CBD 4: Trauma Flashcards

1
Q

Head injury.

a) Primary injury
b) Secondary injury

A

a) Coup

b) Contre-coup

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2
Q

Primary survey

A

Catastrophic bleeding control
Airway and c-spine control
Breathing
Circulation

https://patient.info/doctor/trauma-assessment#nav-0

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3
Q

Secondary survey

A

Head-toe injuries (non-life-threatening)

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4
Q

Imaging in trauma

A

Whole-body CT - gold standard (head, c-spine, chest, abdomen, pelvis, +/- limbs)
FAST (focused assessment with sonography for trauma)

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5
Q

Blood replacement

a) Quickest
b) If less urgent

A

a) O negative blood

b) Crossmatch

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6
Q

Haemothorax

a) Massive - define

A

a) Blood loss > 1.5 L or one-third of the blood volume, requiring a thoracotomy

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7
Q

Pneumothorax

a) Simple
b) Tension
c) Signs of a tension pneumothorax

A

a) No mediastinal deviation or compensation; usually resolve spontaneously
b) Accumulation of air in the pleural space under pressure under the creation of a one-way valve, compressing the lungs and decreasing venous return to the heart (hence reducing stroke volume; note: initially you can compensate with a tachycardia)
c) Tracheal deviation to contralateral side, apex beat displacement, ipsilateral reduced air entry, reduced chest expansion and hyper-resonance to percussion

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8
Q

Management of a tension pneumothorax

a) Initial
b) Then

A

a) Mid-clavicular line, 2nd ICS, above the rib (because below the rib is the neurovascular bundle)
b) Insertion of a chest drain - location?

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9
Q

Life-threatening chest injuries

- ATOM FC

A
  • Aortic disruption/airway disruption
  • Tension pneumothorax
  • Open pneumothorax (wound penetrating thoracic cavity)
  • Massive haemothorax
  • Flail segment (2+ consecutive ribs on same side fractured in 2+ places, so not moving with ventilation)
  • Cardiac tamponade
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10
Q

What is meant by permissive (balanced) resuscitation?

Should you fluid resuscitate?

A
  • Should give low-volume resuscitation to maintain his BP below the usual level but enough to perfuse vital organs
  • This prevents disruption of clotting in patients with active bleeding
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11
Q

Whole body CT

a) Indications
b) If indicated, should be performed within what period of time after arrival to resus?

A

a) - Abnormal observations
- Unable to properly assess clinical outcome (e.g. due to reduced GCS)
- Suspected spinal injury with sensory level

b) 30 mins

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12
Q

Femoral shaft fracture

a) Local anaesthetic
b) Splint

A

a) Femoral nerve block (lateral to femoral artery - NAVY VAN)
b) Thomas splint

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13
Q

John Thomas sign

A

Positive: penis pointing towards the hip fracture
Negative: penis pointing away from the hip fracture

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14
Q

Flail chest.

a) Define
b) Features

A

a) Fractures of 2 or more contiguous ribs in 2 or more locations, causing the creation of a ‘free segment’ in the thoracic cage.
b) Paradoxical chest wall movements, impaired ventilation, hypoxia

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15
Q

Head injury - who to CT

A

https://cks.nice.org.uk/head-injury#!scenario

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