Emergency Medicine - Ms

Front 1

Common presentation of tension pneumothorax

Back 1

Hypotension, tachycardia, deviation of the trachea, neck veins distention, decreased unilateral breath sounds
- Need immediate niddle decompression

Front 2

Most common cause of postinjury death

Back 2

Hypovolemic shock due to hemorrhage

Front 3

Primary survey

Back 3

ABCDE
Airway with c spine control
Breathing and ventillation
Circulation and control of hemorrhage
Disability (neuro status)
Exposure/Environment

Front 4

How do you assess airway

Back 4

Look for foreign bodies or signs of facial, mandibular or tracheal/laryngeal fractures that can cause obstruction. Remain suspicion for c-spine injury and provide immobilization of the neck. Suspect c spine injury in any patient with altered consciousness, blunt injury above clavicles or multisystem trauma

Front 5

How do you assess breathing and ventilation

Back 5

Breathing and ventilation involve lungs, chest, diaphragm and nervous system. Decreased consciousness, pneumothorax, flail chest, pulmonary contusion, hemothorax or rib fractures can impair ventillation - visually examine and auscultate chest

Front 6

How do you assess circulation and control hemorrhage

Back 6

Identify acute massive hemorrhage rapidly by assessing level of consciousness, skin color and pulse. Decrease in circulating blood volume can result in altered consciousness. Ashen or white skin can indicate significant blood loss. Rapid, diminished or absent peripheral pulses can be a sign of acute hypovolemia
Absent central pulses indicate massive volume loss and require immediate fluid resuscitation.
Life threatening hemorrhages can occur into abdominal and thoracic cavities, into muscles secondary to fractures or externally secondary to penetrating trauma. Control external bleeding by direct manual pressure - do not use tourniquettes or hemostats

Front 7

How do you assess disability

Back 7

Perform rapid neurological assessment
Use AVPU method - alert, responsive to vocal stimuli, responsive to painful stimuli, unresponsive.
Glasgow Coma Scale - if less then 8 severe intracranial trauma

Front 8

What does exposure and environmental control stand for

Back 8

Patient must be completely undressed and examined front to back - after that cover patient with warm blanket to protect from hypothermia

Front 9

Describe resuscitation

Back 9

Perform resuscitation with primary survey addressing each problem as it is identified.
- Airway resuscitative maneuvers include jaw thrust, chin lift and nasopharyngeal airway. Endotracheal intubation may be required to maintain airway patency
-Ventillation and breathing -supplemental oxygen (face mask)
- Establish at least two large bore peripheral IV catheters, draw blood for type and crossmatch
- Initiate immediate fluid resuscitation with 2 L of IV crystalloid solution (Ringer lactate or normal saline) for patients with sign of hemorrhage
- If patient doesnt respond to fluid resuscitation - administer blood immediately - type specific or O negative

Front 10

What does secondary survey consist of

Back 10

- Complete more thorough head-to-toe exam
- X ray - lateral c spine, chest, pelvis and extremities if needed
- Place urinary catheter to decompress bladder and monitor urinary output
- Place gastric catheter to empty stomach and prevent aspiration
- Continuously monitor heart, BP and pulse to see if resuscitation is working

Front 11

What do you do after secondary survey

Back 11

Consult with ortho, surgery etc about further diagnostic tests and definitive treatment. Diagnostic tests include CT scans of head, abdomen and pelvis and diagnostic peritoneal lavage

Front 12

Dysrrhythmias in trauma patient can indicate _

Back 12

Blunt cardiac injury

Front 13

Electric pulseless activity of heart can be sign of _

Back 13

Cardiac tamponade
Tension Pneumothorax
Profound hypovolemia

Front 14

How do you take history in trauma patients

Back 14

AMPLE method - allergies, medications, pregnancy/past illness, last meal, environment/events of injury

Front 15

Battle sign

Back 15

Bruising of mastoid

Front 16

Cardiac tamponade

Back 16

Distant heart sounds + narrow pulse pressure

Front 17

6 Ps of compartment syndrome

Back 17

Pain (out of proportion)
Paresthesias
Pallor
Paralysis
Pressure (palpable)
Pulselessness

Front 18

Traumatic rhabdomyolysis

Back 18

Urine dipstick test is positive for HGB but negative for RBC's under microscopic examination - could be due to myoglobin presence
Alkalinization of urine is necessary with sodium bicarb to prevent precipitation of myoglobin