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36 Cards in this Set

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  • Back
What is the most common cause of shock in the trauma patient?
A young patient is in a car crash and arrives unresponsive and intubated. His blood pressure is 70/30 and his pulse is 60. What are potential causes of shock?
Hemorrhagic, since he is a trauma patient, but you should consider neurogenic shock, as he is a young patient and has not generated a tachycardic response. If his shock was cardiogenic you would expect tachycardia.
What are the NEXUS criteria for clearing the C spine clinically?
No neuro deficit, no posterior tenderness, no intoxication, no distracting injury, normal mental status
What is the leading cause of death and disability in trauma patients?
head injury
A patient suffers a head injury, loses consciousness, wakes up briefly, and lapses into unconsciousness again. She has a fixed and dilated pupil on one side and contralateral hemiparesis. What is her diagnosis?
Epidural hematoma
What are clinical features of concussion, and how do they differ from cerebral contusion?
Concussion often involves a brief loss of consciousness, headache, vomiting, and perseveration, but no localizing signs. Contusion patients often demonstrate confusion, altered level of consciousness, and may have localizing signs.
A patient has neck pain after diving into a shallow pool. The cross-table lateral x-ray of the c-spine looks normal. what is the injury?
Jefferson fracture, which is a burst fracture of C1 and is best seen on open mouth odontoid view.
What are the different types of dens fractures, and which carries the worst prognosis?
Type 1 involves the tip, Type 2 traverses the dens at the junction with the body of C2, and Type 3 involves the vertebral body of C2. Type 2 has the worst prognosis.
A patient is struck in the eye with a baseball. They appear to have an inferior wall blow-out. What muscles are at risk for entrapment, and what other injuries should you consider?
Inferior rectus and inferior oblique are at risk for entrapment. Up to 30% of patients with blowout fractures have associated ocular injuries, such has globe rupture or hyphema.
A trauma patient has hypotension, SOB, and tachycardia. They have decreased breath sounds on the right. What is the next thing you should do?
Do a needle decompression of the right side, then do the chest tube.
A patient has an open chest wound that is 2 inches in diameter. The patient is hypoxic. How do you treat the wound?
Apply an occlusive dressing to the wound. Air will preferentially travel through the sucking chest wound if it is 2/3 the diameter of the trachea or more. You should then place a chest tube distant to the site of the wound.
What is the most common potentially life-threatening chest injury?
pulmonary contusion
How soon after an injury will you see a pulmonary contusion on x-ray?
immediately up to 6 hours.
In which kind of drowning is surfactant inactivated, salt water or freshwater drowning?
Freshwater drowning
Wnat are the causes of an epidural hematoma, and what is the characteristic CT finding?
trauma to the head with skull fracture over the temoral area, causing a laceration to the middle meningeal artery. It can also be from a dural sinus tear, or bleeding from the fracture site, but this is rare. CT shows a focal, smooth, lenticular (biconvex) high density accumulation adjacent to the bone, often with mass effect.
What are some common complications of chest tube insertion?
damage to intercostal nerve, artery, vein, laceration or puncture of thoracic or abdominal organs, extrathoracic tube placement, infection, persistent pneumothorax.
what is the most common cause of traumatic head injury in kids less than 2 years old?
What is the most common cause of fetal mortality in trauma involving a pregnant woman?
A 24 week pregnant woman comes in from an accident boarded and collared. Her BP is 85/60. She is awake and alert. What is the first thing you should do?
Tilt the backboard 15 degrees to the left to displace the fetus from the IVC.
needle decompress the chest, then place a chest tube.
what is the first thing you should do if you see this xray?
Placement of a chest tube.
this patient has a normal blood pressure and a sat of 92%. What is the appropriate treatment for his condition?
Urethral injury, bladder injury, hip injury
What injuries are associated with this fracture?
Apply MAST trousers or tie a sheet around the patient's pelvis
What can you do to prevent hemorrhagic shock in this patient?
Pubic rami fractures
What is the injury?
What is the most common cause of pediatric death due to injury?
Head injury
<1, suffocation
>1, MVA
Which anatomic differences predispose children to head trauma?
Proportionately larger head,
Largely ligamentous neck (not fully developed neck bones), Incompletely myelinated brain (ÿ susceptibility to shearing forces)
Why are younger children able to tolerate increased intracranial pressures?
Cartilaginous skulls and open fontanelles.
What is the primary difference between c-spine injuries in adults and children? Why?
*Injuries in children < 12 y/o are typically between the occiput and C2
*Injuries in adolescents and adults are typically lower
*Spines of children have ligamentous laxity, underdeveloped supporting muscles, partially ossified and wedge-shaped vertebrae, horizontal facet joints, higher fulcrum of flexion, instability of atlantooccipital joint
*Injuries in children < 12 y/o are typically between the occiput and C2
*Injuries in adolescents and adults are typically lower
*Spines of children have ligamentous laxity, underdeveloped supporting muscles, partially ossified and wedge-shaped vertebrae, horizontal facet joints, higher fulcrum of flexion, instability of atlantooccipital joint
What is the most commonly injured abdominal organ in children?
Spleen. Liver is second most common.
Are splenic injuries usually worse in children or adults? Why?
*Spleen in children has a thicker capsule and larger amounts of elastin and smooth muscle in both the capsule and the splenic vessels
What is the most common cause of acute pancreatitis in children?
Trauma from handlebar injuries
What is the lap-belt complex?
Intestinal or mesenteric injury with concomitant lumbar spine injury due to a lap belt
What tools are available to assess and triage pediatric trauma patients for transport?
Pediatric Trauma Score and Revised Trauma Score
a patient has amputated his dominant thumb. you are transferring him to a replantation center. how do you store the thumb?
a. put it in a bag, and put that bag in a bag of icewater.
b. put it in a bag of icewater.
c. put it on ice.
d. put it in the freezer.
e. sew it back on the patient loosely, so he doesn't lose it.
a. tissue should be wrapped in sterile moist gauze, placed in a bag, and that bag should be placed in a bag of icewater. do not freeze tissue.
a man accidentally cut off his ear while in a remote area. he was able to cool it adequately, but the injury was 7 hours ago. can it be replanted?
ears can be replanted out to 24 hours.
which can tolerate ischemia time better, a penis or an arm?
a penis. tissue can tolerate ischemia inversely proportional to the amount of muscle in the tissue. the penis has no muscle, contrary to it's moniker "love muscle."