Term
| What is the leading cause of death in ages 0-40 in developed countries? |
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Definition
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Term
| What do you say during the test as you enter and approach the patient? |
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Definition
| "I have universal precautions for myself and my team" |
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Term
| Fisrt examination of the patient? |
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Definition
"What is your name?"
If the patient can answer, you have examined the airway, breathing and circulation. A patient who can complain is a healthy patient. |
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Term
| Why do patients need early gastric decompression? |
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Definition
1. Trauma patients aren't usually fasting for you, and are aspiration risks.
2. They may have been bag-ventilated in the field, and gotten a lot of air forced into their stomaches. This air can cause vagal over stimulation. |
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Term
| What are the AMPLE components to a history? |
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Definition
Allergies
Medications
Past illnesses/Pregnancy
Last meal
Events/environment/mechanism
This is 'key' history. Get what you can... |
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Term
| How do you diagnose a mid-face fracture? |
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Definition
| Grab the incisors and pull. |
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Term
| Trauma patient has horseness? What are you worried about? |
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Definition
| Pneumothorax. Subcutaneous air could have migrated up to the neck and be irritating the vocal cords/nerves. |
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Term
| 3 PE signs of pelvic (not urethral) injury: |
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Definition
1. Pain on palpation
2. Unstable pelvis
3. Unequal leg length |
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Term
| Airway: what do you do first? |
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Definition
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Term
| What 3 pieces of evidence do we need to verify that the cuff is inflated below the vocal cords? |
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Definition
1. bilateral breath sounds
2. CO2 return
3. CXR showing ET tube ~ 4 cm above the carina |
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Term
| In a difficult airway, what non-definitive adjunct may be helpful? |
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Definition
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Term
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Definition
| From the book: "an abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation." 9th edition. |
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Term
| What is the most common cause of shock in the trauma patient? |
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Definition
| Hemorrhage. (= hypovolemic shock) |
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Term
| Pt comes to the trauma bay, he/she is cool and tachycardic. What is his/her diagnosis? |
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Definition
| Shock until proven otherwise. |
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Term
| What determines how much resuscitation you give? |
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Definition
|
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Term
| What are the resuscitation guidelines for pedi patients? |
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Definition
20 ml/kg of crystalloid
10 ml/kg of blood product |
|
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Term
| What blood loss volume is your threshold for giving blood products? |
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Definition
| 1500 ml. Less than 1500 ml is still class I and II shock. |
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Term
| What stage shock do you see a decrease in blood pressure? |
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Definition
| Stage III shock, when the pt has lost between 1500 and 2000 ml of blood. |
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Term
| What mental status can you expect in stage III shock? |
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Definition
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Term
| Book: If you believe your patient has a tension pneumothorax, do you wait for radiologic confirmation? |
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Definition
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Term
| What are 6 life threatening thoracic trauma injuries identifed on primary survey? |
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Definition
1. Airway obstruction
2. Tension pneumothorax
3. Open pneumothorax
4. Flail chest and pulmonary contusion
5. Massive hemothorax
6. Cardiac tamponade |
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Term
| 8 only slightly less life threatening injuries identified on secondary survey (thoracic)? |
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Definition
1. Simple pneumo
2. Hemothorax
3. Pulmonary contusion
4. Tracheobronchial tree injury
5. Blunt cardiac injury
6. Traumatic aortic disruption
7. Traumatic diaphragmatic injury
8. Blunt esophageal rupture |
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Term
| What should you always do during airway assessment that involves removing the C collar? |
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Definition
| Look at the trachea for deviation. |
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Term
| How can you tell between tension pneumo and tamponade? |
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Definition
**Tension pneumo will have no breath sounds on one side, while a tamponade should still have breath sounds**
Also, a tension pneumo should be hyperresonant, and have a deviated trachea contralateral to the decreased breath sounds.
Tamponade: May have distended neck veins, may have a pericardial rub. Good luck with that... |
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Term
| Dr. Jackson, the patient needs an ER thoracotomy! Will you do it?? |
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Definition
| NO! I have not had sufficient training. ER thoracotomies are only indicated when a surgeon with the appropriate training is performing them. |
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Term
| What is the least likely mechanism of injury to benefit from an ER thoracotomy? |
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Definition
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Term
| Why is the patient with flail chest in danger? |
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Definition
| Because underneath the flail chest is probably a massive pulmonary contusion. Alveoli that are full of blood and inflammation cannot participate in gas exchange, leading to hypoxia and hypercapnia. |
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Term
| Congradulations! You put your first chest tube in! What are you going to do now? |
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Definition
| Get a CXR, and then start over at ABCDE. |
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Term
| You put your chest tube in but there is still a pneumo!! DDx? |
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Definition
1. Tracheobronchial tree injury
2. Air leak
3. Tube not working for some reason, check system. |
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Term
| Your blunt trauma patient is not responding with resuscitation. Fast, DPL, and CT have ruled out bleeding. What could it be? |
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Definition
| Blunt cardiac injury. You can diagnose this with echo, and if it is present just give it time to heal. Though you may need ionotropes until then... |
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Term
| So, you have a widened mediastinum and aortic capping (no distinct aortic knob). What should you look at to further your hypothesis of aortic disruption? |
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Definition
| Look for L mainstem bronchus depression. |
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Term
| What are adjuncts used in the secondary survey of the chest? |
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Definition
1. CXR (may have been done as a part of the primary survey work up)
2. ABG
3. Pulse ox
4. ECG monitoring |
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Term
| Cause of prevenatble death after truncal trauma? |
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Definition
| Unrecognized abdominal and pelvic injuries. |
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Term
| What space do we always forget about that is really a bitch? |
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Definition
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Term
| 4 common blunt trauma abd/pelvic injuries: |
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Definition
Liver
Spleen
Small bowel
Pelvic |
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Term
| True or False? Gunshot wounds damage tissue by kinetic energy. |
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Definition
| True. This is why there is increased damage around the track as compared to stab wounds. |
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Term
| True or False? You can look at entry and exit wounds and get a general sense of the organs involved in the injury. |
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Definition
| False. You don't know where that bullet been. |
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Term
| Four patients that get a lap: |
|
Definition
1. Free air under the diaphragm.
2. Diaphragmatic rupture
3. Peritonitis
4. Violation of the peritoneal cavity |
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Term
| Pt rolls in to the trauma bay. Fast is positive, and they are hemodynamically unstable. What next? |
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Definition
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Term
| Pt rolls in to the trauma bay. CT shows SMA extrav, and they are hemodynamically unstable. What next? |
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Definition
|
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Term
| What is the FAST not very good at detecting? |
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Definition
| small bowel, pancreas, or diaphragm injuries |
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Term
| What can a DPL help you diagnose? |
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Definition
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Term
| When would you give your patient rectal as well as IV contrast in the trauma bay? |
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Definition
| When you suspect colon injury. This might be in the case of flank ecchymoses. |
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Term
| Unstable pelvis in a rural hospital. What do you do? |
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Definition
| Bind the pelvis tightly with a sheet. Binding the thighs and ankles can also help. |
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Term
| What GCS is a trigger for intubation? |
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Definition
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Term
| Hypertension and closed head injury: |
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Definition
| early sign of herniation? |
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Term
| You get a CXR that shows your ER intubation is 4 cm above the carina. Can you congradulate yourself yet? |
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Definition
| No. You must also have end tidal CO2, and bilateral breath sounds. |
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Term
| What is the COD in shock? |
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Definition
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Term
| What metabolic disturbance can you get with normal saline resuscitation? |
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Definition
| Hyperchloremic metabolic acidosis. Apparently all that chloride dilutes the bicarb. Hmm. |
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Term
| A 33 wk pregnant pt is admitted s/p MVC. Her PaCO2 is 40. That's normal, right? |
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Definition
| Wrong. As pregnancy progresses, women have a permissive hypocapnia because they have an increased respiratory rate. In a very pregnant patient, a PaCO2 of 40 is hypercapnia. |
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Term
| How do you get the baby off the IVC? |
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Definition
| Turn the woman onto her left side. |
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Term
| Why do we put long bone injuries into traction? |
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Definition
| To minimize bleeding. (No clue why that works.) |
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Term
| Limb threatening injuries are characterized by: |
|
Definition
1. Vascular compromize
2. Severely crushed tissue
3. Impending compartment syndrome |
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Term
| Pt has frostbite. What do you do? |
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Definition
| Rapid rewarming with moist heat. |
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Term
| Your pediatric patient needs a surgical airway, what is the best way to do that? |
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Definition
| Needle cricoidostomy with jet insufflation. |
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Term
| You just placed an ET tube in your rural ER. Pt has been approved for transfer. You don't have to wait on anything but your ______ before transfer. |
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Definition
| CXR confirming tube placement. You cannot transfer a patient with a bad intubation. |
|
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Term
| What are the categories of the GCS? |
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Definition
| Eye opening, verbal response, and best motor response |
|
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Term
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Definition
| eye is 1-4. No response is one, opening to pain is 2, opeing to speech is 3, spontaneous opening is 4. |
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Term
| What are the VERBAL scores? |
|
Definition
no verbal is 1
incomprehensible sounds are 2
inappropriate words are 3
confused conversation is 4
Oriented is 5 |
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Term
| What are the MOTOR scores? |
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Definition
none is a 1
extension (decerebrate) is 2
abnormal flexion (decorticate) is 3
Flexion withdrawal to pain is 4
localization of pain is 5
obeying commands is 6 |
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|
Term
| Two things that have to happen with transfer: |
|
Definition
1. The referring and receiving doctor must talk
2. Appropriate resuscitation like personel and blood products must be sent along with the transfered patient. |
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Term
|
Definition
| All pregnant Rh-negative trauma patients should receive Rh immunoglobulin therapy unless their injury is remote from the uterus. |
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Term
| True or false? Because of their increased intravascular volume, pregnant patients can lose a significant amount of blood without damage to themselves or the fetus. |
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Definition
| False. Bc of the increased intravascular volume, they can lose a lot of blood before their vital signs reflect that loss. Thus, the fetus may be in distress and the placenta deprived of vital perfusion while the mother's condition and vital signs appear stable. |
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Term
| True or false? An elevated white count is worrisome in a pregnant patient. |
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Definition
| False. Pregnant patients may have a low grade elevated WBC count. If it is 27k, no that's not normal, but 12 or 13k should not sound the alarm bells. |
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|
Term
| How low can a normal PaCO2 be in a pregnant woman? |
|
Definition
| 25-30 mmHg says this book. Dang. |
|
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Term
| Do kids get as many laps as adults? |
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Definition
| No. Kids are better at healing with non-op treatment. Though, if they are unstable or non-responders to resuscitaiton, and there is evidence of bleeding, they should get an operation. |
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|
Term
| What is the most common immediately life threatening injury in children? |
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Definition
| Tension pneumothroax. The mobility of mediastinal structures makes a child more susceptible to this process. |
|
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Term
| What is that tape that you lay out next to the pedi trauma patient? |
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Definition
| The Broselow Pediatric Emergency Tape. It has rapid determination of weight based on length, appropriate fluid volumes, drug doses, and equipment size. |
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Term
| What is the rule of nines? |
|
Definition
| The adult body is is generally divided into surface areas of 9% each and or fraction or multiples of 9% |
|
|
Term
| Does the rule of nines work for children? |
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Definition
| Kind of. The infant's or young child's head represents a larger proportion of the surface area, and lower extremities represent a smaller proportion than the adult. |
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|
Term
| Don't forget internal injuries just bc a pt is burned. |
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Definition
| Associated injuries can be sustained while the victim is attemting to escape, there can also be blast injuries. |
|
|
Term
| What do you always think about with a burn patient??? |
|
Definition
| INHALATION INJURY. You should intubate them. |
|
|
Term
|
Definition
| Immediate removal of clothing to prevent further injury, as well as copious irrigation. |
|
|
Term
| How much resuscitation do burn patients need? |
|
Definition
| 2-4 ml LR/kg/%BSA of deep partial-thickness and full thickness burns durin the first 24 hours to maintain adequate circuating blood volume. Calculate your number, give it with the first half to be delivered in the first 8 hours, and watch urine output. If your UOP is fine, your resuscitation is fine. If UOP does not respond, increase your resuscitation. |
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|
Term
| Outside the OR, hemorrhage control is best effected by: |
|
Definition
| well-aimed direct pressure. |
|
|
Term
| A doppler ankle/brachial index of less than ____ is indicative of an abnormal arterial flow 2/2 injury or peripheral vascular disease. |
|
Definition
| 0.9. It means that there is significantly less flow in the legs than the arms. |
|
|
Term
| True or false? All patients with open fractures should be treated with intravenous abx as soon as possible. |
|
Definition
|
|
Term
| 3 important spinal tracts of ATLS: |
|
Definition
the corticospinal tract
the spinothalamic tract
the dorsal columns |
|
|
Term
| What do we call no demonstrable sensory or motor function below a certain spinal level? |
|
Definition
| A complete spinal cord injury. As we know from Downton Abbey, during the first weeks after injury, this diagnosis cannot be made with certainty, because of the possibility of spinal shock. |
|
|
Term
| Where is the corticospinal tract? |
|
Definition
| In the posterolateral segment |
|
|
Term
| What does the corticospinal tract do? |
|
Definition
| Controls motor power on the ipsilateral body. |
|
|
Term
| Where is the spinothalamic tract? |
|
Definition
| In teh anterolateral cord |
|
|
Term
| What does the spinothalami tract do? |
|
Definition
| transmits pain and temperature from the contralateral body. |
|
|
Term
|
Definition
| These are located in the posteromedial aspect of the cord, and control proprioceptive and light-touch information from the ipsilateral body. |
|
|
Term
| ________ shock results from impairment of the descending sympathetic pathways in the cervical or upper thoracic spinal cord. |
|
Definition
| Neurogenic. This condition results in the loss of vasomotor tone and in sympathetic innervation to the heart. |
|
|
Term
| Classic sign of uncal herniation? |
|
Definition
| Ipsilateral pupillary dilation a/w contralateral hemiparesis. |
|
|
Term
| How many times do you scan the head? |
|
Definition
| Twice in pts with cerebral contusions, second scan within 24 hours. We need to make sure that it is not evolving. |
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