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34 Cards in this Set
- Front
- Back
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24 yo male is hit in face with bottle. Complaining of mid facial pain and mal occlusion of his upper teeth. When you grasp his upper teeth and move them, his maxilla and nose move together
what type of injury is this? |
Le Fort Fracture
Le fort I: Transverse fracture through the maxilla, upper teeth move Le Fort II: Fraxture of the maxilla, nasal bridge, lacrimal bones, orbital floor and rim; teeth and nose move Le Fort III: Cranio facial dysjunction; whole face moves |
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Describe what is broken in Le Fort I-III
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Le fort I: Transverse fracture through the maxilla, upper teeth move
Le Fort II: Fraxture of the maxilla, nasal bridge, lacrimal bones, orbital floor and rim; teeth and nose move Le Fort III: Cranio facial dysjunction; whole face moves |
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your grasp a pts upper teeth and move them, given the following, what type of fracture is it?
teeth and nose move |
Le Fort II: Fraxture of the maxilla, nasal bridge, lacrimal bones, orbital floor and rim; teeth and nose move
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your grasp a pts upper teeth and move them, given the following, what type of fracture is it?
upper teeth move |
Le fort I: Transverse fracture through the maxilla, upper teeth move
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your grasp a pts upper teeth and move them, given the following, what type of fracture is it?
whole face moves |
Le Fort III: Cranio facial dysjunction; whole face moves
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this type of intubation is contraindicated in pts who are apneic, facial/skull/or laryngeal fractures
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Nasotracheal
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what type of airway should be obtained in the following pt:
severe edema or deformity of the face and oropharynx, fracture of the larynx, or hemorrhage in the airway? |
Cricothyroidotomy
contraindicated in pts with anterior neck hematoma |
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78 yo woman with hx of CHF and Afib. presents after synocpe in yard. Rakin leaves, felt heart race, passed out, fell forward and hit her head on a bucket.
She now complains of this intense burning sensation in both arms, hyperasthesia to the touch, and on exam has weakness in the arms more than the legs What spinal syndrome is this? |
Central Cord Syndrome
most common Hyperextension injury-->ligamentum flavum buckles into the cord-->contusion of the central portion of the spinal cord-->affects the pyramidal (motor) and spinothalamic tracts (sensory) fibers that innervate distal structures are located more in the periphery of the cord, thus the deficit is greater in the upper extremity >50% of ppl will recover spontaneously |
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Describe Anterior cord syndrome (how does it happen and what are the effects)
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Hyperflexion injury
anterior cord contusion through protrusion of bone fragment or herniated disc or laceration of anterior spinal artery leads to paralysis and hypoalgesia below the lvl of the injury preserved posterior column functions (position, touch, vibration) neurosurgical emergency |
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this injury leads to paralysis and hypoalgesia below the lvl of the injury
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Anterior Cord Syndrome
Hyperflexion injury anterior cord contusion through protrusion of bone fragment or herniated disc or laceration of anterior spinal artery |
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describe Brown Sequard Syndrome (the injury and the deficit)
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Hemisection of the spinal cord
Ipsilateral motor Contralateral sensory deficits (pain and temp) usually from penetrating trauma but can also be from fracture of the lateral mass in the C-spine Most maintain bowel and bladder function |
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what type of injury leads to the following sx:
Ipsilateral motor deficit Contralateral sensory deficits (pain and temp) |
Brown Sequard Syndrome
Hemisection of the spinal cord usually from penetrating trauma but can also be from fracture of the lateral mass in the C-spine Most maintain bowel and bladder function |
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45 yo drunk female crossing woodward at 3am. Hit by a truck at 50mph. Hit mainly in abdomen and chest then propelled 30 feet onto the road. EMS is called and she is on her way to trauma
EMS is bagging the pt who is unresponsive. She has poor respiratory effort when you stop the BVM. She has decreased breath sounds to both lung fields, crepitus over the R chest wall with dull/distant breath sounds on the left. What should we do first? |
Intubate the pt using RSI and oral Endotracheal insertion
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45 yo drunk female crossing woodward at 3am. Hit by a truck at 50mph. Hit mainly in abdomen and chest then propelled 30 feet onto the road. EMS is called and she is on her way to trauma
EMS is bagging the pt who is unresponsive. She has poor respiratory effort when you stop the BVM. She has decreased breath sounds to both lung fields, crepitus over the R chest wall with dull/distant breath sounds on the left. you intubate the pt and notice poor chest rise and fall, O2 sat of 89%, HR in 140s still with poor breath sounds. Absent on the R and decreased on the L what should be done next? |
bilateral chest tubes
on the R the ER resident receives a whoosh of air and a little bit of blood on the L the surgery resident receives about 400 cc of blood |
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You see a chest xray after you put an OG tube in. On the image, you see elevated diaphragm and the end of the tube in the middle of the lung field. What is going on? Most common cause?
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Ruptured diaphragm
penetrating trauma |
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what are considered the "hallmark of severe chest trauma"?
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Fractures to 1st and 2nd rib
small broad thick bones that take significant force to break think twice and do a neurovascular exam |
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Fractures of the 9th-11th ribs suggest an associated what?
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intra-abdominal injury
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What is Flail chest?
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2 or more ribs are fractured at two points
allow a freely mobile segment of the chest wall with inspiration/expiration (the segment moves paradoxical to normal breathing) |
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who is more likely to injure their sternum, old or young? how does it happen
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Old
anterior chest trauma (safety belt) note: younger pts are more likely to suffer mediastinal soft tissue injury |
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What is a simple pneumothorax
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collapse of lung but no communication with the atmosphere
no shift of the mediastinum or hemidiaphragm |
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Accumulation of air under pressure causes shift of the mediastinum-->compression of the contralateral lung and great vessels
this describes? |
tension pnuemothorax
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Describe a tension PTX
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Accumulation of air under pressure causes shift of the mediastinum-->compression of the contralateral lung and great vessels
leads to decreased CO from decreased venous return Classic signs: tachycardia, JVD, absent breath sounds on ipsilateral side with trachea deviated away |
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tachycardia, JVD, absent breath sounds on ipsilateral side with trachea deviated away. Tx?
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Tension PTX
clinical diagnosis, needle decompression |
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Most common cause of hemothorax?
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Injured lung parenchyma
then intercostal/IMA vessel>hilar vessels>great vessels |
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22 yo male is stabbed in the epigastrium. C/o abd pain, head pressure and difficulty breathing
HR 130 BP 80/55 RR 32 O2 96 Xray shows enlarged heart |
Pericardial effusion or tamponade
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What is Beck's Triad?
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Hypotension
Distended neck veins Distant heart sounds seen in Tamponade |
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17 yo is T-boned on driver's side. Gets out of car, ambulates, and says that he is fine other than some mid back pain.
Arrives with C-collar and back board to the trauma bay. Complaining of mid and lower back pain with tingling in both of his legs. He is afraid that he is going to be paralyzed and starts to hyperventilate. You complete your exam, roll the pt, and obtain your portable films. Kid looks at you, says he is going to die, suddenly he is unresponsive and you cannot find a pulse when you check. CXR shows widened mediastinum and cardiomegaly What should you do? |
ED Thoracotomy
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Indications for ED Thoracotomy? (consider 2 types of trauma)
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Penetrating trauma (cardiac arrest at any point with initial vitals or signs of life in the field; persistent hypotension; severe shock with signs of tamponade)
Blunt Trauma (cardiac arrest in ED; blunt traumatic arrest in the field is NOT indication for thoracotomy) |
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most common vessel injured by blunt trauma?
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Thoracic aorta
80-90% of tears occur distal to L subclavian artery |
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which carries a greater risk of mortality: Blunt or Penetrating injuries?
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BLUNT
harder to evaluate and diagnose |
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What organs are most likely hurt in...
Penetrating Injury: Blunt Injury: |
Penetrating Injury: Small intestine, colon, liver
Blunt Injury: SPLEEN >>>> liver, intestine |
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What is seat belt sign?
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contusion/abrasion across the lower abdomen
correlates with intraperitoneal lesions or lumbar spinal injury |
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4 main places blood "hides" in the body after trauma
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Chest
Abdomen Pelvis Femur note: in kids, the cranium is a possibility as the sutures are still open |
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with what fracture will you have the most blood loss?
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Pelvis: up to 3000
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