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75 Cards in this Set
- Front
- Back
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what happens to pulse pressure in acute blood loss |
it decreases |
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if urethral meatal blood is present in trauma, what should you do before placing foley? |
perform RUG |
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initial drainage for chest tube in children that necessitates operative thoracotomy |
>15ml/kg initially or 4ml/kg/hr after that |
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PRBC bolus in pediatric trauma: |
10ml/kg (after 3 20m/lkg bolus's over IVF) |
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PaCO2 goal in head injury of children and adults: |
30-34 mm Hg |
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dose of mannitol to lower ICP in pediatric head trauma |
0.5-1g/kg , but only works a few hours |
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67% of c-spine injuries in children (<12) occur where? |
between occiput and C2 |
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In children w/ SCIWORA, when is typical onset of paralysis: |
delayed (>4 days even) and they actually just present w/ transietn paresthesias, numbness ,or weaknes at time of injury or shortly after |
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widening of the prevertebral soft tissues to what level in children w/ concerns for C-spine injury on plain films is abnormal? |
>8mm in front of C2 or >75% the adjacent veterbral body width in infants |
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percent of C-spine injuries in kids that produce no radiographic abnormalities: |
>66% |
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dose of solumedrol in spinal cord injuries in kids: |
30mg/kg loading dose |
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ETT size / depth / NG/foley size / CT size ---> rules for peds |
ETT = (age/4) + 4 (3.5 cuffed) NG/OG/foley = ETT x 2 ETT depth = ETT x 3 CT size = ETT x 4 *CT size note: 10-12 infants, 16-20 small children, 20-24 children, 24-32 child/small adult |
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indications for getting CTap in children after trauma: |
- abd tendenrnes - abd distention - abd bruising - hematuria (50 RBCs per hpf) - vomiting - neuro obtundatoni - fall or low hct - no bowel sounds |
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which part of bowel in trauma is particularly susceptible to hematoma: |
duodenum, and a duodenal wall hematoma can cause obstruction |
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odontoid fractures are common in what age group |
geriatric, accounting for 20% of Cspine frx in this population |
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trauma in pregnancy critical interventions: |
1) place mom on O2 2) place mom in L lateral deceub 3) establish fetal age 4) T&S and determine Rh 5) full trauma imaging 6) fetal monitoring |
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dose of Rho immunoglobin to give in Rh- mom after abd trauma: |
300 micrograms |
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minimum amount of time to observe someone on toco who is pregnant s/p trauma |
4-6 hours, to exclude sig uterine activity and those exclude abruptions |
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classification of TBI |
Mild - GCS 14-15 Mod - GCS of 9 to 13 Sev - GCS of 3 to 8 |
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MAP guideline in severe TBI: |
MAP > 80 ideal |
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bilateral pinpoint or dilated pupils in setting of TBI |
pinpoint- opiate overdose or pontine lesion dialted - inc ICP w/ poor brain perfusion, b/l uncal herniation, drug effects ,or severe hypoxemia |
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best drugs to control agitated patients w/ suspected TBI you need to CT: |
1-2mg IV versed and propofol 20mg every 10 seondds to desired effect |
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ways to dec ICP in TBI: |
1) keep PCO2 between 35-40 2) head of bed up 30 degrees 3) MAP goal of >80 4) Mannitol boluses 0.25-1.0 g/kg, insert foley to monitor I/O, works in 30min, lasts 6 hrs |
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what to do about a linear skull frx w/ overlying laceration: |
considered open frx: give 1g Vanco IV and 2g Rocephin IV and tetanus ppx and obtain nsgy consultation |
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How to identify csf rhinorrhea |
Test it for beta transferrin |
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Signs of central and cerebllotonsillar herniation |
Central transtrntorial - bl pinpoint pupils, Inc tone, bl babinski. Cerebllotonsillar bl pinpoint, flaccid paralysis, sudden death |
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GSW to brain treatment |
Intubation, prophylactic ceftriaxone 2g |
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When is VB compression considered unstable |
When >25% of VB in c3 thru c7 is compressed or >50% in t or l spine |
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Type of occipital condyle frx and tx |
Type 1 - communited Type 2 - extension of linear basilar skull frx Type 3 - avulsion of frament You'll see lower CN deficit and ue weakness. Type III or any deficit request ORIF |
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Useful way to detect occipitoatlantal subluxation |
Basion dental interval - distance between Basion and superior cortex which should be < 8.5 mm on CT |
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How to tell if jefferson frx is unstable |
If displacement of both lateral masses (measured as offset from superior corner of c2 vertebral body on each side) is >7mm when added together, than transverse ligament is likely ruptured and it's unstable |
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How to identify a transverse lig disruption in c1/2 without frx |
Measure predental space - measurement of more than 3mm on plain films or 2mm on CT implies damage. More than 5mm implies rupture |
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fractures of the arch of the atlas and how they occur: |
anterior avulsion frx - hyperextnsion; look for prevertebral swelling posterior arch frx - hyperextension, considered stable if isolated |
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types of odontoid fractures: |
Type I - avulsion of tip; stable, good prognosis Type II - odontoid body, most common, unstable Type III - superior portion of C2 at base of dens, unstable |
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describe hangman's frx: |
traumatic spondyolisthesis of axis - both pedicles of C2 are frx allowing body of C2 to displace anteriorly on C3 |
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difference in wedge frx and burst frx of cervical spine |
wedge has no vertical frx of VB, and it is usualy stable |
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what is teardrop frx? |
when extreme felxion produces teardrop shaped fracture complex at the atnerior-inferior portion of VB that is highly unstable |
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what is a clay-shoveler's frx: |
avulsion of tip of spinous prcoess classically C7, due to intense flexion against contracted posterior erector muscle |
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recognize unilateral face dislocation on plain films: |
VB displaced <50% it's width rotation and "bow tie" sign of inter-locking facets |
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identify and b/l facet d/l on plain films: |
VB will be d/l at least 50% it's mass and "perched" or locked facets |
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what is a pillar frx: |
frx through lateral mass of cervial vertebrae --> by extension and rotation usually MVA |
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a burst frx is stable or unstable? |
unstable |
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what might clue you in to hyperextension dislocation of the cervial spine |
severe facial trauma, central cord syndrome, and pre-vertebral swelling |
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patients w/ blunt chest trauma and mediastinal widening should be evaluated for not just aortic injury, but also.... |
thoracic vertebrae injury |
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minor T/L spine injuries and major injuries (3 minor and 4 major) |
Minor: TP frx, spinous process frx, pars interarticularis frx Major: compression (wedge) frx, burst frx, flexion/distraction (seatbelt) injuries, flexion-dislocation (translational) injuries |
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when are compression frx of t/l spine considered unstabel? |
when they reduce the VB height by more than 50%; only involves 1 column though |
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difference in compression and burst |
burst involve 2 columns and retropulsion of bone and fragments into canal; unstable |
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what are flexion-distraction t/l spine injuries? another name for it? |
often when only lap belt is used--> acts as axis of rotation leading to failure of both posterior and middle coluns; usually inc heigh of posterior VB, frx of posterior wall of VB, posterior opening of disk space also called CHANCE fracture |
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the most damagin type of t/l spine injury: |
frx-dislocation - involves all 3 columns; |
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which type of sacral frx do you need to be aware of that cause bowel or bladder dysfunction? |
frx through the central canal |
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treatment and diagnosis of cocyx frx: |
rectal exam by eliciting pain w/ motion of coccyx... treatment is analgesia and donut pillow |
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can you deem a spinal cord lesion complete when spinal shock is present |
in short, no you have to wait till shock resolves |
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when to intubate reflexively in cervical spinal cord injury |
if it is at C5 or above (due to phrenic nerve involvement) |
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MAP goal in neurogenic shock: |
85-90 |
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why test ano-gential reflexes in someone who looks obvious like total sensory and motor loss? |
bc preservation or "sacral sparing" denotes an incomplete spinal cord injury - squeeze penis and determine whether anal sphincter simultaneously contracts - also test cremaster relfex - test area around anus w/ pin and if it "winks" there is some response and spinal cord integrity - priapism implies complete injury |
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on plain films, what lines do you look at to align cervical vertebra: |
anterior long lig line posterior long lig line spinolaminar line spinous process line |
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how to measure pre-vertebral swelling in cervical vertebrae |
space ant to C3 should be <5mm pre-dental space <3mm in adults |
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dose of steroids to give in blunt spinal cord injury: |
methylprednisolone 30mg/kg bolus over 15 min wait 45 minutes methylprednisolone 5.4 mg/kg/hr infusion for 23 hrs |
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treatment of penetrating spinal cord injuries in ED: |
1) initially - if there is a trans-abdominal tract, prophylactic abx 2) if bullet is in thoraco-lumbar spine, bullet removal does typical improve outcomes (doesn't as much for cervial or thoracic) |
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one of the most common cervical spine frx in children < 10 |
odontoid fracture |
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classic views to evaluate for Le Fort fractures: |
Lateral view - dish face deformity frontal view - donkey face |
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difference in binocular and monocular double vision in trauma |
binocular - suggest entrapment of extraocular muscles monocular - lens dislocation |
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what is telecanthus |
widening of normal interpupillary distance, occurs w/ naso-orbito-ethmoid injuries |
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imaging studies to get in low vs high suspision of facial fracture |
possible midface frx - low suspision --> waters view; high supsision - CT possible mandible frx - low --> panorex, high - mandibular or face CT |
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do you need an addiontal waters view if you have low suspision for facial fractures in pat's getting head CT? |
no |
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any sinus fracture needs what? |
abx - first gen cephalasporins or augmentin |
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what is a true classical blowout frx of orbit? |
when object strikes glob w/o hitting orbital ridge and causes pressure wave through fluid that cna break the inferior or medial orbital walls and adipose tissue or inferior rectus or inferior oblique can hernieate and become entrapped |
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isolated orbital fractures or other sinus frx that you discharge |
1) treat w/ augmentin 2) decongestants, afrin 3) avoid nasal blowing 4) discharge after consultation and f/u arranged |
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what orbital fractures require admission |
naso-orbito-ethmoid fractures --> for consultation w/ face and nsgy (From blow to nasal bridge) |
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what is the "tripod" fracture |
zygomaticomaxillary frx --> results from high-energy deceleration injury w/ disruption on zygomaticofrontal suture, zygomaticotemporal junction, and infraoribtal rim |
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ZMC frx require what treatment? |
any loss of vision or displacement requires admission for IV abx and surgery |
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different Le Fort fractures: |
Le Fort I - alveolar, transvere fracture separating body of maxillar from pterygoid plate and ansal septum; only hard papalte and teeth move, like loose upper dentures Le Fort II - ZMC, pyramdial through central maxilla and hard palate; movement of hard palate and nose occurs, but not eyes Le Fort III - cranial facial dystoiss - when entire face is separated from skul from frx of frontozygomatic suture line, across orbit, and thru base of nose and ethmoids; entire face shifts w/ globes held in place only by optic nerve (damn) |
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after intubation in the hypovolemic trauma pt, what should settings be? |
no more than 5-8 ml/kg of TV no more than 10-14 rr *make sure to pass OG tube after intubation to prevent stomach inssuflation |
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indications for operative mngt after chest tube: |
>1500ml of blood immeidetly after placement OR 200ml of blood per hour for 4 hours |
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size CT to use in trauma: |
simple pneumo -24 - 28 fr hemo/pneumo o- 32-40 fr |
