| Term | Definition |
|---|
| head and chest trauma | Greatest cause of death from injury due to? |
| Cool, clammy skin, change in mental status, decreased urine output and prolonged capillary refill | Physical indicators of hypoperfusion? |
| Initially normal, then tachy/bradycardia, hypotension, tachypnea, hypothermia and shock index greater than .9 | Vital indicators of hypoperfusion? |
| Metabolic acidosis, increased lactate, and increased base deficit. | Metabolic markers of hypoperfusion? |
| 3:1 | Ratio of needed electrolyte solution:blood loss? |
| Obstructive, Cardiogenic, Distributive, Hypovolemic, and Neurogenic | What are the differential diagnoses for shock? |
| Cardiac Tamponade, Tension pneumothorax, and pulmonary thromboembolism | What are the causes of Obstructive shock? |
| cardiac contusion, acute coronary syndrome | What are the causes of Cardiogenic shock? |
| Sepsis, adrenal insufficiency | What are the causes of distributive shock? |
| Hemorrhage | What are the causes of hypovolemic shock? |
| spinal cord injury | What are the causes of neurogenic shock? |
| Hypotension | On presentation ________ represents decompensated shock. |
| SBP below 90 mmHg | Definition of initial hypotension? |
| heart rate | What is the most sensitive indicator of inadequate perfusion? |
| worse than -20; 65% | With SBP less than 90 mmHg, base deficit typically ______ and mortality ____. |
| metabolic acidosis is present and part of the cause is of metabolic origin | Negative base excess means what? |
| tachycardia and vasoconstriction | What are the earliest signs of hemorrhagic shock? |
| volume resuscitation using warmed crystalloids | What is the initial treatment of hemorrhagic shock? |
| blood loss 0-15% (0-750cc) with HR < 100; crystalloids only | Define class 1 hemorrhage. Treatment? |
| Blood loss 15-30% (750-1500cc) with tachypnea and tachycardia >100; crystalloids and blood products if necessary | Class 2 hemorrhage? Treatment? |
| Blood loss 30-40% (1500-2000cc) with tachypnea and tachycardia (HR >120), decreased systolic blood pressure and change in MS; Blood products and crystalloids and type blood if possible | Class 3 hemorrhage? Treatment? |
| Blood loss > 40% (2L) with tachycardia > 140, decreased BP, confusion, lethargy; use blood warmers, 2L crystalloid and Type O blood (no time to type) | Class 4 hemorrhage? Treatment? |
| decrease in Hct. 3-5% 24 hours after injury | How do you detect class 1 hemorrhage clinically? |
| 70mL per kg | How much blood do we have? |
| GCS - Best eye response (4), Best verbal response (5), Best motor response (6) | What is the prognostic indicator for head injuries? |
| 13-15 | GCS minor head trauma? |
| CT scan - not minor | GCS < 13 indicates? |
| 8 | Severe head trauma GCS < ? |
| Intubate, Maintain cerebral perfusion pressure at 70mmHg, ICP less than 20, MAP > 90, Rapid CT, CSF drainage >> Mannitol | Management of Severe head trauma Pt? |
| crescenteric and does not respect suture lines. Poorer prognosis than epidural hematoma | Subdural Hematoma - apperance? outcome? |
| lenticular shape respects suture lines, assoc. with scull fx; LOC, lucid, then rapid decompensation | Epidural Hematoma - apperance? many associated with? Presentation? |
| bleeding into subarachnoid space around brain and spinal cord | Subarachnoid hemorrhage - ? |
| SAH | WHat is the most common type of intracranial hemorrhage in trauma? |
| frontal/temporal; salt and pepper | Intracerebral hematoma - predilection for ____ lobes. Apperance on CT? |
| shear injury; grey-white junction | Diffuse axonal injury is a type of ______. Where? |
| linear | Skull fx: ____ not significant alone. |
| Basilar | ________ skull Fx are linear fractures that run thru the base of the skull often thru petrous temporal or anterior cranial fossa. |
| frontotemporal region; > 1cm of depression | Where do most depressed skull Fx. occur? Surgical intervention when? |
| Skin, subcutaneous tissue, galea aponeurosis, loose areolar tissue, skull periosteum | What are the five layers of the scalp? |
| hypotension, bruit, thrill, crepitus, hematoma, hemoptysis, hematemesis, hemothorax, hemopheumothorux, respiratory distress | Presentation of vascular/respiratory injury? |
| Zone 2 | Which Zone may require exploration? |
| Isthmus (distal to great vessels) | Most common location of aortic rupture? |
| aortic injury | Large hemothorax should raise suspicion for ____. |
| Chest X Ray; CT | Primary screening modality for blunt aortic injury? Negative with high clinical suspicion do what? |
| widened mediastinum | What is the most reliable sign of aortic injury? |
| deviation of trachea or esophagus to right, left apical cap, loss of aorta-pulmonary window, downward displacement of left mainstem bronchus, fx ribs 1 and 2, and abnormal aortic conture | What are the signs of aortic injury on chest X-ray? |
| CT scan; aortic pseudoaneurysm, intimal flap, luminal clot, active bleeding | What is the DIAGNOSTIC test of choice for aortic injury? Findings? |
| Transesophogeal echocardiography | Can't do CT for aortic injury do what? |
| lower HR and BP | Tx. Hemodynamically stable aortic injury? |
| stable: EKG and ED monitoring; unstable: Echo | Cardiac contusion: management stable vs. unstable? |
| arrythmias, conduction abnormalities, cardiogenic shock, ventricular wall rupture, valvular insufficiency, ventricular aneurysm, constrictive pericarditis, and ventricular arrythmias from scar tissue (last three are LATE) | What are the complications of cardiac contusions? |
| Chest X ray; CT | What is the first modality of imaging for pulmonary contusion? Most sensitive study? |
| supportive; avoid intubation as long as possible | Management of Pulmonary Contusion? |
| minutes | How long does it take hypoxemia to develop? |
| analgesia, pulmonary toilet, tube thoracostomy if hemothorax is present; steroids and antibiotics | What is the treatment for Pulmonary contusion? Contraindication? |
| Chest X ray | How is sternal fx diagnosed? |
| EKG | _____ should be obtained in all patients with sternal injury. |
| elderly, pts. with underlying cardiac disease, significant pain, or unstable fx, intractable pain, significant displacement, new EKG changes, or other significant injury | Who should be admitted with sternal fx? |
| admission | New EKG changes = ? |
| tenderness, crepitus, echymosis at injury site | What are the symptoms of rib fx? |
| analgesia, nerve block for multiple, spirometer for home pulmonary toilet | What is the treatment for rib fx? |
| elderly pt. with more than 3 fx. and underlying pulmonary disease, with intractable pain, or dyspnea, 2 fractures over 55 years, pulmonary toilet | Who should be admitted with rib fx? |
| pleuritic chest pain or SOB, decreased breath sounds, decreased oxygen sat., normal BP | What is the presentation for simple pneumothorax? |
| obvious distress, decreased breath sounds, hyperresonance to percussion, and trachial deviation, hypotension, tachycardia, and hypoxia may be present | WHat is the presentation of tension pneumothorax? |
| Subcutaneous air | _______ is diagnostic for pneumothorax. |
| clinical | Diagnosis of tension pneumo. is ___________. |
| hemodynamically stable | When is chest x ray used for pneumothorax? |
| 2 negative x rays | When do you discharge a pt. with pneumothorax? |
| pleuritic chest pain, chest wall deformity, hyperresonance and decreased breath sounds, crepitus, retractions, tachycardia | What are the signs and symptoms of pneumothorax? |
| all regular pneumo. plus agitation, air hunger, possible severe impairment of venous return, tachycardia, decreased CO, hypotension, shock | What are the signs and symptoms of tension pneumothorax? |
| decompression with 14 gauge needle in second intercostal space, miclavicular line or lateral followed by a chest tube (32-36 French chest tube) | What is the treatment for tension pneumo? |
| chest tube, smaller if only pneumothorax | What is the treatment for simple pneumothorax? |
| soft tissue injury signs, decreased breath sounds, abn. chest wall mvmt. | What is the presentation of hemothorax? |
| FAST ultrasound | What is used to diagnose hemothorax? |
| chest tube drainage atleast 32 french, posterior in simple hemothoraces, anterior if combo with pneumo or req. ventilation, | How is hemothorax treated? |
| penetrating or blunt tramua or underlying heart rupture or leak or aortic disruption | What are the risk factors for pericardial tamponade? |
| Hypotension (uncommon), neck vein distention, muffled heart sounds | What is the presentation of pericardial tampanade? |
| FAST US, CT if stable pt., esophagoscopy/bronchoscopy for mediastinal injuries | How is pericardial tamponade diagnosed? |
| Liver > Spleen | What organ in abdomen is most likely to be injured by blunt trauma? |
| hollow viscus | Penetrating trauma more likely to injure _______. |
| intrabdominal findings, neurologic, or distal vascular findings | Presentation of vascular abd. trauma? |
| 24% | What is the mortality rate for vascular abd. trauma? |
| penetrating trauma mostly, also blunt; left side b/c right protected by liver | When are diaphragm injuries seen? Where? |
| PE not focal, respiratory distress, bowel sounds in chest | How is a diaphragmatic injury diagnosed? |
| normal, elevated hemi-diaphragm, poorly defined hemi-diaphragm, hemothorax, pneumothorax, bowel in chest | What is seen on chest X-ray with diaphragm injuries? |
| not standard of care | CT in diaphragm injury? |
| 5 ml gross blood, RBC > 100,000 cells/mm3, RBC > 10,000 cells/mm3 for penetrating trauma, WBC > 500 cells/mm3, food particles, bile, feces, bacteria on gram stain, exit of lavage fluid via chest tube or bladder catheter, amylase 320 IU/L or alkaline phosphatase 33 IU | What are characteristics of a positive peritoneal lavage? |
| highly sensitive, less specific | Sensitivity/specificity of DPL? |
| Small bowel > large bowel > stomach | Commonality of damage to abd. hollow viscuses? |
| CT | Test of choice for retroperitoneal trauma? |
| blunt trauma; conservative | When do solid organ injuries take place? Management is _______. |
| CT | Study of choice for solid organ injuries? |
Combine with other sets
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