Trauma
Terms
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- What is the most common cause of shock in the trauma patient?
- hemorrhagic
- A young patient is in a car crash and arrives unresponsive and intubated. His blood pressure is 70/30 and his pulse is 60. What are potential causes of shock?
- Hemorrhagic, since he is a trauma patient, but you should consider neurogenic shock, as he is a young patient and has not generated a tachycardic response. If his shock was cardiogenic you would expect tachycardia.
- What are the NEXUS criteria for clearing the C spine clinically?
- No neuro deficit, no posterior tenderness, no intoxication, no distracting injury, normal mental status
- What is the leading cause of death and disability in trauma patients?
- head injury
- A patient suffers a head injury, loses consciousness, wakes up briefly, and lapses into unconsciousness again. She has a fixed and dilated pupil on one side and contralateral hemiparesis. What is her diagnosis?
- Epidural hematoma
- What are clinical features of concussion, and how do they differ from cerebral contusion?
- Concussion often involves a brief loss of consciousness, headache, vomiting, and perseveration, but no localizing signs. Contusion patients often demonstrate confusion, altered level of consciousness, and may have localizing signs.
- A patient has neck pain after diving into a shallow pool. The cross-table lateral x-ray of the c-spine looks normal. what is the injury?
- Jefferson fracture, which is a burst fracture of C1 and is best seen on open mouth odontoid view.
- What are the different types of dens fractures, and which carries the worst prognosis?
- Type 1 involves the tip, Type 2 traverses the dens at the junction with the body of C2, and Type 3 involves the vertebral body of C2. Type 2 has the worst prognosis.
- A patient is struck in the eye with a baseball. They appear to have an inferior wall blow-out. What muscles are at risk for entrapment, and what other injuries should you consider?
- Inferior rectus and inferior oblique are at risk for entrapment. Up to 30% of patients with blowout fractures have associated ocular injuries, such has globe rupture or hyphema.
- A trauma patient has hypotension, SOB, and tachycardia. They have decreased breath sounds on the right. What is the next thing you should do?
- Do a needle decompression of the right side, then do the chest tube.
- A patient has an open chest wound that is 2 inches in diameter. The patient is hypoxic. How do you treat the wound?
- Apply an occlusive dressing to the wound. Air will preferentially travel through the sucking chest wound if it is 2/3 the diameter of the trachea or more. You should then place a chest tube distant to the site of the wound.
- What is the most common potentially life-threatening chest injury?
- pulmonary contusion
- How soon after an injury will you see a pulmonary contusion on x-ray?
- immediately up to 6 hours.
- In which kind of drowning is surfactant inactivated, salt water or freshwater drowning?
- Freshwater drowning
- Wnat are the causes of an epidural hematoma, and what is the characteristic CT finding?
- trauma to the head with skull fracture over the temoral area, causing a laceration to the middle meningeal artery. It can also be from a dural sinus tear, or bleeding from the fracture site, but this is rare. CT shows a focal, smooth, lenticular (biconvex) high density accumulation adjacent to the bone, often with mass effect.
- What are some common complications of chest tube insertion?
- damage to intercostal nerve, artery, vein, laceration or puncture of thoracic or abdominal organs, extrathoracic tube placement, infection, persistent pneumothorax.
- what is the most common cause of traumatic head injury in kids less than 2 years old?
- abuse
- What is the most common cause of fetal mortality in trauma involving a pregnant woman?
- abruption.
- A 24 week pregnant woman comes in from an accident boarded and collared. Her BP is 85/60. She is awake and alert. What is the first thing you should do?
- Tilt the backboard 15 degrees to the left to displace the fetus from the IVC.
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what is the first thing you should do if you see this xray? - needle decompress the chest, then place a chest tube.
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this patient has a normal blood pressure and a sat of 92%. What is the appropriate treatment for his condition? - Placement of a chest tube.
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What injuries are associated with this fracture? - Urethral injury, bladder injury, hip injury
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What can you do to prevent hemorrhagic shock in this patient? - Apply MAST trousers or tie a sheet around the patient's pelvis
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What is the injury? - Pubic rami fractures
- What is the most common cause of pediatric death due to injury?
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Head injury
<1, suffocation
>1, MVA - Which anatomic differences predispose children to head trauma?
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Proportionately larger head,
Largely ligamentous neck (not fully developed neck bones), Incompletely myelinated brain (ÿ susceptibility to shearing forces) - Why are younger children able to tolerate increased intracranial pressures?
- Cartilaginous skulls and open fontanelles.
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What is the primary difference between c-spine injuries in adults and children? Why?
*Injuries in children < 12 y/o are typically between the occiput and C2
*Injuries in adolescents and adults are typically lower
*Spines of children -
*Injuries in children < 12 y/o are typically between the occiput and C2
*Injuries in adolescents and adults are typically lower
*Spines of children have ligamentous laxity, underdeveloped supporting muscles, partially ossified and wedge-shaped vertebrae, horizontal facet joints, higher fulcrum of flexion, instability of atlantooccipital joint - What is the most commonly injured abdominal organ in children?
- Spleen. Liver is second most common.
- Are splenic injuries usually worse in children or adults? Why?
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*Adults
*Spleen in children has a thicker capsule and larger amounts of elastin and smooth muscle in both the capsule and the splenic vessels - What is the most common cause of acute pancreatitis in children?
- Trauma from handlebar injuries
- What is the lap-belt complex?
- Intestinal or mesenteric injury with concomitant lumbar spine injury due to a lap belt
- What tools are available to assess and triage pediatric trauma patients for transport?
- Pediatric Trauma Score and Revised Trauma Score
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a patient has amputated his dominant thumb. you are transferring him to a replantation center. how do you store the thumb?
a. put it in a bag, and put that bag in a bag of icewater.
b. put it in a bag of icewater.
c. put it on ice.
d. - a. tissue should be wrapped in sterile moist gauze, placed in a bag, and that bag should be placed in a bag of icewater. do not freeze tissue.
- a man accidentally cut off his ear while in a remote area. he was able to cool it adequately, but the injury was 7 hours ago. can it be replanted?
- ears can be replanted out to 24 hours.
- which can tolerate ischemia time better, a penis or an arm?
- a penis. tissue can tolerate ischemia inversely proportional to the amount of muscle in the tissue. the penis has no muscle, contrary to it's moniker "love muscle."