Emergency Trauma Management: A Comprehensive Guide, Exams of Nursing

Download Emergency Trauma Management: A Comprehensive Guide and more Exams Nursing in PDF only on Docsity!

Chapter Review

Questions

for the

ATLS

Student Course

Manual

Chapter 1 Initial Assessment and Management

A cast-cutter should be used to remove a trauma victim's helmet if there is evidence of a C-spine injury or if. the patient experiences pain or paresthesias during an initial attempt to remove the helmet. The "A" in ABCDE stands for. Airway; however, always be cautious about and protect the cervical spine. Any patient who is cool and tachycardic is considered to be until proven otherwise. in shock The definition of tachycardia depends on the patient's age. What heart rate is considered tachycardic for infants, toddlers/preschoolers, school age/prebuscent, and adults? Infants > 160, toddlers/preschoolers > 140, school age/prepubescent > 120, and adults > 100 Compensatory mechanisms may preclude a measurable fall in systolic blood pressure until up to % of the patient's blood volume is lost. 30% What is the trauma triad of death? The trauma triad of death is the combination of hypothermia, coagulopathy, and acidosis. Severe hemorrhage in trauma diminishes oxygen delivery, and may lead to hypothermia. Hypothermia, in turn, can halt the coagulation cascade, which exacerbates the hemorrhage. Since tissues are hypoperfused, anaerobic metabolism increases, causing the release of lactic acid and other acidic compounds. Such an increase in acidity can reduce myocardial performance, further exacerbating tissue hypoperfusion. And so, the viscious cycle continues, ultimately ending in death ... unless someone trained in ATLS intervenes. A patient may be abusive and belligerent because of , so don't just assume it's due to drugs, alcohol, or that he is a jerk. hypoxia

Describe the Glasgow Coma Scale (GCS). A patient opens her eyes only to painful stimuli, utters inappropriate words, and localizes pain. What is her GCS score? E = 2 V = 3 M = 5 Therefore, GCS = 2+3+5 = 10 Patients with a GSC of less than usually require intubation. 9

What information is in an “AMPLE” patient history? A = Allergies M = Medications P = PMH/Pregnancy L = Last meal E = Events/Environment of injury When is this done? During the secondary survey. You should assume that any patient with multisystem trauma and altered level of consciousness, or blunt injury above the clavicle, has what type of injury? Cervical spine injury. How can you clear the C-spine without imaging? The C-spine can be cleared clinically if the patient: is awake, alert, and sober; has no distracting injuries; has no neurological deficits referable to the cervical spine; has no midline neck pain or tenderness on palpation; and can flex, extend, and laterally rotate his head to both sides without pain. Otherwise, when would C-spine films be obtained? During the secondary survey. When should most images be obtained? During the secondary survey. There are a small number of exceptions (see next question). What imaging is done during the primary survey? CXR and pelvis films (both AP views), and FAST scan. What should you do for every female patient of childbearing age? Pregnancy test.

What possible injuries would you suspect with a frontal impact automobile collision? Head trauma, cervical spine fracture, anterior flail chest, myocardial contusion, pulmonary contusion, pneumothorax, hemothorax, traumatic aortic disruption, fractured spleen and liver, posterior fracture/dislocation of hip and knee. Size of needle for needle cricothyroidotomy? 12 gauge Size of needle for needle thoracentesis? 14 gauge Size of needle for peripheral IV? 16 gauge Size of needle for pericardiocentesis? 18 gauge (spinal needle)

Chapter 2 Airway and Ventilatory Management

What two places would you look at on a patient if you suspected hypoxemia? Lips and fingernail beds Can a patient breathe on his own after complete cervical cord transection? Yes, if the phrenic nerves (C3-C5) are spared (“C3, 4, 5 keep the diaphragm alive”). This will result in "abdominal" breathing. The intercostal muscles will be paralyzed though. The proper size ET tube for an infant is. The same size as the infant's nostril or littlefinger. (usually size 3 for neonates; 3. for infants) How do you calculate what size ET tube to use for children? Internal diameter = (age / 4) + 4 mm What size cuffed endotracheal tube do you use for an emergency cricothyroidotomy? 5 or 6. Patients with tension pneumothorax and patients with cardiac tamponade may present with many of the same signs. What findings will you see with a tension pneumothorax that you will not see with tamponade? Absent breath sounds and hyperresonance to percussion over the affected hemithorax; and tracheal deviation away from the affected hemithorax. Immediate thoracic decompression is warranted for anyone with absent breath sounds, hyperresonance to percussion, tracheal deviation, , and. acute respiratory distress and subcutaneous emphysema

Chapter 3 Shock

The most effective method of restoring adequate cardiac output and end-organ perfusion is to restore venous return to normal by locating and stopping the source of , along with appropriate repletion. bleeding; volume Any injured patient who is cool and has tachycardia is considered to be until proven otherwise. in shock Hypotension is caused by until proven otherwise. hypovolemia Tachycardia is diagnosed when the heart rate is greater than beats per minute (BPM) in infants, BPM in preschool children, BPM in children from school-age to puberty, and BPM in adults. 160 BPM in an infant, 140 BPM in a preschool-aged child, 120 BPM in children from school age to puberty, and 100 BPM in adults. Elderly patients may not exhibit tachycardia in response to hypovolemia because of limited cardiac response to catecholamines. Why else? They may be on beta-blockers, or have a pacemaker. When you don't have a blood pressure, what are three things to look for when evaluating perfusion.

1. Level of consciousness (brain perfusion)
2. Skin color (ashen face and grey extremities)
3. Pulses (bilateral femoral – thready and rapid) Which arm should you not place a pulse oximeter? The arm with a blood pressure cuff attached. Elderly patients have a limited ability to to compensate for blood loss. increase heart rate

Urinary catheters are good for assessing renal perfusion and volume status. List 5 signs of urethral injury that might prevent you from inserting one. Blood at urethral meatus, perineal ecchymosis, blood in scrotum, high-riding/non-palpable prostate, and pelvic fracture The most common cause of shock in the injured trauma patient is. hemorrhage Base deficit and/or levels can be useful in determining the presence and severity of shock. lactate Massive blood loss may produce acute decrease in the hematocrit or hemoglobin concentration. only a minimal Why might you want a Bair Hugger for a patient who smells of alcohol? Alcohol ingestion causes vasodilation, which can lead to hypothermia. Vascular access must be obtained promptly. This is best accomplished by inserting two large-caliber (minimum of -gauge in an adult) peripheral intravenous catheters before placement of a central venous line is considered. 16-gauge Resuscitation fluids should be warmed to 39 degrees Celsius (102.2 F). Can you use a microwave oven to do this? Yes, for crystalloids only (but not for blood products). What things are you looking for when you perform a digital rectal exam (DRE) in a trauma patient? Blood, tears, high-riding prostate (in males), and sphincter tone. Adult patients should maintain urine output of at least? Adults 0.5 mL/kg/hr (children 1.0 ml/kg/hr).

How does shock reduce the total volume of circulating blood? Anaerobic metabolism --> insufficient ATP --> endoplasmic reticulum damage, then mitochondrial damage --> lysosomal rupture --> sodium and WATER enter cells (which swell and die) --> decreased intravascular volume Which vasopressors should you use to treat hemorrhagic shock? Trick question. Never use vasopressors for hypovolemicshock - use volume replacement. Pressors will worsen tissue perfusion in hemorrhagic shock. Approximately % of total blood volume is in the veins. 70% What physical signs suggest pericardial tamponade? Beck's Triad: JVD, muffled heart sounds, and hypotension (resistant to fluid therapy). Also likely is tachycardia. Can isolated intracranial injuries cause neurogenic shock? No. How do you calculate total blood volume in an adult? 70 mL per kg ideal weight. E.g. a 70 kg person has about 5 liters of circulating blood (70 x 70 = 4,900 mL). How do you calculate total blood volume in a child? 80-90 mL per kg ideal weight. The blood volume of an obese person is calculated based on their weight. ideal Fluid replacement should be guided by , not simply by the initial classification of hemorrhage (classes I-IV). the patient's response to initial fluid therapy How much blood volume is lost with class I hemorrhage? Up to 15%. Donating 1 pint, or ~500 mL, of blood is about a 10% volume loss and would qualify as class I hemorrhage.

How do you treat a class I hemorrhage? You don't (usually). Transcapillary refill and other compensatory mechanisms usually restore blood volume within 24 hours. How much blood volume is lost with class II hemorrhage? 15-30% (750-1500 mL in a 70 kg adult). How do you treat a class II hemorrhage? Usually only with crystalloids. Subtle CNS changes such as anxiety, fright, and hostility would be expected in a patient with a class hemorrhage. II How much blood volume is lost with class III hemorrhage? 30-40% (2000 mL in a 70 kg adult). A class hemorrhage represents the smallest volume of blood loss that is consistently associated with a drop in systolic blood pressure. III A patient with inadequate perfusion, marked tachycardia and tachypnea, significant mental status change, and a measurable fall in systolic blood pressure likely has a class hemorrhage. III or IV. These patients almost always require a blood transfusion, which depends on their response to initial fluid resuscitation. The first priority is stopping the hemorrhage. How much blood volume is lost with class IV hemorrhage? More than 40%. Unless very aggressive measures are taken, the patient will die within minutes. Loss of more than % of blood volume results in loss of consciousness. 50% Up to mL of blood loss is commonly associated with femur fractures. 1500 mL

Unexplained hypotension or cardiac dysrhythmias (usually bradycardia from excessive vagal stimulation) are often caused by , especially in children. gastric distention How much crystalloid should you give an adult as an initial fluid resuscitation bolus? 2 liters How much crystalloid should you give a child as an initial fluid resuscitation bolus? 20 mL/kg (may repeat and give as much as 60 mL/kg). But, with a high reserve in children, if in shock they should get blood sooner rather than later. Each mL of blood loss should be replaced with mL of crystalloid, thus allowing for replacement of plasma volume lost to interstitial and intracellular spaces. 3 mL "Blood on the floor and four more" is a memory aid for searching for occult blood loss where? Chest; abdomen and pelvis; retroperitoneum; and thigh. For children under 1 year of age, urinary output should be mL/kg/hr. 2 Would patients in early hypovolemic shock be acidodic or alkalotic? Alkalotic - respiratory alkalosis from tachypnea. Then metabolic acidosis from hypoxia ensues. "Rapid responders," i.e. those whose vital signs return to normal (and stay there) after fluid resuscitation likely have had a class hemorrhage. I or II "Transient responders" are associated with class hemorrhage. II or III

What is the differential diagnosis for "non-responders" following fluid resuscitation? Non-hemorrhagic causes, e.g. tension pneumothorax, pericardial tamponade, cardiac contusion, MI, acute gastric distention, neurogenic shock, etc. Most patients receiving blood transfusions need calcium replacement. True or false? False. How long can an intraosseous (IO) line be kept in? Intraosseous infusions should be limited to emergency resuscitation and shoud be discontinued as soon as other venous access is obtained. How should you position the patient when inserting a subclavian or internal jugular line? Supine, trendelenburg (head down) at 15 degrees to distend the veins and prevent air embolism, and turn the head away from you (and only if the C-spine has been cleared). Where is an incision for a saphenous vein cutdown made and how long should the incision be? The saphenous vein can be accessed approximately 1 cm anterior and 1 cm superior to the medial malleolus. Make a 2.5 cm transverse incision through the skin, taking care not to injure the vein.

Chapter 4 Thoracic Trauma

A patient arrives in the trauma bay intubated and there are absent breath sounds over the left hemithorax. Where should you place your decompression needle? Trick question. This may not be a pneumothorax. For relatively stable intubated patients always suspect a right main stem bronchus intubation before attempting needle decompression. Where would you insert a large caliber needle to decompress a tension pnuemothorax? Through the 2nd intercostal space in the midclavicular line of the affected hemithorax. For an open pneumothorax (sucking chest wound), air passes preferentially through the chest wall defect (least resistance) if the diameter of the defect is at least the diameter of the trachea. 2/ Flail chest results from multiple rib fractures. By definition, this would be or more ribs, fractured in or more places. 2 or more ribs fractured in 2 or more places Flail chest is invariably accompanied by which can interfere with blood oxygenation. Pulmonary contusion - do not over-fluid resuscitate these patients. Both tension pneumothorax and massive hemothorax are associated with decreased breath sounds on auscultation. You can tell which it is by. Percussion - hyperresonant with pnuemothorax; dull with hemothorax. By definition, how much blood is in the chest cavity to call it a "massive hemothorax"? 1500 mL or 1/3 or more of the patient's total blood volume. Some also define it as continued blood loss of 200 mL/hr for 2-4 hours - but ATLS does not use this rate for any mandatory treatment decisions. If a patient doesn't have JVD, does this mean a tension pneumothorax or pericardial tamponade is not present? No, the patient may be hypovolemic.

What size chest tube might you use to evacuate a massive hemothorax? #38 French - inserted at the 4th or 5th intercostalspace, just anterior to the midaxillary line. What is Kussmaul's sign? A rise in venous pressure with inspiration while breathing spontaneously. It is a true paradoxical venous pressure abnormality associated with cardiac tamponade. How well do CPR compressions work on someone with a penetrating chest injury and hypovolemia? "Closed heart massage" for cardiac arrest is ineffective in patients with hypovolemia. Patients with PENETRATING thoracic injuries who arrive pulseless but with myocardial electrial activity (PEA), may be candidates for a thoracotomy in the ED. Are all patients with PEA who have sustained a thoracic injury candidates for an ED thoracotomy? No - Only PEA with PENETRATING thoracic injuries are candidates for an ED thoracotomy. An ED thoracotomy can allow you to do what? Evacuate pericardial blood, cardiac massage, direcly control hemorrhage, cross-clamp the descending aorta to slow blood loss below the diaphragm and increase perfusion to the heart and brain. For a patient with a traumatic simple pneumothorax, what should you do BEFORE you start positive pressure ventilation or take them for surgery? Insert a chest tube - positive pressure ventilation can turn a simple pneumothorax into a tension pneumothorax, so insert a chest tube first. Should you evacuate a simple hemothorax if it is not causing any respiratory problems? Yes - A simple hemothorax, if not evacuated, may result in a retained clotted hemothorax with lung entrapment; or, if infected, develop into an empyema. A pneumothorax associated with a persistent large air leak after tube thoracostomy suggests a injury. tracheobronchial - Use bronchoscopy to confirm. You may need more than one chest tube before definitive operative management.

What radiographic findings are suggestive of traumatic aortic disruption? Widened mediastinum, obliteration of aortic knob, deviation of trachea to the right, depression of left mainstem bronchus, deviation of esophagus (NG tube) to right, widened paratracheal stripe, fracture of 1 st^ or 2 nd^ ribs, or scapula A deceleration injury victim with a left pnuemothorax or hemothorax, without rib fractures, in pain or shock out of proportion to the apparent injury, and has particulate matter in the chest tube, may have. an esophageal rupture - a forceful blow causes expulsion of gastric contents into the esophagus, producing a linear tear in the lower esophagus allowing leakage into the mediastinum Fractures for the lower ribs (10-12) should increase suspicion for injury. hepatosplenic Why are upper torso, facial, and arm plethora with petechiae associated with crush injuries to the chest? Temporary compression of the superior vena cava How does ATLS suggest you should review a chest radiograph? Trachea and bronchi, pleural spaces and parenchyma, mediastinum, diaphragm, bones, soft tissues, tubes and lines. You should use a 6 inch, 18 gauge needle for pericardiocentesis. How do you insert it? Puncture the skin 1-2 cm inferior to the left xiphohondral junction at a 45 degree angle to the skin and aim towards the top of the left scapula. What's a good way to know if you've advanced your needle too far during pericardiocentesis and have entered ventricular muscle? ECG Changes - extreme ST-changes, widened QRS, PVCs, etc. Withdraw needle until ECG returns to baseline What should you do with your needle after you successfully evacuate blood during pericardiocentesis? If possible, use the Seldinger technique to insert a 14 gauge flexible catheter. Close the stopcock and leave the catheter in place in case re-evacuation is needed. This is not a definitive treatment.

Chapter 5 Abdominal and Pelvic Trauma

Early consultation with a is necessary whenever a patient with possible intraabdominal injuries is brought to the ED. surgeon What does FAST stand for? Focused Assessment Sonography in Trauma FAST has a sensitivity, specificity, and accuracy in detecting intraabdominal fluid comparable to. DPL What are the advantages of FAST? Rapid, noninvasive, accurate, and inexpensive means of detecting intraabdominal fluid that can be repeated frequently. What are the four places you should look first when doing a FAST scan? Mediastinum, hepatorenal fossa, splenorenal fossa, pouch of Douglas. Name two anatomical challenges that can interfere with doing a FAST scan? Obesity and bowel gas (since fat and gas attenuate sound waves). What do you need to do BEFORE you do a DPL (other than getting instruments and materials together and surgically prepping, etc.)? Decompress the bladder and decompress the stomach. For patients with facial fractures or basilar skull fractures, gastric tubes should be inserted before doing a DPL. orally What is "adequate" fluid return when getting DPL fluid back? 30% DPL is considered to be % sensitive for detecting intraperitoneal bleeding. 98% DPL is indicated when a patient with multiple blunt injuries is hemodynamically unstable, especially when they have. Change in sensorium (brain injury, EtOH or drug intoxication, etc.), change in sensation (spinal cord injury), injury to adjacent structures (pelvis, lumbar spine),

lap-belt sign (from seatbelt), or if patient is going for long studies (CT, surgery, etc.). What is the only ABSOLUTE contraindication to DPL? An existing indication for laparotomy. What are some RELATIVE contraindications to DPL? Morbid obesity, advanced cirrhosis, pre-existing coagulopathy, and previous abdominal operations (adhesions). When should you use an open supraumbilical approach for a DPL? Pelvic fractures (don't want to enter a pelvic hematoma) and advanced pregnancy (don't want to damage uterus or fetus). When performing a DPL, what INITIAL findings (not from lab) would mandate a laparotomy? Free blood (>10 mL) or GI contents (vegetable fiber, bile, feces, etc.). If you don't get gross blood upon initial DPL aspiration, what do you do next for an adult? For a child? Adult: 1,000 mL warm isotonic crystalloid intraperitoneally. Child: same, but 10 mL/kg. What parameters would make a DPL positive?

100,000 red cells/mm^3 , 500 white cells/mm^3 , or bacteria on gram stain. List three methods of hemorrhage control. Pelvic stabilization, laparotomy, angiographic embolization. Your trauma patient needs an urgent laparotomy, can you take them to the CT scanner first to evaluate injuries? No, if they need an emergent laparotomy, they are unstable - unstable patients should go to the OR, not the CT scanner. What are some indications for laparotomy in patients with penetrating abdominal wounds? Unstable, GSW, peritoneal irritation, fascial penetration. What percentage of stab wounds to the anterior abdomen do not penetrate the peritoneum? 25-33%

Do you need to operate on everyone with an isolated solid organ injury? No, not if they remain hemodynamically stable (of all patients who are initially thought to have an isolated solid organ injury, <5% will have hollow viscus injury as well). Does an early, normal serum amylase level exclude major pancreatic trauma? No. Anterior/posterior forces cause book pelvic fractures, and lateral forces cause book fractures. AP: open book; lateral: closed book Which is less likely to have a life-threatening hemorrhage: an open book or a closed book pelvic fracture? Closed book - the pelvic volume is compressed, so there is less room for blood to extravasate. Which are more common, open or closed book pelvic fractures? Closed book: 60-70% (open book: 15-20%; vertical shear: 5-15%) You need to do retrograde urethrography PRIOR to foley placement if there is . inability to void, unstable pelvic fracture, blood at urethral meatus, scrotal hematoma, perineal ecchymoses, or high-riding prostate.

Chapter 6 Head Trauma

Describe the Glasgow Coma Scale (GCS). See page 2. You need to know how to determine a patient's GCS score quickly – know it inside out. When calculating GCS and there is right/left assymetry in the motor response - which one do you use? The BEST response (better predictor than the worst response). Ideally, you want to wait to perform a GCS on a person with SEVERE brain injury until what? BP is normalized. Patients with a GCS between 3 and 8 meet the accepted definition of "coma" or " brain injury." severe What are the GCS scores for "minor" and "moderate" brain injury? Minor is 13-15, Moderate is 9- What signs might you see if a patient has a basilar skull fracture? Periorbital ecchymosis (raccoon eyes), retroauricular ecchymosis (battle sign), otorrhea, and rhinorrhea. A fixed and dilated (blown) pupil in a patient with a traumatic injury is caused by compression of which nerve? Superficial parasympathetic fibers of the occulomotor nerve (cranial nerve III). What criteria may make admission necessary for a patient with minor brain injury? focal neurological deficits, abnormal CT (or no scan available), penetrating head injury, prolonged loss of consciousness, worsening level of consciousness, moderate to severe headache,

significant drug or alcohol intoxication, skull fracture, otorrhea, rhinorrhea, GCS remains < 15, nobody at home to observe patient. What is a "normal" ICP in the resting state? 10 mm Hg (pressures > 20, particularly if sustained, are associated with poor outcomes). The Monro-Kellie Doctrine describes compensatory mechanisms to stabilize pressure inside the calvarium. What are the 2 main ones? Venous Blood and CSF decrease in equal volumes. When this is exhausted, herniation can occur and brain perfusion will likely be inadequate. Preventing hypercarbia is critical in patients who have sustained a injury. head High levels of CO 2 will cause cerebral vasculature to. dilate (to increase blood flow) - So you might want to hyper ventilate patients with brain injuries. Your patient has a dilated pupil and you want to give mannitol on the way to the OR. What is the dose? 0.25 - 1.0 g/kg IV rapid bolus. What would you want to do if a patient with a minor brain injury failed to reach a GCS of 15 within 2 hours post-injury, had LOC >5min, is older than 65, had emesis x 2, or had retrograde amnesia >30 minutes? Urgent head CT scan. Everything but the 30 min of retrograde amnesia makes him high risk for needing neurosurgical intervention. What is the difference between retrograde amnesia and anterograde amnesia? These are terms easily confused. Retrograde amnesia is the inability to recall events that occurred before the trauma. Anterograde amnesia is the loss of the ability to create new memories after the trauma.

What two things do you need to do first for everyone with a moderate brain injury (according to ATLS algorithm)?

1. Transfer to a facility capable of definitive neurosurgical care, and
2. Obtain a head CT scan (however, this should not delay patient transfer). A FAST scan, DPL, or ex-lap should take priority over a CT scan if you cannot get the brain injured patient's sBP up to mmHg.
3. If a patient has a systolic BP over 100 with evidence of intracranial mass (e.g. blown pupil, assymmetrical motor exam), then a CT would take priority. A midline shift of greater than often indicates the need for neurosurgical evacuation of the mass or blood. 5 mm Cerebral perfusion pressure (CPP) is defined as mean arterial blood pressure minus . intracranial pressure (CPP = MAP – ICP) Hyperventilation will ICP in a deteriorating patient with expanding intracranial hematoma until emergent craniotomy can be performed. lower In general, it is preferable to keep the PaCO 2 at approximately mm Hg, the low end of the normal range. 35 mm hg (4.7 kPa) Brief periods of hyperventilation (PaCO 2 of to mm Hg) may be necessary for acute neurologic deterioration. 25 to 30 mm Hg Mannitol should not be given to patients with hypotension, because mannitol is a potent osmotic and does not lower ICP in hypovolemia. This can further exacerbate hypotension and, therefore, cerebral. diuretic; ischemia

Acute neurologic deterioration, such as the development of a dilated pupil, hemiparesis, or loss of consciousness, is a strong indication for administering mannitol, provided the patient is. In this setting, a bolus of mannitol ( g/kg) should be given rapidly (over 5 minutes). euvolemic; 1 g/kg Reasons for a patient with mild traumatic brain injury to return to the hospital include: Drowsiness or increasing difficulty in awakening patient, nausea or vomiting, convulsions, severe headaches, weakness or loss of feeling in the arm or leg, confusion or strange behavior, one pupil much larger than the other, peculiar movements of the eyes, double vision, or other visual disturbances, very slow or very rapid pulse, unusual breathing pattern, and bleeding or watery drainage from the nose or ear.

Chapter 7 Spine Trauma

What are the possible mechanisms that can result in spine injuries? Penetrating and blunt trauma, axial loading, flexion, extension, rotation, lateral bending, and distraction. Can you clear the C-spine without imaging? Yes. The C-spine can be cleared clinically if the patient: is awake, alert, and sober; has no neurological deficits referable to the cervical spine; has no distracting injuries; has no midline neck pain or tenderness on palpation; and can actively flex, extend, and laterally rotate his head to both sides without pain (never do this passively). What are the indications for C-spine radiographs in a trauma patient? Midline neck pain, tenderness on palpation, neurological deficits related to C-spine injuries, altered LOC, or intoxication. Which views should be obtained? Lateral, AP, and open-mouth odontoid views. With the proper views of the C-spine, and a qualified radiologist, what is the sensitivity for finding an unstable cervical spine injury?

97% (CT with 3 mm slices > 99%). Approximately % of patients with a cervical spine fracture have a second, noncontiguous vertebral column fracture. 10% Cervical spine injury requires immobilization of the entire patient with: semirigid cervical collar, head immobilization, full-length backboard, and straps.

Attempts to align the spine for the purpose of immobilization on the backboard are not recommended if they. cause pain What is the most common type of C1 fracture? Burst fracture (Jefferson fracture) As long as the patient’s spine is , evaluation of the spine and exclusion of spinal injury may be safely deferred, especially in the presence of systemic instability, such as hypotension and respiratory inadequacy. protected In the presence of neurologic deficits, or is recommended to detect any soft tissue compressive lesion, such as a spinal epidural hematoma or a traumatized herniated disk MRI; CT myelography Describe the muscle strength grading scale used in ATLS. A paralyzed patient who is allowed to lie on a hard board for more than hours is at high risk for pressure ulcers. 2 hours Partial or total loss of respiratory function may be seen in a patient with a cervical spine injury above. C6

shock refers to the loss of muscle tone and loss of reflexes seen after spinal cord injury. Spinal What is neurogenic shock? Spinal cord injury (SCI) --> loss of sympathetic tone --> vasodilation of blood vessels --> pooling of blood --> hypotension. SCI may also cause bradycardia or inhibit the tachycardic response to hypotension. Neurogenic shock is rare in spinal cord injury below the level of. T6 What is a major difference in a physical finding between hypovolemic shock and neurogenic shock? Hypovolemic shock: usually tachycardic; neurogenic shock: usually bradycardic. How do you treat neurogenic shock? Judicious use of pressors and moderate fluid resuscitation. Too much fluid may result in fluid overload and pulmonary edema. syndrome is characterized by a greater loss of strength in the upper extremities than in the lower extremities, with varying degrees of sensory loss. Central cord syndrome is characterized by paraplegia and a dissociated sensory loss with a loss of pain and temperature sensation. Dorsal column function (position, vibration, and deep pressure sense) is preserved. Anterior cord syndrome results from hemisection of the cord, usually as a result of a penetrating trauma. In its pure form, the syndrome consists of ipsilateral loss of motor function (corticospinal tract) and position sense (dorsal column), associated with contralateral loss of pain and temperature sensation (spinothalamic tract) beginning one to two levels below the level of the injury. Brown-Séquard