Term
| % Thorocotomy in blunt trauma |
|
Definition
|
|
Term
| % Thorocotomy with penetrating trauma |
|
Definition
|
|
Term
| dislocation of sternoclavicular joint causes the following airway symptoms |
|
Definition
Stridor
Changes in voice quality
obvious trauma to the base of the neck |
|
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Term
| How to reduce a sternoclavicular dislo cation |
|
Definition
Extend shoulders
Grasp clavicle with a pointed clamp
Manually reduce fracture |
|
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Term
| Unusual cause of tension pneumothorax |
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Definition
|
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Term
| Where are chest tubes usually placed |
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Definition
| 5th interspace in the anterior axillary line |
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Term
| Mechanism of trauma leading to myocardial injury. |
|
Definition
Rapid deceleration injuries
Sternal trauma |
|
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Term
|
Definition
Tension pneumo
Cardiac tamponade
Severe hemorrhagic shock
Cardiac Rupture |
|
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Term
Type of trauma causing Massive Hemothorax.
What is injured that bleeds? |
|
Definition
Mostly from penetratng trauma
Disrupts systemic or hilar vessels |
|
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Term
| Hook up chest tube with massive hemothorax to |
|
Definition
| 38 fr and autotransfusion system |
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Term
| Probable indication for thoracotomy |
|
Definition
200ml/hr for 2-4 hours -
greater than 1500 cc on initial chest tube |
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Term
| Mechanism of cardiac tamponade |
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Definition
| Mostly penetration sometimes blunt |
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Term
| Becks triad for cardiac tamponade |
|
Definition
Distended neck veins -
Hypotension -
Muffled heart sounds - |
|
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Term
|
Definition
| A rise in venous pressure with inspiration |
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|
Term
| Indications for resuscitative thoracotomy |
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Definition
PEA or cardiac massage in penetrating trauma but not blunt trauma -
Left anterior thoracotomy is performed |
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Term
| 4 advantages of resuscitative thoracotomy |
|
Definition
1.Evacuation of pericardial blood -
2. direct control of bleeding -
3. Open massage -
- 4. Cross clamp if the descending aorta to slow blood loss below the diaphragm and inc perfusion to the brain and heart |
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|
Term
| Secondary survey 8 life threatening thoracic injuries |
|
Definition
Simple pneumothorax
-Hemothorax
-Pulmonary contusion
-Tracheal bronch tree injury
-Blunt cardiac trauma
-Traumatic aortic rupture
-Traumatic diaphragmatic injury---Mediastinal traversing injuy |
|
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Term
| Causes of simple hemothorax |
|
Definition
1. PENETRATING OR BLUNT TRAUMA
-2. Laceration of intercostals or internal mammary
-3. Thoracic spine dislocation |
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Term
| Where is blunt trauma to the tracheal-bronchial tree located? |
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Definition
| occur within 1 inch of the carina, usually DOA |
|
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Term
| Frequent signs of tracheobronchia tree injury |
|
Definition
hemoptysis
-subcu emphysema
-tension pneumo
-MORE THAN ONE CHEST TUBE NECESSARY |
|
|
Term
| 3 INJURIES FROM BLUNT CARDIAC INFJURY |
|
Definition
Myocardial muscle contusion
-Cardiac chamber rupture (usually leads to tamponade)
-Valvular rupture |
|
|
Term
| 2 Common causes of traumatic aortic rupture |
|
Definition
Auto collision
-fall from great height |
|
|
Term
| Surviviors of aortic disruption |
|
Definition
1. Incomplete laceration near the ligamentum arteriosum
2. Intact adventitial layer
3. Contained mediastinum hematoma |
|
|
Term
| Aortic disruption and hypotension in surviviors |
|
Definition
| rare because contained by hematoma |
|
|
Term
| % positiive angiograms with widened mediastinum |
|
Definition
|
|
Term
| High suspicon of aortic disruption |
|
Definition
History of deceleration injury
Characteristic 11 radiologic findings
Followed by angiography |
|
|
Term
| What % of widened mediastinum = abn angio |
|
Definition
|
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Term
| adjunctive radiologic signs of aortic disruption |
|
Definition
Widened mediatstinum
Obliteration of the aortic knob
Deviation of trachea to right
Obscuration of AP window
Depression of left main bronchus
Deviation of esaphogus and ng tube to the right
Widened paratracheal stripe
Presence of pleural or apical cap
Left hemthorax
Fractures of 1st or 2nd rib or scapula |
|
|
Term
| Aortic disruption and TEE |
|
Definition
| Useful and less invasive tool |
|
|
Term
| Aortic disruption and Helical contrast-enhanced CT of chest |
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Definition
| Accurate screening, if negative no need for angio, if positive need angio to assess extent of injury. |
|
|
Term
| Blunt vs penetrating results of diapragmatic injury |
|
Definition
Blunt - large radial tears
- Pentrating - small holes taking years to diagnose |
|
|
Term
| Define mediastinal transversing injuries |
|
Definition
| Penetrating objects that transverse the mediatinum diagnosed with careful examination of chest with entrance wound in one hemithorax and the exit or missiles found in the contralateral chest. |
|
|
Term
| Diagnosis of mediastinal transversing injuries |
|
Definition
Contrast helical CT or angiography
-If negative:
- Water contrast esophagoscopy
- esaphagoscopy
- Bronchoscopy
- CT or TTE of heart |
|
|
Term
| Overall mortality rate of mediastinal penetrating wounds |
|
Definition
|
|
Term
| %Mediastinal traversing injury with hemodynamic instability |
|
Definition
|
|
Term
More facts about mediastinal traversing wounds
% unstabe?
% requiring surgery? |
|
Definition
50% present hemodynamically unstable
- 30% have positive diagnostic evaluation warranting operative intervention. |
|
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Term
| Mechanisms and signs that lead the doctor to suspect blunt esaphageal rupture |
|
Definition
Left hemo or pneumothorax
- Severe blow to the lower sternum or epigstric area
- Particulate matter in chest tube
- Mediastinal air (get contrast study or esaphacoscopy) |
|
|
Term
| The pelvic cavity peritoneal components? |
|
Definition
| Contains both the peritoneal and retroperitoneal space |
|
|
Term
| Upper peritoneal cavity 5 organs (thoracoabdominal) |
|
Definition
Diaphragm
Liver
Spleen
Stomach
Transverse colon |
|
|
Term
| Lower peritoneal cavity contains 5 organs |
|
Definition
Small Bowel
Parts of ascending colon
Parts of descending colon
Sigmoid colon |
|
|
Term
| Blunt abdominal trauma - organs affected |
|
Definition
Spleen (40-55%)
Liver (35-45%)
Small Bowel (5-10%)
retroperitoneal hematoma (15%) |
|
|
Term
|
Definition
Liver 40%
Small Bowel 30%
Diaphragm 20%
Colon 15% |
|
|
Term
|
Definition
trajectory and kinetic energy favor bowel injury and vascular injury
Small bowel 50%
Colon 40%
Liver 30%
Abdominal Vascular Structures - 25% |
|
|
Term
| What % of stab wounds do not penetrate the peritoneum |
|
Definition
|
|
Term
| Penetrating injuries to buttocks |
|
Definition
| 50% incidence of intraabdominal injury |
|
|
Term
| Indication for diagnostic Peritoneal Lavage |
|
Definition
Hemodynamically abnormal patient with multiple blunt injuries esp.......
Change is sensorium central and spinal cord
Injury to lower ribs, pelvis and lumbar spine
Equivocal physical exam
Before transporting patient around the hospital
Abdominal wall contusion |
|
|
Term
| Relative contraindications to DPL |
|
Definition
Previous abdominal operations
Morbid obesity
Advanced cirrhosis
Preexisting coagulopathy |
|
|
Term
| What does FAST stand for? |
|
Definition
| Focused Assesment Sonography in Trauma |
|
|
Term
| FAST difficult to use with |
|
Definition
Subcu air
Obesity
Previous abdominal surgery |
|
|
Term
| mechanism and diagnosis of Pancreatic Injury |
|
Definition
Direct blow that compresses the pancreas against the vertebral column
Duble contrast CT may not identify injury in the first 8 hours |
|
|
Term
| Urological injuries with negative blood in urine |
|
Definition
Thrombosis of renal artery
- Disruption of renal pedicle secondary to deceleration injury (has severe abdominal pain) |
|
|
Term
|
Definition
Transverse ecchymosis on the abdominal wall.
- May lead to small bowel injury (look - for Chance fracture) |
|
|
Term
|
Definition
| Better choice to diagnose small bowel injury |
|
|
Term
| Lap Seat Belt - Compression injury describe organ systems involved. |
|
Definition
Tear or avulsion of mesentery
- Rupture of small bowel or colon
- Thrombosis of iliac atery or abdominal aorta |
|
|
Term
| Lap seat belt - Hyperflexion causes what kind of spinal injury? |
|
Definition
| Chance fracture of lumbar vertebrae |
|
|
Term
| Shoulder Harness - Submarining causes what type of injuries? |
|
Definition
Intimal tear of inominate,carotid, subclavian or vertebral artery
- Fraction dislocation of c-spine |
|
|
Term
| Shoulder harness - compression causes what type of injuries? |
|
Definition
Intimal tear or thrombosis in subclavian artery
-Rib fractures
-Pulmonary contusion
-Rupture of upper abdominal viscera |
|
|
Term
| Air bag (contact deceleration) causes what type of devastating injury? |
|
Definition
|
|
Term
| airbag Contact causes what kind of injuries? |
|
Definition
| eye injuries, face and neck injuries |
|
|
Term
| Worry about hip dislocation in what type of vehicle crashes? |
|
Definition
| deformation to the front of the vehicle from a head on collision |
|
|
Term
Bent steering wheel
deformation of the dashboard
damage to the windscreen |
|
Definition
Sternal
clavicular
spinal
hip dislocation |
|
|
Term
|
Definition
| signal must have a triphasic quality to assure no proximal lesion. |
|
|
Term
| Doppler ankle/brachial index |
|
Definition
| less than.9 is indicative is indicative of abnormal flow. |
|
|
Term
| Calculation of the ankle/brachial doppler index |
|
Definition
| Doppler ststolic pressure of the injured ankle divided bt the doppler systolic pressure of the normal brachial artery. |
|
|
Term
| The only reasons not to get x-rays prior to treatment of a dislocation especiallt ankles |
|
Definition
Vascular compromise
Impending skin breakdown |
|
|
Term
| Lateral force to the pelvs |
|
Definition
| Closes down the pelvic volume, however the pubis is driven into the lower gu system creating injury to the bladder and urethra |
|
|
Term
|
Definition
| Occasionally disrupts the iliac system |
|
|
Term
| Indication of pelvic instability |
|
Definition
Leg length instability
Usually external rotation of the leg.
Muscular pull and gravity |
|
|
Term
| Techniques to stabilize pelvic fractures |
|
Definition
Longitudinal traction through the skin and bones
Internal rotation by
1. Sheet wrapped around the pelvis as a sling
2. a vacuum type long spine splinting device
3. PASG |
|
|
Term
| How many hours can a muscle tolerate ishemia? |
|
Definition
|
|
Term
| Arteriography and the avascular extremity |
|
Definition
| arteriography must not be delay reestablishing arterial blood flow and is only indicated after surgical consultation. |
|
|
Term
| Which fractures are at high risk for compartment syndrome? |
|
Definition
tibia;
-and forearm fractures |
|
|
Term
| Status of pulses in compartment syndrome |
|
Definition
| Loss of pulses are a late sign |
|
|
Term
| Tissue pressures associated with compartment syndrome |
|
Definition
|
|
Term
| Clinical indications of inhalation injury include |
|
Definition
FACE AND OR NECK BURNS -
Singing of eyebrow and nasal hair -
Carbon deposits and acute inflammatory changes in the oropharynx -
Hoarsness -
Impaired mentation or confinement in a burning environment -
Explosion with burns to head and torso -
Carboxhemoglobin levels greater than 10% |
|
|
Term
| Burn % requiring circulatory support |
|
Definition
|
|
Term
| CO levels causing headache |
|
Definition
|
|
Term
| CO levels causing confusion |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| How to reduce neck and chest edema |
|
Definition
| Head of the bed 20 to 30 % |
|
|
Term
| Important concept about pelvic fractures. |
|
Definition
| Unexplained hypotension may be the only initial indication of major pelvic disruption with instability in the posterior ligamentous complex. |
|
|
Term
| Most important physical signs of pelvic fracture |
|
Definition
Progressive:-
Flank
scrotal
or perianal swelling or bruising |
|
|
Term
| Signs of pelvic ring instability |
|
Definition
Open fracture wounds about the pelvis -
High riding prostate gland -
Blood at the urethral meatus -
Demonstratable machanics instability- |
|
|
Term
| Indications of pelvic ring instability |
|
Definition
| Leg length discrepancy or rotational deformity (usually external) - |
|
|
Term
| Mechanical stabilization of the pelvis |
|
Definition
External counter pressure with pneumatic antishock garment -
Longitudinal traction applied throgh the skin -
Internal rotation by:
Sling the pelvis -
A vacuum type long spine splinting device
An Neann Vacmat Vacuum Mattress has been purchased by Colac Branch for the transportation of trauma patients over long distances. The splint is made up of a tuff tarp type outer skin filled with tiny balls about 1 mm in diameter. The mattress is placed under the patient and then air is sucked out of the splint to form a rock hard device that prevents body movement. The mattress is used for patients being transferred with spine, pelvic and leg injuries. |
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