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64 Cards in this Set
- Front
- Back
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What is the #1 cause of death in <44 yo?
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trauma
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what is meant by trimodal period?
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1. Immediate-- on impact (50% of deaths)
2. early (30%) - Golden hour, platinum 15min (due to hemorrghages mainly 3. Late (20%) - death usually due to sepsis, multi organ failure |
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what is the name of the dr. that coined the golden hour and had the quote that made prof. barratt cry? he was a pioneer in the field of emergency medicine and tx of trauma
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dr. R. Adams Cowley
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who created a model trauma center and EMS system embodying vision to tx everyone the best possible?
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Dr. R. Adams Cowley
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what are the 3 mechanisms of injury?
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1. first impact of a car hitting a tree
2. second impact of the body hitting the dashboard or steering wheel 3. third impact of the organs within the body impact with supporting structures |
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cervical spine injury and the severity of them occurs most frequently in what kind of MVC?
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T bone - lateral
(think clavicle, ribs, shoulder girdle as well) |
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in MVC injury potential increases if?
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1. ejection occurs
2. speed was >30 mph 3. death of another occupant in vehicle 4. invasion of the passenger compartment by more than one foot. |
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MC type of Rear-end collision?
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when you are sitting at the stop light and a car hits you from behind
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who created the 3 point seat belt?
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Nils Bohlin of Volvo
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the seat belt was introduced in 1949 by ....
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nash motor
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severe c -spine injury and decapitation can occur with what mode of incorrect seat belt use?
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if the shoulder belt is worn alone without a lap belt
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which passenger has a high incidence of lumbar spine separation?
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passengers in the back seat with only a lap belt
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in a duodenal wall hematoma what sign might you see on X-ray?
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stacked coin sign
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who invented the airbag and when?
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1952 - john hetrick
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what are common seatbelt injuries?
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o Cervical, thoracic spine and clavicular fracture
o Seatbelt contusion to chest and abdomen o Admoninal trauma |
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what severe even fatal injuries have been seen with airbags?
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1. when driver is seated less than 10 or more inches from center of steering wheel
2. unconscious driver slumped over the steering wheel 3. should-lap belt not being used |
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most motorcyle deaths are due to ?
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severe head trauma
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cricoid to mandible is what zone?
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zone 2
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the severity of a stab wound depends on?
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1. length of blade
2. area of body penetrated 3. angle of penetration |
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what are indications for intubation?
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1. acute resp. failure
2. loss of airway protective reflex 3. acid-base abnormalties 4. spinal injury 5. secretion control 6. altered mental status with inability to protect airway |
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what are indications for surgical intubation?
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1. absolute need for definitive airway
and unable to do ETT and risk of not intubating greater than surgical airway risk and other methods dont allow for effective ventilation and respiration 2. apneic with suspected c-spine injury 3. facial trauma with suspected c-spine injury 4. severe facial neck trauma |
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pyramidal fx of the maxilla
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LeForts Fx II
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in a mulitple injured patient ____ is the most common cause of altered mental status
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blood loss
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what type of accidents account for 70-80% of significant blunt chest trauma?
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MVA
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what is the first sign of impaired perfusion?
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altered mental status
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what are the lethal six conditions of chest trauma?
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1. airway obstruction
2. open pneumothorax 3. tension pneumothorax 4. cardiac tamponade 5. massive hemothorax 6. flail chest |
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what can we do for an airway obstruction?
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1. heimlich
2. orophayngeal airway 3. Nasophayngeal airway 4. intubation 5. tracheotomy 6. cricothryoidotomy (emergency situation) |
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Bubbling sucking heard with respirations. dyspnea/tachypnea, cyanosis, profound resp. distress, decreased breath sounds on one side?
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open pneumothorax
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tracheal deviation to unaffected side, resp distress, hemodynamic instability, distended neck veins?
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tension pneumo
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what is the tx for open pneumo?
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1. make a three way flap and insert chest tube
2. insert chest tube, intubate, and use positive pressure ventilation |
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what is the tx for tension pneumo?
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1. immediate needle decompression
2. insert chest tube |
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in a massive hemothorax, 90% are due to injury of what veins?
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internal mammary veins and intercostal veins
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in a hemothorax what will you hear on percussion?
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dullness
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what is the tx for hemothorax?
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1. rapid volume resusciation
2. tube thoracostomy (36F) 3. xray 4. Thoracotomy only used in severe cases!!!! |
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what is the indication for thoracotomy in hemothorax?
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if lost greater than 1500ml-2000ml and continues to lose blood at 100-200 ml/hr.
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what is the tx for flail chest?
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1. analgesics
2. aggressive pulm toilet with suctioning (incentive spirometry, early mobilization, humidification of air) want to avoid pneumonia which is MC complication!! |
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what are the sx of pericardial tamponade?
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BIC Tdap
Beck's traid Increased central venous pressure Tachypnea Dyspnea Agitation, anxiety Pulses paradoxus |
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what is beck's triad?
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Narrowed pulse pressure
Muffled heart sounds Jugular venous distension |
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in traumatic aortic rupture the MC site of injury occurs where?
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occurs distal to the origin of the left subclavian artery at the site of the ligamentum arteriosum
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when will you see an indistinc aortic know, depresson of the left bronchus, deviation of trachea to the right, apical or pleural cap?
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traumatic aortic rupture
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how do we dx traumatic aortic rupture?
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1. gold standard is aortography
2. TOC = helical/spiral CT |
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test of choice for dx of DVT?
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ultrasound, then CT venogram but remember its more invasive since it requres dye wouldnt want to do on someone with renal insufficiency
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what is the Dx test of choice for PE?
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CT angiogram (spiral CT) is the Test of choice. Pulmonary angiogram was the gold standard but more invasive since injecting into an artery! with CT spiral only need IV access. Could also get VQ scan if poor renal perfusion but much less sensitive
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diaphragm rupture is more common on what side?
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the left, on the right you have liver to provide resistance
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what would you suspect with a penetrating trauma at or below 4th intercostal space anteriorly, 6 interspace laterally, or 8th interspace posteriorly?
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diaphragmatic rupture
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what is the MC injured organ in blunt trauma?
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spleen followed by the liver
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what are the xray findings of a traumatic aortic rupture?
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1. Deviated NG tube to the right
2. Widened mediastinum 3. Indistinct aortic nob 4. Depression of L bronchi 5. deviation of trachea to the right 6. Apical or pleural Cap (blood above the pleura) |
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big fall, weak leg pulse, HTN in the arms, interscapular pain, dyspnea, rapid decelerations,
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Traumatic aortic rupture
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esophageal trauma is especially deadly because you can get?
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mediastinitis. your esophagus is not sterile!
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what is another name for pneumomediastinum? ALso when might you see this, as in injury to what structure?
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Also known as Hamman's Crunch
Seen in esophageal trauma |
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if you have a delay in dx of esophageal trauma (12-16hrs) what is your surgical tx?
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esophageal exclusion. You clamp esophagus off at the top and bottom. make a spit bag and use a feeding tube. Later you re-anastomos this with transverse colon
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percussion of lung = dullness?
hyperesonance? |
dullness - hemothorax
hyperessonace = pneumothorax |
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in hemothorax when do we decide to do thoracostomy?
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if >1500ml initially or >200ml/hr
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MC fx ribs?
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#4-9
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what are the 6 indications for THoracotomy?
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1. penetrating chest or high epigastric wounds with patients in full arrest.
2. Patient with blunt of penetrating trauma who's arrest is witness during eval and resuscitation. 3. Acute pericardial tamponade unresponsive to cardiac massage 4. exsanguinating intrathoracic hemorrhage 5. intra-abdominal hemorrhage requiring aortic cross clamping 6. need for internal cardiac massage |
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most commonly injured organ in a stab wound?
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small bowel
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what are the most commonly injured organs in blunt trauma?
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Spleen and liver
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the most reliable indicator of intraabdominal hemorrhage is?
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presence of shock without an identifiable source
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modalities MC used to determine if laparotomy is indicated in patients with blunt abdominal trauma include:
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DPL, US, CT
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DPL is useful because its fat and can determine presence of intra-abdominal bleeding in hypotensive patients. However, what injuries does it miss?
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injury to diaphragm and can't exclude injury to retroperitoneal structures!
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if someone has and abdominal injury with hematuria which of these dx studies would you do?
1. CT scan 2. DPL 3. US |
Not DPL, hematuria is a kidney injury and that is found in the retroperitonium. DPL can't get to that.
DOnt seind any patient that is unstable to CT scan |
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if you have a hemodynamically unstable patient describe the FAST algorithim
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Do FAST:
positive -- take them to the OR negative -- consider other sites for blood loss, repeat FAST or do DPL |
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if you have a hemodynamically STABLE patient describe the FAST algorithm
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If patient is stable do FAST
positive -- ok, where is the blood coming from do a CT SCAN (more sensitive than US) negative -- ok watch the patient, and consider repeating or CT |
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in damage control what is the lethal triad?
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1. severe acidosis
2. hypothermia 3. coagulopathy |
