A4 Em Trauma

Front 1

Criteria for trauma 1

Back 1

head: penetrating wound
GCS <8
heart: hypotensive <90, HR > 120
lung: resp distress, unstable airway
torso: penetrating wound, pelvis fracture

Front 2

Criteria for trauma 2

Back 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

Front 3

ABCs: always remember what with airway?

Back 3

cervical spine protection

Front 4

what conditions dx in B step of ABCs?

Back 4

tension PTX
open PTX
flail chest
tamponade
hemothrorax

Front 5

If radial pulse, systolic is at least ?

If femoral or carotid, pulse is at least ?

Back 5

80

60

Front 6

What patients may not mount a tachycardic response to shock?

Back 6

spinal cord injury
beta blockade

elderly
children

athletes

Front 7

How do you control external bleeding in trauma?

Back 7

direct pressure, not tourniquet

Front 8

T/F Class I hemorrhage can be treated with PO rather than IV fluids.

Back 8

true (depends on clinical judgment)

Front 9

What is checked in D step of ABCs?

Back 9

pupils
GCS
mental status

Front 10

What can cause decreased level of consciousness besides trauma and drugs?

Back 10

hypoglycemia

Front 11

Cs of GCS

Back 11

6- obeys commands
5 - LOCALIZES pain
4- WITHDRAWS from pain
3 - decorticate flexion
2 - decerebrate extension
1 - no movement

Front 12

S of GCS

Back 12

5 - oriented speech
4 - fluent but confused speech
3 - word salad
2 - sounds only
1 - none

Front 13

Sensitivity of lateral cervical spine Xray

Back 13

75%

Front 14

Most important blood test in a trauma patient?

Back 14

type and cross

Front 15

Most common cause of death in trauma bay / ER?

Back 15

undiagnosed hemorrhage

Front 16

Signs of basilar fracture

Back 16

raccoon eyes
Battle sign

Front 17

Signs of temporal bone fracture

Back 17

CSF otorrhea
hemotympanum

Front 18

Which brain hematoma has a lucid interveral?

Back 18

epidural

Front 19

What is the treatment for epidural or subdural hematoma?

Back 19

surgical evacuation of clot

Front 20

What is Cushing's response?

Back 20

sign of increased intracranial pressure
--increased blood pressure with BRADYCARDIA
--irregular respiration

Front 21

What is the treatment for increased ICP?

Back 21

elevate head of bed
mannitol
sedation / paralysis / phenobarb coma
neurosurgical consultation immediately

Front 22

blown pupil indicates ?

Back 22

uncal herniation

Front 23

? percent of spinal injuries are cervical?

Back 23

55%

Front 24

full series of neck films include what views?

What must you make sure to see on neck film?

Back 24

lateral, AP, odontoid, oblique

must see C7-T1

Front 25

What is a Jefferson fracture?

Back 25

C1 compression fracture

Front 26

5 criteria for clearing C spin

Back 26

NOT INTOXICATED (alert)

no midline neck tenderness
no neck pain (paraspinous is OK)
no focal signs
no distracting injury

Front 27

what size needle for needle decompression of PTX? where?

Back 27

14 gauge
2nd intercostal, midclavicular

Front 28

Where is chest tube placed for PTX?

What type of CT?

Back 28

5th intercostal midaxillary line

36 French

Front 29

What is Beck's triad? What does it diagnose?

Back 29

muffled heart tones
JVD
hypotension

cardiac tamponade

Front 30

most common cause of cardiac tamponade?

Back 30

penetrating trauma

Front 31

What amount of blood is symptomatic in tamponade?

What amount of aspirated blood will improve stroke volume by 20%?

Back 31

150-200 cc

5-10 cc

Front 32

Old method of knowing you are in pericardial space with pericardiocentesis (pre US)

Back 32

place needle on V2 electrode
when negative deflection, you are touching heart muscle

Front 33

most common location of aortic disruption

Back 33

between left subclavian artery and ligamentum arteriosum

Front 34

Signs / circumstances to suspect aortic trauma

Back 34

high speed deceleration impact or side impact
multiple rib fractures, flail chest
PULSE DEFICITS IN BOTH UE
SYSTOLIC MURMUR OVER BACK
CXR WIDENED MEDIASTINUM

Front 35

If you find widened mediastinum on CXR, what should you do?

Back 35

consider CT if patient is stable, or go directly to OR

Front 36

What are the most common organs harmed in a deceleration injury?

Back 36

1. spleen 55%
2. liver 45%
3. small bowel 5%

Front 37

What are the most common organs injured in a gunshot wound?

Back 37

1. small bowel 50%
2. colon 40%

Front 38

What are the most common organs injured in stabbing injury?

Back 38

1. liver 40%
2. small bowel 30%
3. diaphragm 20%

Front 39

Signs of positive DPL

Back 39

10 ml gross blood

Lavage:
100,000 RBCs
500 WBCs
positive gram stain
bowel material

Front 40

What can an abdominal CT miss?

Back 40

diaphragm injury
some bowel and pancreatic injuries

Front 41

Contraindications to foley

Back 41

inability to void
unstable pelvic fracture

blood at meatus
high riding prostate

scrotal hematoma

Front 42

How much blood can be lost in pelvic disruption?

Back 42

5 liters

Front 43

5 Ps of compartment syndrome

tx compartment syndrome

Back 43

pain, pallor, parasthesia, poiko
pulseless (late)

fasciotomy

Front 44

Tx of open extremity fracture

Back 44

1 wrap with saline gauze
2. irrigate
3. Give abx (cefazolin)
4. Give tetanus prophylaxis (Td)
5. immobilize

Front 45

Best antibiotic for open fracture

Back 45

CEFAZOLIN

Front 46

amputation is level [1 , 2] trauma

Back 46

2, surprisingly

Front 47

burn > 40% is level [1 ,2] trauma

Back 47

2

Front 48

pelvic fracture is level [1, 2] trauma

Back 48

1