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60 Cards in this Set
- Front
- Back
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hoarseness
change in voice stridor |
signs of laryngeal edema
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continual reassessment is crucial during trauma. T/F?
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true
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airway assessment:
pt talks = ? |
patent airway
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stridor
hoarsenss evidence of increased airway resistance |
signs of airway obstruction
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signs of airway obstruction
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1.stridor
2.hoarseness 3.evidence of increased airway obstruction |
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signs of laryngeal edema
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1.hoarseness
2.change in voice 3.stridor |
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how to test for clear upper airway?
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gag reflex
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indications for intubation
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1.glasgow < 8
2.AMS 3.inability to protect airway3 4.compromised respir. mechanics |
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simple pneumothorax Tx
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large-diameter chest tube
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large-diameter chest tube insertion method
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1.insert finger into pleural space
2.insert chest tube |
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large-diameter chest tube management
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1.water seal + suction
2.serial CXR 3.remove when...no air leaks, lung inflated |
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chest laceration to lung that "sucks" air
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sucking chest wound
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chest laceration to lung that "sucks" air
next step? |
1.seal w/occlusive dressing
2.chest tube @ different site |
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chest tube insertion + continuous air leak
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major airway injury (bronchus/trachea)
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chest tube insertion + continuous air leak
next step? |
1.thoracotomy
2.partial lung resection |
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chest tube insertion + no lung inflation
what's wrong? |
1.wrong location
2.tube not functional |
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can you observe a small, uncomplicated pneumothorax?
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yes, if not enlarging + no other injuries + no free fluid + aSx
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tension pneumothorax Sx
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1.hypotension
2.JVD 3.(-)BS |
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tension pneumothorax
management? |
1.needle aspiration
2.chest tube |
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JVD + hypotension
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1.tamponade
2.tension pneumothorax 3.myocardial contusion |
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JVD + hypotension + clear BS
next step? |
1.pericardiocentesis or U/S
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tamponade Sx
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1.hypotension
2.JVD 3.muffled heart sounds 4.pulsus paradoxus 5.Kussmaul sign |
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Kussmaul sign
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increase in CVP during inspiration
seen in tamponade |
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pulsus paradoxus
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decrease in sBP >10 on inspiration
seen in tamponade |
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most common cause of hypotension in trauma
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hypovolemia
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hypotension fr/trauma
next step? |
1.2 large-bore IV + 1-2L NS
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how to measure adequate fluid resuscitation
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1.urine output
2.HR 3.MS 4.BP |
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continued hypotension despite fluid resuscitation
what's going on? |
1.intra-abdominal injury
2.pelvic fracture |
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Cushing reflex
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brain swelling + ischemia
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nl pregnancy hct
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31-35% (due to increased plasma volume)
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prior to catheter insertion, must do...
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rectal exam
check for prostatic injury |
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cervical spine management
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1.immobilization
2.palpation 3.motor & sensory check 4.lateral cervical spine XR |
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level of consciousness assessment
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Glasgow coma scale
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how to decrease brain edema?
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1.head elevation to 30
2.hyperventilation 3.mannitol 4.phenytoin (seizure prevention) |
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glasgow 10 + dilated R pupil (sluggish response to light)
what's wrong? |
space-occupying CNS lesion
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blood behind eardrum
what's wrong? |
basal skull fracture
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ecchymosis/blood around eyes
("racoon eyes") what's wrong? |
basal skull fracture
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ecchymosis in mastoid region
(Battle's sign) what's wrong |
basal skull fracture
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brain injury --> hyponatremia, concentrated urine, elevated urine [Na+], brain edema
what's wrong? |
SIADH
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SIADH Tx
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fluid restriction
3% Na+ over 3-4 hrs |
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caveat of rapid hyponatremia correction
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central pontine myelinosis
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diabetes insipidus Tx
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vasopressin/desmopressin/ddAVP + free water
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how hypothermia affects platelets?
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platelet dysfxn & increased PT, PTT
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poor coagulopathy not corrected by temperature normalization.
next step? |
FFP (restore coag factors)
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continued hemorrhage + low platelet count
what's wrong? |
1.DIC
2.sepsis |
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continued hemorrhage + low platelets
next step? |
platelet transfusion
(keep >60,000) |
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abdominal compartment syndrome?
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tense abdominal compartment due to accumulating fluid & blood
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abdominal distention + oliguria
what's wrong? |
abdominal compartment syndrome decreases renal blood flow
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blood loss v. NS replacement ratio
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3ml NS : 1ml blood
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elevated SVR seen in...
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1.vasoconstrictors
2.cardiogenic shock 3.hypovolemic shock 4.HTN |
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depressed SVR seen in...
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1.septic shock
2.neurogenic shock 3.vasodilators |
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type of shock most commonly seen in trauma pts
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neurogenic shock
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traumatic AV fistula Dx
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1.palpable thrill
2.audible bruit 3.angiogram 4.occlusion --> drop HR |
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Branham's sign
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drop of >10 beats/min
seen in AV fistula occlusion via pressure |
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AV fistula sites
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1.traumatic sites
2.AAA + IVC 3.ESRD dialysis pts |
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airway burns signs
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1.carbonaceous sputum
2.facial burn 3.facial/nasal hair burns 4.low o2 sat 5.dyspnea |
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prophylactic abx for burn pts?
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no! abx resistance
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most common burn bugs
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1.pseudomonas
2.staph aureus 3.strep 4.candida |
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electrical burn suspected
next step? |
1.EKG, cardiac enzymes
2.maintain high urine output, alkalinze urine (prevent renal failure) |
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stab wounds -
zone I marker zone III marker |
zone I - cricoid cartilage
zone III - mandible angle |
