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203 Cards in this Set
- Front
- Back
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When should rings/jewelery be removed?
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As soon as possible
pg 299 |
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What are the most predictive factors for infection of a wound (5)?
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1. Location
2. Age, 3. Depth 4. Configuration 5. Contamination pg 299 |
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Who are more likely to form keloid scars?
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Blacks and Asians
pg 299 |
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T/F: Blunt trauma wounds are more likely to have foreign bodies, like glass, wood, or metal.
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False: Penetrating wounds
pg 299 |
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Pt in MVA c/o foreign body sensation in the hand. Local wound exploration is negative for FB. What is next step?
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Image (xray/US) the hand to r/o FB. Those reporting FB sensation aer more likely to have.
pg 299 |
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Which laceration is more vital to close quickly to decrease risk of infection, head or extremities?
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Extremities are more likely to heal slowly and become infected.
pg 299 |
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If a wound is a high risk for infection, how many hours/days should primary closure be considered?
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96hrs or 4 days of open wound management decreases risk of infection.
pg 299 |
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Psych evals are required for this type of injury.
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Self inflicted.
pg 299 |
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Which anatomical locations are more likely to produce a bacterial infection?
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Axilla, perineum, toe webs, and intertriginous areas harbor millions of bacteria.
pg 299-300 |
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Wounds in which setting are more likely to become infected, high or low vascular flow?
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Low
pg 300 |
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_____ _____ is the single most important step in treating a traumatic wound.
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Wound preparation.
pg 301 |
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Name the four risk factor categories for poor wound repair outcomes.
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1.Immunosupressed (DM, pregos, HIV)
2.Tissue Ischemia 3.Poor wound healing (smoker, elderly, malnourished) 4.Wound Factors (Crush, contaminated, FB, peripheral location) pg 302 |
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T/F: Full sterile technique does not reduce the rate of postrepair infections.
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True
pg 302 |
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What should be completed before and after a wound repair?
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Sensory, motor and vascular exams
pg 302 |
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What is the preferred method of hemostasis?
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Direct pressure - least risk
pg 302 |
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What is the progression for hemostasis if initial direct pressure is not effective?
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1. Direct Pressure
2. Ligation 3. Cautery (electrical or chemical) 4. Tourniquet pg 302 |
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If an extremity tourniquet is required where is the best location to repair the wound?
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Operating Room
pg 302 |
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T/F: Probing the depth of the wound with a gloved fingertip is the best method for detecting a FB.
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False: Visual inspection down to the full depth
pg 304 |
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T/F: Iodine or Chlorhexidine should be used to cleanse the wound before repair.
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False: they impair host defense. use around wound edges.
pg 304 |
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What is the best method for hair removal before a wound repair?
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Clipping 1-2mm above the skin with scissors. Shaving damages the hair follicles
pg 304 |
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Low pressure irrigation is acceptable for uncontaminated wounds. High pressure is achieved by using what in the ED?
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50ml syringe and 18g catheter
pg 305 |
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T/F: Wound soaking and scrubbing of a wound are not effective and may actually increase the bacterial count.
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True.
pg 305 |
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Why is normal saline much more effective than tap water for irrigation?
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It is not. Tap water is equally as effective, cheaper and available in large quantities.
pg 305 |
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What are the advantages of debridement of nonviable tissue?
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1. removes foreign matter, bacteria, and dead tissue
2. creates clean wound edges pg 305 |
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What is Autolytic Debridement?
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refers to the body's natural ability to heal through phagocytosis and lysis.
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How can Autolytic debridement be promoted by the provider?
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Occlusive dressing of a noninfected wound has accelerated wound healing, less likely to get infected, less painful, and better cosmesis.
pg 305 |
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What is the most effective method of debridement?
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surgical excision
pg 305 |
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What is the rate of infection of traumatic wounds repaired in the ED?
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3-5%
pg 306 |
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Most important steps in prevention of wound infection?
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Irrigation and debridement.
pg 305 |
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What is the best method to release tension around a wound before closure?
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Undermining.
pg 307 |
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Which method of closure is the strongest and most accurate at approximating wound edges?
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Sutures
pg 307 |
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Benefit of staples?
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1. Rapid application
2. Low tissue reactivity 3. Low cost pg 307 |
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Benefit of Tissue Adhesives?
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1. Rapid application
2. Pt comfort 3. Resistant to bacterial growth 4. No removal pg 307 |
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What size suture is best used on the face, scalp, trunk, extremities, digits?
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Face - 6-0 nylon
Scalp - 4-0 nylon Trunk - 4-0 nylon Extremities - 4-0 nylon Digits -5-0 nylon pg 309 |
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How many knots should be tied when finishing a suture?
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Generally, # of knots should be the same as the suture size (ie. 4 knots for 4-0 nylon)
pg 309 |
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When is a Running Suture appropriate?
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Long linear lacs
pg 309 |
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What is the purpose of the Deep Dermal Sutures?
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Reduce tension on wound and close dead space.
pg 309 |
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What is the purpose of the Horizontal Mattress Sutures?
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Closing tip of skin flaps
pg 311 |
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What is the purpose of the Vertical Mattress Sutures?
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Excellent wound edge eversion in thin or lax skin (over a shin). Far to far, near to near
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What is the most cost effective and least reactive of all the wound closures?
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Adhesive Tapes (limited to low tension)
pg 312 |
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What are some pitfalls of Tissue Adhesives?
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Runoff, Wound Dehiscence, Infection, Getting Stuck
pg 314 |
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Tissue Adhesives should cover how much area around the wound?
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5-10mm on either side of the wound edges and the entire length
pg 314 |
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T/F: It is very important to debride wound edges on facial and scalp lacerations for repair.
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False: often tissue that appears nonviable will recover and heal.
pg 315 |
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Any facial trauma presenting to the ED without an exact known mechanism should be suspicious for _______?
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Domestic Violence
pg 315 |
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It takes __ x less bacteria to cause an infection in blunt trauma than sharp wounds.
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10
pg 315 |
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What is the time frame for removal of Scalp, Face, Trunk, Extremity sutures?
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Scalp - 10 days
Face - 3-5 days Trunk - 10 days Extremities - 10-14 days pg 317 |
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Eyelid lacerations need what in particular prior to repair?
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Exam of the structure, function, and search for FB before repair.
pg 318 |
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How close to the medial canthus should be considered for a nasolacrimal duct issue?
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6-8mm
pg 318 |
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What is the most common fracture in domestic violence?
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Nasal fracture
pg 318 |
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What is the most important assessment of a nasal laceration?
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depth and involvement of the deeper tissues. (higher risk of infection)
pg 318 |
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24yo M nasal fracture after bar fight. Laceration over the bridge and minor bleeding. Provide notices mucoid discharge from nose. What is next step?
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R/O cribriform plate fracture
pg 318 |
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T/F: Isolated intraoral mucosal lacerations may not be need to be sutured if < 1.0cm.
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True. Suture when >2.0cm, can trap food particles, or have a tissue flap interferring w/ chewing
pg 320 |
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What anatomy needs to be considered when repairing the cheek?
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The parotid gland/ duct and facial nerve
pg 321 |
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Motor and Sensory testing of Radial Nerve is?
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Motor - dorsiflexion
Sensory - first dorsal web space pg 322 |
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Motor and Sensory testing of Median Nerve is?
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Motor - thumb abduction
Sensory - Volar tip of index finger pg 322 |
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Motor and Sensory testing of Ulnar Nerve is?
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Motor - Adduction/ abduction of digits
Sensory - Volar tip of little finger pg 322 |
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For hand and finger injuries ROM should be tested. What does weak, limited or painful movement indicate?
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Partial involvement of a tendon
pg 322 |
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What is normal two point discrimination?
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<6mm, poor is >15mm
pg 322 |
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Cap refill time > __ seconds is concerning for significant vascular injury.
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3 seconds
pg 323 |
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Explain the best method for tourniqueting a finger.
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Penrose drain stretched to no more than 50% of its length, no longer than 20min and clamped (or hemostat)
pg 323 |
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Why is important to inspect the injured extremity in a variety of positions?
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To avoid missing injuries that may move out of the field of view in neutral position.
pg 323 |
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If a laceration is near a joint, how do you test the integrity of the capsule?
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Inject NS (w/ or w/out flourescein) in an area away from the lac. If fluid drips out, then open joint = call ortho
pg 323 |
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Besides antibiotics, what else should be considered in bite wounds or "fight bite" in close fists injuries?
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Tetnus and Hep B vaccines
pg 324 |
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Lacerations from a closed fist injury should be treated with? Primary, Secondary, or Tertiary intent?
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Secondary - assume laceration is from punching someone in the mouth, large source of bacteria.
pg 324 |
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Best abx for "fight bite"?
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Augmentin 3-5 days
pg 324 |
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How are a Mallet finger and Swan Neck deformity related?
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Swan neck is the result of an untreated Mallet Finger. The lateral bands displace dorsally.
pg 325 |
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What is the difference btwn a Boutonniere and a Swan neck deformity?
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They are opposites. Boutonniere- hyperflexion of the PIP and hyperext of the DIP
pg 325 |
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What is the best suture for the classic suicide attempt across the volar wrist surface?
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Horizontal Mattress to cross all lacerations
pg 326 |
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These, though innocuous appearing, lacerations have great potential for damage in the hand.
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Palm Lacerations -careful assessment of flexor tendon function and two discrimination is important
pg 326 |
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What is the best treatment option for a flexor tendon injury?
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early consult to a hand surgeon, repair in the OR due to the complexity
pg 326 |
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If a Hand Surgeon is not available immediately for flexor tendon lacerations what should the ED provider do?
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Clean and close the skin, splint the extremity with the wrist in extension and the PIP/DIP joints in extension (to prevent contraction)
pg 326 |
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At what point do you suspect digital nerve injury with two point discrimination?
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>10 or greater on one side of the volar pad than the other.
pg 327 |
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Distal finger tip amputations that are __ mm/cm or less w/out exposed bone or nail bed can be conservatively treated w/ serial dressing changes alone.
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1cm or 10mm
pg 327 |
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This injury usually results from closure of the fingertip in a door and can include a distal tuft fx 50% of the time.
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Nail bed injuries.
pg 328 |
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After a closure in a door a subungual hematoma often follows. What is the treatment for this?
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Trephination - pin, cautery or nail drill to allow for decompression. If fx associated remember to treat as open fracture
pg 328 |
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What type of abx ointment or cream should be used with a laceration closed with a tissue adhesive?
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None, as they will loosen the adhesive.
pg 356 |
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Are topical antibiotics indicated for coverage over recently repaired wounds?
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Yes, reduced infection rates with topical abx due to providing a warm, moist environment beneficial for wound healing.
pg 356 |
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When are prophylactic oral abx indicated (6)?
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1. Human bites
2. Cat bites 3. Deep dog bites/ puncture 4. open fx 5. bite/wounds to the hand 6. exposed joint or tendon pg 356 |
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What type of abx is indicated for uncomplicated pt and wound?
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first line cephalosporin (Keflex) or macrolide (zithromax)
pg 357 |
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What type of abx is indicated for prosthetic heart valve or ortho implant?
|
Keflex or Zithomax + Vancomycin
pg 357 |
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What type of abx is indicated for injuries involving animals or feces?
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Augmentin or Ceclor (2nd gen cephalosporin)
pg 357 |
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What type of abx is indicated for saltwater injury?
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3rd Gen cephalosporin (Rocephin or Omnicef) +/- doxycycline
pg 357 |
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What type of abx is indicated for freshwater injury?
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Antipseudomonal Aminoglycoside (Gentimycin) or PCN
pg 357 |
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What type of abx is indicated for abscesses and infections involving drug users?
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Augmentin or Ceclor (2nd Gen cephalosporin
pg 357 |
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What type of abx is indicated for necrotizing fasciitis?
|
Imipenem
pg 357 |
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What type of abx is indicated for bite wounds?
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Augmentin
pg 357 |
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What type of abx is indicated for open fractures?
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1st Gen cephalosporin (Keflex) or PCN, + aminoglycoside
pg 357 |
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What is the length or treatment in a nonbite injury vs a bite injury?
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Nonbite - 3-5 days
Bite - 5-7 days pg 357 |
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For any contaminated wound or puncture when would you give the Tetnus toxoid?
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<3yo, >3yo and last dose in the 5-10 yr range, or last dose >10yrs ago.
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What is the only contraindication to receiving the tetnus toxoid?
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Hx of neurological or severe systemic reaction after a previous dose
pg 357 |
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From time of closure, how many days until removal of staples or sutures for face, scalp, trunk, extremities, and hand?
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Face- 3-5 days
Scalp -10 days Trunk - 10 days Extremities - 10 days Hand - 10 days pg 358 |
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How long should a pt wait to clean or wash an area that has been repaired?
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8 hours after closure without an increase in infection rate.
pg 358 |
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Why are drains used in wound repairs?
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Allow for near complete wound closure when otherwise would be impeded by pus, fluid, or blood.
pg 358 |
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What are three types of drains?
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1. gauze wick
2. Penrose (open system) 3. collection reservoirs (closed systems) pg 358 |
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What is the most common drain in the ED?
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1/4-1" packing gauze
pg 358 |
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How often should gauze packings be changed out?
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daily as long as the wound produces exudate, once exudate has stopped d/c packing and use external dressing
pg 358 |
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What is often overlooked in pt education regarding a closure?
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Scarring. Educate the pt on what to expect, don't expose to sun.
pg 359 |
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What are some injuries/disorders associated with drownings?
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1. spinal cord injures
2. hypothermia 3. seizures pg 1372 |
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After a submersion, the degree of ___ and ____ insult determines the ultimate outcome of drowning victims.
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pulmonary and CNS insult
pg 1372 |
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What is "dry drowning" and how often is it present?
|
laryngospasm followed by hypoxia leading to LOC, 10-20% of submersions
pg 1372 |
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What is "wet drowning" and how does it affect the lungs?
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water is aspirated in to the lungs. washout of the pulmonary surfactant diminishes gas exchange
pg 1372 |
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What two signs are predictive of poor outcome for drowning victims?
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unstable cardio function and coma
pg 1372 |
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What are the three main things to assess upon arrival in the ED of a drowning victim?
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Secure airway, provide O2, and determine core temperature.
pg 1372 |
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Pt with a GCS of >___ and O2 sat of >___% are at low risk for complications.
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GCS 13 and 95% O2 sat
pg 1372 |
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How long should you observe a low risk drowning victim?
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4-6 hours
pg 1373 |
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If a drowning victim is high risk and O2 saturation is at 88% with NRB 12L what may need to occur?
|
Intubation.
pg 1372 |
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What has better outcomes, cold or warm water drownings?
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Cold
pg 1372 |
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Most common locations for chemical burns on the body?
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Face, eyes, and extremities
pg 1381 |
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Describe first, second and third degree burns.
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1st- redness, burning, itching, superficial
2nd - bullae, plus 1st degree 3rd - deep dermal layer burn pg 1381 |
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Difference btwn acid and alkaline burns.
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Acid- cause coagulation necrosis and forms tough leathery eschar
Alkaline - liquidification necrosis, chemical burns deeper pg 1381 |
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What is the first priority in a chemical burn pt?
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Removing the offending agent. Water or saline should not be delayed while looking for another treatment option.
pg 1381 |
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How do you know when to stop irrigating a chemical burn?
|
Alkaline may require several hours. Check 10-15min after completing irrigation with litmus paper. Goal is normal pH.
pg 1381 |
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What is the most important feature of a chemical burn that a provider can alter?
|
Contact time with the skin!
pg 1382 |
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Most common chemical burn to the scalp in women and how to treat?
|
Acetic Acid (40% solution from in hair wave neutralizers).
Txmt - copious water irrigation, oral abx if scalp burn is extreme. pg 1382 |
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This acid is found in toilet bowel cleaners and battery acid, what is it and the treatment?
|
Sulfuric acid, tap water irrigation and wound debridement if necessary.
pg 1382 |
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This acid is found in high octane fuels, dyes, plastics and fireproof material. It acts like an alkaline and causes progressive tissue loss.
|
Hydroflouric Acid.
pg 1383 |
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Hydroflouric acid cause nerve tissue damage and pain due to the free flouride ions. What is the treatment for hydroflouric acid burns?
|
Txmt - 1st phase irrigation, 2nd phase - electrolyte replacement (Ca+, Mg+) binds the remaining acid. Or intralesion injections of Calcium gluconate 5% per square centimeter of burn.
pg 1383 |
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Give three examples of alkalis.
|
Lye, Lime, and Portland Cement.
pg 1384 |
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What type of burn is water contraindicated?
|
Metal burns. Water causes a exothermic reaction. Treat with sand Fire Extinguisher class D or smother
pg 1384 |
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In this type of burn, death has occurred with <10% BSA. It ignites and continues to burn with contact to air. Even small burns should be treated immediately and aggressively.
|
White Phosphorus.
pg 1385 |
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T/F: Chemical burns to the eyes require immediate irrigation and are ocular emergencies.
|
True
pg 1385 |
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What is the minimum amount and length of time to irrigate eye burns?
|
1-2L NS over 30min.
pg 1386 |
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Define high vs low voltage injuries.
|
High >1000 V
Low < 1000V pg 1386 |
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At the same Voltage which current is more dangerous, AC or DC?
|
Alternating Current is more dangerous than Dire and can cause ventricular fibrillation, tetany (causing the pt to not let go).
pg 1387 |
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What is the serous/fatal level of voltage?
|
>600 V
pg 1387 |
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Electrical Arcs are dangerous because it takes thousands of volts to produce them. What degree F do they produce?
|
35,000F
pg 1387 |
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What are two common injuries besides the burn associated with AC electrical injuries?
|
Dislocations and fractures from the sustained muscular contractions.
pg 1387 |
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Pt's who die from cardiac issues usually do so before reaching the ED, but pt's should be monitored for nerve and deep tissue injury how?
|
peripheral and central neuro checks and seriel CPK levels.
pg 1388 |
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Neurological impairment occurs in about ___% of pts with high voltage injuries.
|
50%
pg 1388 |
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|
27yo M arrives by EMS after down power line accident. Pt has "entry" wound on the right lower leg and "exit" from the right shoulder. Pt's leg is swollen, pale and decreased DP pulse. Concern is for what?
|
Compartment syndrome.
pg 1388 |
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A painful abdomen after a electrical current injuries should be worked up immediately for what two concerns?
|
Perforation or intra-abdominal hemorrhage
pg 1389 |
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A normal ECG but elevated CK-MB is concerning for what type of injury after a low voltage accident?
|
Skeletal muscle injury and not cardiac
pg 1389 |
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|
How is fluid resuscitation guided in burn victims and describe.
|
Parkland Formula
Weight (kg) x TBSA burned (%) x 4ml = Total fluid requirement x 24hrs give half in the first 8hrs, then the rest over 16 hrs. pg 1389 |
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|
If pt is suspected to have myoglobinuria and a serum CK > 5x normal, what condition are you concerned for and how do you treat?
|
Rhadmyolysis - aggressive IV fluid therapy 1.5L/hr with goal UOP 1-2L/kg/hr, Correct lytes, consider sodium bicarb.
pg 1389 |
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|
What are some predictive factors of potential need for a fasciotomy in a burn victim? (3)
|
1. myoglobinuria
2. burns over 20% of TBSA 3. full thickness (3rd degree) burns over 12% TBSA pg 1389 |
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|
Define low voltage and high voltage injuries.
|
Low - <600 V
High - >600 V pg 1390 |
|
|
What are the five life threatening conditions associated with TASER use?
|
1. Hyperthermia
2. Hyperkalemia 3. Metabolic Acidosis 4. Respiratory Acidosis 5. Rhabdomyolysis pg 1390 |
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|
If a pt has been severely agitated after a TASER incident but is now asymptomatic, how long before discharge?
|
2hrs if:
no abnormalities requiring txmt pt is calmed down, no LOC appears well on exam normal w/ 2hrs of cardiac monitoring pg 1390 |
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|
How long should pregnant pts beyond 20 weeks be monitored in the ED after electric shock?
|
4 hours
pg 1391 |
|
|
Define Keraunoparalysis in regards to lightning injuries.
|
Neurologic and muscular stunning following a lightning strike. lower limb weakness, sensory abnormalities, pallor, coolness, diminished pulses
pg 1391 |
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|
What are the different types of lightning strikes? (4)
|
1. Direct strike - baazinga
2. Side flash - nearby object hit, current travels through air 3. Contact strike - hits something the pt is holding (ie. telephone indoors) 4. Ground strike - current transmitted by the ground pg 1391 |
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|
Which injury is more likely to kill a person, lightning, high voltage AC or low voltage AC?
|
High Voltage AC
pg 1392 |
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|
A lightning strike victim, 24y M, arrives by EMS, 90/68, 116, 16, 96.8, 92% NC 4L. Pt is conversing normally and is a "little shaken up" but no other complaints. What is the concern?
|
Hypotension, tachycardia.
hypotension is not a common finding in lightning strikes and hemorrhage should be r/o. pg 1392 |
|
|
T/F: Autonomic dysfxn from lightning strike may lead to pupillary changes NOT related to brain inury and have no prognostic significance.
|
True
pg 1393 |
|
|
What is a common injury to the eye seen after lightning strikes?
|
Cataracts.
pg 1393 |
|
|
A C3 transverse process fracture is caught on a head CT of a lightning strike victim, what other imaging is needed?
|
Entire CT of spine. Spinal fractures typically occur at multiple levels.
pg 1393 |
|
|
What are superficial feathering or ferning patterns on the skin as a result of electron showering during a lightning strike, not true thermal burns and disappear in 24hrs?
|
Lichtenberg Figures (pathognomonic for lightning strikes.
pg 1393 |
|
|
Most common cause of fatal poisonings in the US, either intentional or accidental is ___?
|
Carbon Monoxide
pg 1410 |
|
|
What is the binding affinity of CO compared to O2?
|
CO 200x great than O2
|
|
|
Which way does the oxyhemoglobin curve shift in a CO poisoning pt?
|
Left shift - leading to less perfusion to the tissue
pg 1410 |
|
|
CO poisoning causes hypoxia and hypotension from cellular toxicity and the release of nitric oxide. What is the concern with myocytes?
|
Ischemia-reperfusion injury
pg 1411 |
|
|
Pt presents comatose, has an anion gap of 25, metabolic acidosis, and lactate of 5. What must be consider in the DDX?
|
CO poisoning
pg 1411 |
|
|
Elderly husband and wife arrive to the ED and c/o headaches, husband reports wife has confusion, and some N/V. Pt states he thinks its the flu. Pulse ox reads 100% on RA for both pts but VBG reads 80%. What is a possibility?
|
Carbon Monoxide poisoning.
pg 1412 |
|
|
What are some common indicators for Hyperbaric Oxygen treatment of CO poisoning?
|
-Seizure, Confusion/AMS, Syncope, Coma, Focal Neuro deficit, Prego w/ carboxyhemoglobin level >15%, or AMI
pg 1412 |
|
|
Major causes of death in trauma pt's are ___, ____, and ___?
|
Head, Chest, and Major Vascular injuries
pg 1671 |
|
|
If a pt is making inadequate respiratory effort what is one of the first steps to correct this?
|
Airway adjunct (naso or oralpharyngeal airway)
pg 1671 |
|
|
GCS 3-8 or agitated pts with head injury, hypoxia, drug or alcohol induced delerium are candidates for _______?
|
endotracheal intubation
pg 1671 |
|
|
What are the NEXUS criteria?
|
1. No posterior midline cervical spine tenderness
2. No evidence of intoxication 3. No AMS 4. No focal neuro deficits 5. No painful distracting injuries pg 1674 |
|
|
What are the Candian Cervical Spine Rules?
|
No to any get imaging.
1.Any high risk factors (age >65, dangerous mechanism of injury, paresthesias) 2. Any low risk factors allowing for ROM test (able to sit or ambulate, delayed onset of neck pain, simple rear-end MVA, absence of midline c-spine tenderness) 3.Able to rotate neck 45degrees pg 1675 |
|
|
Plain film can miss up to ___% of c-spine fractures.
|
15%
pg 1672 |
|
|
Definition of a massive hemothorax based on CT output?
|
1000ml initial output or 200mL/hr
pg 1672 |
|
|
How do you quickly monitor the pt's hemodynamic status in the primary survey?
|
Level of consciousness, skin color, peripheral pulses, and pulse pressure (SBP - DBP)
pg 1672 |
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|
How do you fluid resusitate a trauma pt?
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2L crystaloid, then 1:1:1 of PRBCs, FFP, and platelets
pg 1674 |
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Both __ and ___ contribute to a coagulopathy and need to be corrected quickly during resusitation.
|
acidosis and hypothermia
pg 1674 |
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T/F: A GCS of 15 r/o a head injury.
|
False. TBI may still be present.
pg 1674 |
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If TBI is suspected what is a way to reduce ICP via controlling ventilations?
|
mild hyperventilation (Co2 levels of 30-35mmHg)
pg 1674 |
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|
What is an often missed step after exposing a pt and completing the logroll exam?
|
Covering the pt with warm blankets
pg 1675 |
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|
If suspected TBI and coma, defer any procedures that do not address a problem in the primary survey until after _____?
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CT head
pg 1675 |
|
|
Describe the blood loss and classifications of hemorrhagic shock.
|
Class I - <750cc
Class II - 750-1500cc Class III- 1500-2000cc Class IV - >2000cc pg 1675 |
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Penetrating abdominal wound with distention and hypotension. What is next step?
|
Emergent surgery. place NG tube and peripheral lines if they don't slow definitive care.
pg 1675 |
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Impaled objects: remove or leave in the ED?
|
Leave in place until OR.
pg 1675 |
|
|
What pt tends to have the best survival after ED thoracotomy?
|
penentrating chest trauma with witnessed signs of life in ED and cardiac activity at arrival.
pg 1676 |
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|
What is the purpose of the secondary survey?
|
Set priorities for ongoing evaluation and management.
pg 1676 |
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|
What is the next step when there is blood at the meatus and what does it indicate?
|
Blood at the meatus suggests uretheral injury and needs a retrograde urethrography before foley insertion.
pg 1676 |
|
|
What are the most frequently missed conditions during a trauma?
|
Ortho
pg 1676 |
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|
What is the most important step in trauma care for children?
|
Airway intervention
pg 1677 |
|
|
What are some signs of hypoxia?
|
Cyanosis, Agitation, Poor Cap refill, Bradycardia, Desaturation
pg 1677 |
|
|
What are some signs of inadequate ventilation?
|
Tachypnea, Nasal flaring, Grunting, Retractions, and Stridor
pg 1677 |
|
|
If a small pneumothorax is suspected and the child requires positive pressure ventilation do they require a chest tube?
|
Yes, may be appropriate early.
pg 1677 |
|
|
A child is tachypnic and has some stridor. Lungs are clear bilaterally. High flow O2 is not improving sats. What is next?
|
Positive pressure ventilation. Breath sounds may be transmitted across in children.
pg 1678 |
|
|
What is the next step if a tension pneumothorax is suspected?
|
needle decompression before radiological imaging.
pg 1678 |
|
|
Operative thoractomy should be considered in children with chest tube initial drainage ___mL/kg or > __mL/kg/h.
|
15mL/kg initially or 4mL/kg/h
pg 1678 |
|
|
Where should cap refill be measured on children to minimize environmental factors?
|
Head or Chest
pg 1678 |
|
|
If child is in hemorrhagic shock, then bolus them with __mL/kg x 3 of NS, then __mL/kg of RBCs.
|
20mL/kg x 3 NS
10mL/kg of RBCs pg 1678 |
|
|
What is Beck's triad in relation to cardiac tamponade?
|
Hypotension, muffled heart sounds, and JVD.
pg 1678 |
|
|
How can you diagnose and treat Beck's triad?
|
echocardiogram and pericardiocentesis or thoracotomy.
pg 1678 |
|
|
What does AVPU stand for?
|
Alert, repsonds to Verbal stimuli, responds to Painful stimuli, or is Unresponsive
pg 1678 |
|
|
T/F: Hypothermia occurs much easier in children compared to adults.
|
True. Keep them covered and consider external warming devices.
pg 1678 |
|
|
During trauma resuscitation medication is often overlooked in children?
|
Pain meds
pg 1678 |
|
|
What is the leading cause of death due to injury in children?
|
TBI
pg 1679 |
|
|
Which skull fracture is most common in children?
|
Parietal bone fractures 60-70%
pg 1679 |
|
|
Child fell off the trampoline and hit his head. Reports vomiting, dizziness, HA, and irritability since. Pt is laying supine on bed. What should be corrected first?
|
HOB to 30 degrees
pg 1680 |
|
|
Children experiencing __ or more seizures or seizure lasting longer than ___ min should receive anticonvulsant therapy.
|
two or more, few minutes
pg 1680 |
|
|
What anticonvulsant is recommended for acute seizures?
|
Phenytoin or fosphenytoin (15-20mg/kg IV load)
pg 1680 |
|
|
For kids <12yo, when compared to adults, have C-spine injuries where?
|
Occiput to C2 compared to lower cervical spine in adults
pg 1680 |
|
|
8yo is brought back to the ED 4 days after MVA. Pt was cleared by xray for any spinal injuries but now c/o right sided paresthesia, numbness and weakness. What is the concern for?
|
SCIWORA (spinal cord injury without radiological abnormality.
pg 1680 |
|
|
What are the three views for a plain film imaging of the c-spine?
|
Lateral, AP, and odontoid
pg 1681 |
|
|
If SCIWORA is considered what must happen next for treatment and consult?
|
CT of the spine, admission to hospital, and neurosurg consult
pg 1681 |
|
|
What mechanism of injury mostly causes pancreatic injury in children?
|
Handlebar injuries
pg 1683 |
|
|
What is a leading cause leading to bowel obstruction in kids?
|
Duodenal hematoma
pg 1683 |
|
|
If a anterior abdominal bruise is found on a child what else must be r/o?
|
lumbar fx and intra-abdominal injury
pg 1683 |
|
|
If a child has >50 RBC on UA and has unstable vital signs, then what is next?
|
Emergent need for operative treatment and should undergo IV pyelography
pg 1683 |
|
|
If a child has >50 RBC on UA and is stable what is next?
|
CT scan
pg 1683 |
