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48 Cards in this Set

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Criteria for trauma 1
head: penetrating wound
GCS <8
heart: hypotensive <90, HR > 120
lung: resp distress, unstable airway
torso: penetrating wound, pelvis fracture
Criteria for trauma 2
auto: high speed, rollover, ejection, death in same compartment, extraction > 20 minutes
motorcycle: > 20 mph, ejection
pedestrian struck: > 5 mph
fall: > 20 feet

GCS 9-13
open fracture
multiple closed fracture
traumatic amputation
penetrating injury proximal to knee or elbow w/ neurovascular compromise
major burn >40% TBSA
any electrical burn
ABCs: always remember what with airway?
cervical spine protection
what conditions dx in B step of ABCs?
tension PTX
open PTX
flail chest
tamponade
hemothrorax
If radial pulse, systolic is at least ?

If femoral or carotid, pulse is at least ?
80

60
What patients may not mount a tachycardic response to shock?
spinal cord injury
beta blockade

elderly
children

athletes
How do you control external bleeding in trauma?
direct pressure, not tourniquet
T/F Class I hemorrhage can be treated with PO rather than IV fluids.
true (depends on clinical judgment)
What is checked in D step of ABCs?
pupils
GCS
mental status
What can cause decreased level of consciousness besides trauma and drugs?
hypoglycemia
Cs of GCS
6- obeys commands
5 - LOCALIZES pain
4- WITHDRAWS from pain
3 - decorticate flexion
2 - decerebrate extension
1 - no movement
S of GCS
5 - oriented speech
4 - fluent but confused speech
3 - word salad
2 - sounds only
1 - none
Sensitivity of lateral cervical spine Xray
75%
Most important blood test in a trauma patient?
type and cross
Most common cause of death in trauma bay / ER?
undiagnosed hemorrhage
Signs of basilar fracture
raccoon eyes
Battle sign
Signs of temporal bone fracture
CSF otorrhea
hemotympanum
Which brain hematoma has a lucid interveral?
epidural
What is the treatment for epidural or subdural hematoma?
surgical evacuation of clot
What is Cushing's response?
sign of increased intracranial pressure
--increased blood pressure with BRADYCARDIA
--irregular respiration
What is the treatment for increased ICP?
elevate head of bed
mannitol
sedation / paralysis / phenobarb coma
neurosurgical consultation immediately
blown pupil indicates ?
uncal herniation
? percent of spinal injuries are cervical?
55%
full series of neck films include what views?

What must you make sure to see on neck film?
lateral, AP, odontoid, oblique

must see C7-T1
What is a Jefferson fracture?
C1 compression fracture
5 criteria for clearing C spin
NOT INTOXICATED (alert)

no midline neck tenderness
no neck pain (paraspinous is OK)
no focal signs
no distracting injury
what size needle for needle decompression of PTX? where?
14 gauge
2nd intercostal, midclavicular
Where is chest tube placed for PTX?

What type of CT?
5th intercostal midaxillary line

36 French
What is Beck's triad? What does it diagnose?
muffled heart tones
JVD
hypotension

cardiac tamponade
most common cause of cardiac tamponade?
penetrating trauma
What amount of blood is symptomatic in tamponade?

What amount of aspirated blood will improve stroke volume by 20%?
150-200 cc

5-10 cc
Old method of knowing you are in pericardial space with pericardiocentesis (pre US)
place needle on V2 electrode
when negative deflection, you are touching heart muscle
most common location of aortic disruption
between left subclavian artery and ligamentum arteriosum
Signs / circumstances to suspect aortic trauma
high speed deceleration impact or side impact
multiple rib fractures, flail chest
PULSE DEFICITS IN BOTH UE
SYSTOLIC MURMUR OVER BACK
CXR WIDENED MEDIASTINUM
If you find widened mediastinum on CXR, what should you do?
consider CT if patient is stable, or go directly to OR
What are the most common organs harmed in a deceleration injury?
1. spleen 55%
2. liver 45%
3. small bowel 5%
What are the most common organs injured in a gunshot wound?
1. small bowel 50%
2. colon 40%
What are the most common organs injured in stabbing injury?
1. liver 40%
2. small bowel 30%
3. diaphragm 20%
Signs of positive DPL
10 ml gross blood

Lavage:
100,000 RBCs
500 WBCs
positive gram stain
bowel material
What can an abdominal CT miss?
diaphragm injury
some bowel and pancreatic injuries
Contraindications to foley
inability to void
unstable pelvic fracture

blood at meatus
high riding prostate

scrotal hematoma
How much blood can be lost in pelvic disruption?
5 liters
5 Ps of compartment syndrome

tx compartment syndrome
pain, pallor, parasthesia, poiko
pulseless (late)

fasciotomy
Tx of open extremity fracture
1 wrap with saline gauze
2. irrigate
3. Give abx (cefazolin)
4. Give tetanus prophylaxis (Td)
5. immobilize
Best antibiotic for open fracture
CEFAZOLIN
amputation is level [1 , 2] trauma
2, surprisingly
burn > 40% is level [1 ,2] trauma
2
pelvic fracture is level [1, 2] trauma
1