Docsity
Log inSign up
Docsity
Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity

Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan

Guidelines and tips
Guidelines and tips
Sell on Docsity
Sell on Docsity
Log inSign up

Prepare for your exams

Study with the several resources on Docsity

Find documents

Prepare for your exams with the study notes shared by other students like you on Docsity

Search Store documents

The best documents sold by students who completed their studies

Search through all study resources
Docsity AINEW

Summarize your documents, ask them questions, convert them into quizzes and concept maps

Explore questions

Clear up your doubts by reading the answers to questions asked by your fellow students

Earn points to download

Earn points by helping other students or get them with a premium plan

Share documents
download point icon20 Points

For each uploaded document

Answer questions
download point icon5 Points

For each given answer (max 1 per day)

All the ways to get free points
Get points immediately

Choose a premium plan with all the points you need

Study Opportunities

Choose your next study program

Get in touch with the best universities in the world. Search through thousands of universities and official partners

Community

Ask the community

Ask the community for help and clear up your study doubts

University Rankings

Discover the best universities in your country according to Docsity users

Free resources

Our save-the-student-ebooks!

Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors

From our blog

Exams and Study
Go to the blog

Trauma Assessment and Management, Study notes of Medicine

A.T. Still University of Health Sciences (ATSU)Medicine

This comprehensive guide covers the assessment and management of various trauma types, including blunt and penetrating injuries to the chest, abdomen, genitourinary system, and spine. It details the primary survey, diagnostic procedures, and appropriate treatment strategies for conditions like pneumothorax, hemothorax, cardiac tamponade, and spinal cord injury. Highly relevant for healthcare professionals in emergency and trauma settings.

Typology: Study notes

2023/2024

Available from 07/29/2024

LEARNERSTORE
LEARNERSTORE 🇺🇸

3.9

(9)

1.9K documents

1 / 21

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
1 / 21
EM: Chest, Abdomen, GU, Injuries
1.what is blunt trauma?: the result of force to the body that causes injury
without penetrating soft tissues
2.what is penetrating trauma?: injury caused by an object that passes
through the skin or other body tissues
3.what is an example of blunt trauma?: motor vehicle accident
4.what is an example of penetrating trauma?: gunshot wound
5.what makes up the primary survey?:
Airway Breathing
Circulation
Disability
Exposure
Fast
(eFAST) Go
to CT
6.part of the posterior lower lobes of both lungs sit below the level of the
apex of the diaphragm (T/F): true
7.if pt has diminished or absent breath sounds, what should you be
thinking?-
: possible pneumothorax or hemothorax
8.what should be obtained with a trauma pt?: at least 2 large bore (>18
gauge) needles
9.what should be used to resuscitate fluid loss in a trauma pt?: crystalloid
fluids or blood- depending on the situation
10.all trauma patients should be given supplemental oxygen (T/F): true
pf3
pf4
pf5
pf8
pf9
pfa
pfd
pfe
pff
pf12
pf13
pf14
pf15

Partial preview of the text

Download Trauma Assessment and Management and more Study notes Medicine in PDF only on Docsity!

1 / 21

EM: Chest, Abdomen, GU, Injuries

1.what is blunt trauma?: the result of force to the body that causes injury without penetrating soft tissues 2.what is penetrating trauma?: injury caused by an object that passes through the skin or other body tissues 3.what is an example of blunt trauma?: motor vehicle accident 4.what is an example of penetrating trauma?: gunshot wound 5.what makes up the primary survey?: Airway Breathing Circulation Disability Exposure Fast (eFAST) Go to CT 6.part of the posterior lower lobes of both lungs sit below the level of the apex of the diaphragm (T/F): true 7.if pt has diminished or absent breath sounds, what should you be thinking?- : possible pneumothorax or hemothorax 8.what should be obtained with a trauma pt?: at least 2 large bore (> gauge) needles 9.what should be used to resuscitate fluid loss in a trauma pt?: crystalloid fluids or blood- depending on the situation 10.all trauma patients should be given supplemental oxygen (T/F): true

2 / 21 11.how do we relieve chest wall pain in a trauma patient?: small frequent ones of narcotic meds (morphine) 12.when would a trauma pt need to be intubated?: hypo-ventilators secondary to head trauma or shock 13.if a trauma pt CO2 is rising, what may need to be given?: NIPPV or intubation 14.where does the breathing exam start?: above the clavicle 15.where should we feel for the trachea?: low down in the midline neck 16.what is a very specific finding for a chest injury?: crepitus in the lateral neck above the clavicle 17.what is the first step of assessing airway/breathing?: visual inspection of the chest wall 18.how do we palpate the chest to assess airway/breathing?: - start with both palms open, one hand on each side of the chest

  • ask pt to take a deep breath
  • next gently push on every rib left and right of the sternum 19.how do we auscultate the chest to assess airway/breathing?: place stetho- scope over the most anterior location 20.what does good circulation mean?: vital organs are being adequately per- fused with oxygenated blood 21.how do we start to assess circulation?: check for a pulse 22.what pulses should be checked in the extremities to assess circulation?- : DP/PT in lower extremity Radial in upper extremity Brachial if infant/toddler

4 / 21 suspect until proven otherwise?: brain herniation 35.how do we assess disability in a trauma pt?: - GCS and pupils

  • Movement and sensation in extremities
  • DRE 36.why would we perform a DRE in a trauma pt?: to assess for:
  • rectal hemorrhage
  • r 37.what is the FAST exam?: Focused Assessment with Sonography in Trauma 38.what is the purpose of the FAST exam?: looks for the presence of fluid (presumed to be blood) in four areas 39.what are the areas of the FAST exam?: - pericardial
  • perihepatic
  • perisplenic
  • pelvic 40.what is the eFAST exam?: same as FAST but surveys the anterior and lateral pleural spaces to evaluate for PTX or pleural effusion 41.in a hemodynamically unstable pt, a positive eFAST may indicate?: the need for immediate intervention 42.what is the most common cause of traumatic shock?: acute blood loss anemia 43.why do we five saline bolus to blood loss caused shock?: to STAGE their shock 44.how do we give blood to a shock pt?: 1-1-1 + calcium PRBCs, FFP, platelets

5 / 21 45.what are immediate life-threatening thoracic injuries?: - tension PTX

  • open PTX
  • massive hemothorax
  • cardiac tamponade
  • flail chest 46.when does a tension PTX develop?: when a one-way air valve leak occurs from either the lung or chest wall 47.describe what happens in a tension PTX: air enters the pleural space but can't escape, leading to a build up in pressure, collapse of lung, and shift of mediastinal contents 48.what are symptoms of a tension PTX?: - respiratory distress
  • tachypnea
  • hypoxia
  • hyperresonance to percussion
  • absent/decreased breath sounds 49.how do we confirm a tension PTX in the ED?: eFAST or CXR 50.what is the tx for a tension PTX?: immediate needle decompression (put on 100% oxygen via non rebreather too) 51.what is a open PTX?: sucking chest wall wound from penetrating injury 52.where does air go in an open PTX?: through the path of least resistance (open wound) instead of the trachea 53.what is done for an open PTX?: - put pt on 100% oxygen via non rebreather
  • occlusive dressing over wound
  • close wound asap and place chest tube

7 / 21 65.how do we confirm cardiac tamponade in the ED?: eFAST 66.if pt has cardiac tamponade and is unstable, what might be necessary to save the pts life?: emergency thoracotomy 67.what is the tx for cardiac tamponade in a stable pt in the ED?: US guided pericardiocentesis 68.when does flail chest occur?: when a segment of the chest does not have a bony continuity with the rest of the thoracic cage 69.what happens with a flail chest when pt breathes in?: the flail segment moves inward 70.what are the 2 main symptoms of flail chest?: - pain

  • respiratory distress 71.what is the tx for flail chest in the ED?: - oxygen
  • pain meds
  • most likely need surgical fixation 72.what is a pulmonary contusion?: injury of the lung parenchyma with hemor- rhage and edema associated with a lacteration 73.what is the most common complication of pulmonary contusion?: pneu- monia 74.what is the most important sign of a pulmonary contusion?: hypoxia 75.what is the imaging modality of choice for pulmonary contusion?: CT scan 76.what is the mainstay of tx for pulmonary contusion?: supportive care 77.when are myocardial contusions common?: with sternal fractures 78.what are myocardial contusions?: distant areas of hemorrhage
  1. what ventricle is most commonly involved in a myocardial contusion?:

8 / 21 right ventricle 80.what are the symptoms of myocardial contusion?: nonspecific:

  • chest pain
  • subtle EKG changes
  • hypotension 81.if myocardial contusion is suspected in the ED, what should we order?: - EKG and troponin 82.do we treat myocardial contusions?: not unless there's a STEMI 83.what is a diaphragmatic hernia?: rupture of the diaphragm either from direct violation or secondary to increased intrathoracic pressure 84.left sided diaphragmatic hernias are more common than right sided (T/F)- : true 85.what is the treatment for a diaphragmatic hernia?: emergency laparotomy 86.what are symptoms of esophageal perforation?: - throat pain
  • dysphagia
  • odynophagia
  • hoarseness
  • chocking 87.what will CXR show with esophageal disruption?: pneumomediatstinum widened mediastinum left pleural effusion 88.what diagnostic test will show esophageal perforation?: CXR with wa- ter-soluble contrast (gastrografin) or CT with oral contrast 89.what is the tx of a esophageal disruption?: depends on location and

10 / 21

  • hypoxia
  • persistent PTX 98.what is the main diagnostic procedure for a tracheobronchial injury?: bron- choscopy 99.what should pts with a tracheobronchial injury be tx with?: endotracheal intubation preferably with a bronchoscope
  1. what is the most common injury sustained in blunt thoracic trauma?: rib fracture
  2. what is the better imaging modality for rib fractures?: CT
  3. how do we treat rib fractures?: - rapid mobilization
  • respiratory support
  • pain management
  1. what is the most common injury in postmenopausal females?: sternal fracture
  2. what usually causes a sternal fracture?: direct impact (steering wheel)
  3. what are the symptoms of a sternal fracture?: pleuritic chest pain with focal tenderness over the sternum
  4. what is the tx for a sternal fracture?: symptomatic management
  5. what is traumatic asphyxia?: severe crush injury of the thorax of abdomen that can cause retrograde flow of blood from the right heart into the great veins of the head and neck
  6. how will a pt present with traumatic asphyxia?: purplish-blue color of face and neck , subconjunctival and retinal hemorrhages, loss of consciousness (due to cerebral hypoxia)

11 / 21

  1. what is the only tx for traumatic asphyxia?: oxygenation
  2. what is commotio cordis?: sudden cardiac death or near sudden cardiac death after blunt, low impact chest wall trauma in the absence of structural cardiac abnormalities
  3. what is the most commonly reported dysrhythmia with commotio cordis?: v-fib
  4. who is most at risk for commotio cordis?: young male athletes ages 5-18 yo
  5. death is usually instantaneous with commotio cordis (T/F): true
  6. what do stab wounds commonly injury?: ascending aorta
  7. what do gunshot wounds typically injure?: descending thoracic aorta
  8. if a pt presents with penetrating trauma, what should be done?: evaluation for signs of vascular injury (unequal pulses in extremities, new vascular bruits)
  9. how do we treat significant shock be treated in a patient with penetrating trauma?: IV fluid bonuses and blood transfusion
  10. where should majority of penetrating trauma objects be removed?: in the OR
  11. any penetrating injury below the level of the nipple warrants evaluation for intra-abdominal injury (T/F): true
  12. what is the "seat belt sign"?: external sign on the stomach/chest suggestive of intra-abdominal injury
  13. what are special considerations for assessing abdominal trauma?: - care- fully examine chest and abdomen with MVA

13 / 21 radiation to right shoulder

  1. what do unstable pts with liver injures require?: laparotomy or selective arterial embolization to attempt hemorrhage control
  2. where does diaphragmatic rupture occur?: commonly on the left side
  3. what tests are done for diaphragmatic injuries?: CT scan +/- diagnostic laparoscopy
  4. what levels are more specific for the pancreas, amylase or lipase?: lipase
  5. how may a pt with pancreatic injury present?: with epigastric or back pain
  6. what imaging modality is best for pancreatic injury?: CT (80% sensitive)
  7. what kind of pancreatic injury usually warrants surgical intervention?: - disruption of the main pancreatic duct
  8. all pts with traumatic pancreatic injuries should be admitted (T/F): true
  9. what symptom should raise suspicion for urologic injury?: hematuria (particularly gross)
  10. what imaging can we use to evaluate a renal injury?: CT scan
  11. when are hollow viscous injuries (GI tract) more common?: in penetrating injuries
  12. what is the most common organ injured in penetrating trauma?: small bowel

14 / 21

  1. in blunt abdominal trauma, free air is specific for GI tract injury (T/F): true
  2. what imaging is best for hollow viscous injury?: CT
  3. most genitourinary trauma cases are not immediately life threatening (T/F): true
  4. what are clues that may lead you to suspect a genitourinary injury?: - lumbar vertebral or lower rib fx
  • pelvic fx
  • flank pain/hematoma
  • abnormal prostate
  • blood at urethral meatus
  • gross hematuria
  1. what should be done in men during the secondary survey for GU trauma?- : evaluate for a boggy or high riding prostate on DRE, perineal or scrotal hematoma, and any evidence of blood at urethral meatus
  2. if any abnormal findings (boggy or high riding prostate on DRE, perineal or scrotal hematoma, and any evidence of blood at urethral meatus) are found in the GU trauma exam, what should be done?: perform a retrograde urethra gram before inserting a foley
  3. if any of these signs (boggy or high riding prostate on DRE, perineal or scrotal hematoma, and any evidence of blood at urethral meatus) are absent in a GU trauma pt, what can be done?: insert a foley if indicated
  4. what are the most common urologic injuries?: renal injuries

16 / 21

  1. what is the imaging of choice for a bladder injury?: CT cystography
  2. what bladder injuries require surgical intervention?: intraperitoneal rup- tures and all penetrating injuries to the bladder
  3. what is the most reliable and accurate sign of a urethral injury in a male?: blood at the urethral meatus
  4. what part of the urethra is most commonly damaged during blunt trauma associated with bony pelvic injuries (males)?: posterior urethra (prostatic and membranous portions)
  5. the urethra is usually sheared off proximal to the urogenital diaphragm (T/F): true
  6. what is the initial management for posterior urethral injuries?: urinary drainage and suprapubic catheterization may be necessary
  7. what makes up anterior urethral injuries in men?: bulbous and penile portions of urethra
  8. what commonly causes anterior urethral injuries?: contusion or laceration due to straddle injuries, penetrating injuries, a direct blow to the perineum, instru- mentation, or improper foley cather placement
  9. what are the most common treatment options for anterior urethral in- juries?: long-term catheter drainage or direct reanastomosis
  10. what is a retrograde urethrogram?: x-ray or CT taken after you inject contrast dye into the urethra
  11. why do we perform retrograde urethorgram?: looks of extravasation
  12. how do penile fractures occur?: blunt trauma to the erect

17 / 21 penis causing rupture of the corpus cavernosum

  1. describe pt presentation of a penile fracture: pt heard a loud "cracking" sound and then had immediate pain and loss of erection
  2. what is the 1st line imaging for penile fracture?: US w/ doppler
  3. what tx is needed for a penile fracture?: immediate urology consult for surgical repair
  4. how are subcutaneous hematoma of the penis typically treated?: with NSAIDs and cold compresses
  5. where do majority of spinal cord injuries occur?: cervical
  6. what causes 50% of spinal cord injuries?: MVC
  7. who should be assumed to have spinal column injuries until proven otherwise?: pts with blunt trauma (head, severe mechanism, or neuro complaints)
  8. how do approach a pt with spinal cord injury?: - apply C collar
  • head taped to immobilizer
  • log roll pt
  1. what is done for immediate management of spinal cord injury?: establish airway and maintain ventilation establish satisfactory circulation minimize neuro injury treat complications
  2. when does neurogenic shock cause hypotension as a result of loss of sympathetic tone below the level of the spinal cord injury?: when injury is at or above T6 level

19 / 21 following a hyperextension injury

  1. what is anterior cord syndrome?: compression of the anterior portion of the spinal cord by bone fragment or from occlusion of the anterior spinal artery
  2. what usually causes anterior cord syndrome?: cervical hyperflexion injury or anterior spinal artery injury
  3. what motor and sensory loss will occur in anterior cord syndrome?: loss of motor function and pain/temperature bilaterally below the level of the lesion
  4. what is brown-sequard syndrome?: result of penetrating trauma with spinal cord hemisection
  5. what becomes disrupted in Brown-sequard syndrome?: motor, propriocep- tion, vibration sense and light touch sensation are disrupted on the side of the lesion AND pain and temp are diminished on the opposite side
  6. what usually causes C2 fracture?: high velocity trauma (flexion of neck)
  7. what are the 3 types of odontoid fracture?: type I + II- unstable type III- stable
  8. what is a burst (jefferson) fracture?: fracture to anterior and posterior ring of C

20 / 21

  1. what is a Hangman's fracture?: fracture to bilateral pedicles of C
  2. what commonly causes a Hangman's fracture?: high force injury causing extension of the neck
  3. what kind of imaging may we need with a transverse foramen fracture?- : CTA imaging in order to evaluate the vertebral arteries
  4. what is Clay Shoveler's fracture?: avulsion type fracture in lower cervical or upper thoracic spine
  5. how will a pt present with a clay shovelers fracture?: sudden onset of pain between shoulder blades or base of neck w/ reduced ROM of head/neck
  6. what causes Clay Shoveler's fracture?: direct trauma or laborers
  7. what does a spinal cord injury w/o radiographic abnormality suggest in children?: SCIWORA
  8. what is the most widely used imaging choice in the ED?: CT
  9. what should be obtained with possible head trauma/AMS in the ED?: head CT
  10. if a patient has a fracture in one portion of the spinal column, the entire spinal column should be imaged (T/F): true
  11. what imaging modality will show a more detailed view of the spinal cord, MRI or CT?: MRI
  12. what are the cervical spine imaging criteria?: Nexus Criteria Canadian C-spine Rule
  13. who are the only pts who do not need admission in the ED?: those