reflecting cardiac tamponade) | Muffled HS, increased JVD, hypotension |
| GCS ≥13 = | mild brain injury |
| GCS of 9-12 = | moderate injury |
| GCS ≤8 = | severe injury |
| How can you evaluate the stable trauma patient with abdominal pain? | Observation w/ serial exam is an option only for stable pts w/ a reliable PE (no drugs or head injury) |
| Abdominal CT is used for: | stable pts w/ equivocal exams or with high-risk mechanisms. |
| Advantage of abdominal CT over DPL is: | ability to evaluate the retroperitoneum (aorta, IVC, pancreas, kidneys, and portions of duodenum and colon). |
| Ultrasound in trauma pt eval: | non-invasive but can be performed anywhere; can detect free intraperitoneal fluid as well as many solid organ injuries |
| Diagnostic Peritoneal Lavage (DPL) is for: | unexplained hypotension or for equivocal exam in a multiply injured pt. DPL can be performed anywhere & in less than 5 min |
| A positive DPL = | aspiration of gross blood or >100,000 rbc/ml on lab exam of lavage fluid. DPL is 98% sensitive for intraperitoneal bleeding. |
| Immediate exploratory laparotomy is indicated for: | most penetrating trauma or for the unstable patient with obvious evidence of abdominal injury on physical exam. |
| Unstable pts with pelvic fractures should undergo: | emergent external fixation |
| Closed head injury: CPP = | Cerebral perfusion pressure = MAP-ICP |
| Closed head injury: Rx: | Intubate, ICP monitoring, keep CPP >70 to prevent secondary injury; No steroids, Ventilate to keep CO2 30-35 |
| 3 types of shock most commonly seen in surgery: | Obstructive (cardiogenic), Hypovolemic, Distributive (neurogenic; septic; anaphylactic) |
| Hypovolemic Shock: <20% | Decreased pulse pressure; Ortho hypotension; Flat neck veins; increased Hct |
| Hypovolemic Shock: 20-40% | Thirst; Tachycardia; Oliguria; Mod hypotension |
| Hypovolemic Shock: >40% | MS changes; Severe hypotension; EKG-ischemic arrhythmias |
| Most significant cause of morbidity in pts w/ traumatic brain injuries: | DAI (diffuse axonal injury) |
| Closed head injury = | Intracranial hemorrhage |
| Closed head injury: Epidural | arterial bleed assoc w/ skull fx requiring immediate surg intervention; assoc w/ lucid interval following LOC |
| Closed head injury: Subdural | venous bleed btw cortex & dura requiring surg evacuation depending on severity |
| Closed head injury: Intracerebral | hemorrhage within the parenchyma, often associated with other injuries |
| Closed head injury: Subarachnoid | frequently missed on CT and rarely requiring immediate treatment |
| Hemothorax: Tx | if drains >1500cc blood, insert chest tube; if >200cc/hr: to OR for thoracotomy to r/o great vessel injury |
| Cardiac tamponade: Tx | OR or ED Thoracotomy (classic answer: pericardiocentesis) [ED thoracotomy: Subxyphoid, substernal notch, 45 degree angle, shoulder] |
| Intra-abdominal Injuries: must R/O: | hemoperitoneum |
| which GCS indicates the need for intubation | <8 |
Created by:
Abarnard
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