Baby on board
Plasma volume ____
Functional residual capacity _____
Increases by 45% but RBC volume only increases 15% causing physiologic anemia
Decreases d/t displacement of diaphragm upward by gravid uterus. O2 consumption is increased by nearly 20%.
Describe the zones of the neck
Zone 1: sternal notch to cricothyroid
Zone II: cricothyroid to angle of mandible
Zone III: angle of mandible to skull base
Name the bleed:
***
Left to right: Intraparenchymal, subdural, epidural
What is the leading cause of unintentional injury death in children 1-4 years old?
Drowning
Parkland formula
Fluid resuscitation in first 24hr
4mL/kg x %TBSA burn
Half over first 8 hrs then the remaining over the next 16hr
True or False:
Normal physiologic fluid in pregnancy will be visible on FAST giving a false positive
FALSE
FAST has 80% sensitivity and 100% specificy. Normal fluid (7-21mL) is not detected on FAST. FAST does not definitively r/o intra-abdominal or fetal injury.
Name 2 hard signs of vascular injury and 3 soft signs
Hard signs: brisk bleeding, expanding or pulsatile hematoma, massive subq emphysema, absent distal pulse, thrill or bruit
Soft signs: dysphagia/odynophagia, dysphonia, hemoptysis/hematemsis, wide mediastinum, h/o significant bleeding, proximity to named vessel, diminished pulse, neuro deficit
List the components and scoring of GCS
Eye 1-4
Verbal 1-5
Motor 1-6
A 6 month old female is seen in the ED. The child is lethargic and has bruises over her extremities? What are you concerned about? What is your workup and initial management?
NAT
skeletal series
eye exam for retinal hemorrhage
brain imaging
(LFTs)
Social work evaluation
What commonly used topical agent can cause neutropenia?
Silver sulfadiazine
A 22 yo female at 32wk is the restrained passenger in a high speed MVC. In the trauma bay HR 105, BP 110/60, ABCDE are intact. FAST in negative. She complains of epigastric pain. What is the best imaging study?
CT
CT should be obtained for the same indications in pregnant and nonpregnant patients. The risk of missed injury is greater than the potential risk of radiation to the fetus.
*** DAILY DOUBLE - how much radiation is acceptable in pregnancy?
Describe the BCVI grades
1: intimal irregularity
2: dissection, intramural hematoma with narrowing >25%
3: PSA
4: occlusion/thrombosis
5: transection with active extrav
What physical findings would you expect with neurogenic shock? (4 things)
Bradycardia
Hypotension
Warm extremities
Loss of motor function
Injury above T6
A 70 year old male with PMH of a-fib on warfarin presents after a ground level fall with left femur fracture. HR 100. BP 105/65. What labs do you want and what fluid will you give?
CBC, BMP, INR, TEG
Vital signs less reliable in elderly, may be on beta blocker.
Reverse INR, give blood, FFP.
A 53 year old female is involved in a house fire and has extensive upper body burns. In addition to the burns, what else must she be evaluated for and how?
Inhalation injury
Carboxyhemoglobin level
Normal 5% in nonsmokers and 10% in smokers
Who needs the Kleihauer-Betke test? What does a positive test mean?
All Rh negative and consider in Rh-positive with blunt injury.
Positive test associated with abruptio plancentae and predicts preterm labor. If positive test and Rh negative mother then need Rhogam
Abruptio planetae occurs in up to 60% of patients with severe abdominal trauma.
Describe a 4 compartment fasciotomy
Medial incision 1 finger breadth behind tibia, open fascia over soleus, free muscles from attachments to posterior tibia
Lateral incision 1 finger breadth in front of fibula, horizontal incision to identify anterior intermuscular septum then vertical incisions 1 cm anterior and 1 cm posterior
Why is hypertension, bradycardia, and irregular respirations significant in a trauma patient? What is the eponym? How do you treat it?
Elevated ICP, impending herniation
Cushings reflex
HTS, mannitol, OR
***DAILY DOUBLE Who needs ICP monitoring?
A 62 year old women drives into a tree. Initial GCS is 14 for confusion. Trauma workup is negative and her mental status improves. What is her dispo? Explain
Needs medical workup for cause of trauma. Stroke? MI? Arrhythmia? Seizure?
A 37 year old male is found down. No external signs of trauma. Temp is 31C in the trauma bay. HR 35. What is your management?
Warm fluids
Intravascular warming catheter -> ECMO if <32C and cardiac arrest
Treat hypokalemia, acidosis
Avoid intubation, NGT, CVC
V fib at temp <30C is from hypothermia
Must rewarm to >32 to call TOD
A 28 yo female at 36wks is evaluated in the trauma bay after high speed MVC. She suddenly develops hypoxia and seizes. BP is 60/palp. TEG shows long R time and decreased alpha angle and MA. What happened?
Amniotic fluid embolism - very rare
A 58 year old male sustains a stab wound to the neck. CT is concerning for esophageal injury with extensive subcutaneous gas. Describe your management.
Debride and close in 2 layers
Buttress with healthy tissue
Avoid tracheostomy
Drain
Can perform esophagostomy if required
Describe NEXUS criteria
Determine who needs c spine imaging
Focal neuro deficit
Midline TTP
AMS
Intoxication
Less reliable in children and elderly (>65). Children lateral and AP plain film, add odontoid image if >3 yo.
An 8 year old male is the restrained passenger in a high speed MVC. He complains of abdominal pain and has a seatbelt sign on exam. What injuries must be considered?
Chance fracture
Bowel injury
Pancreatic injury
Mesenteric injury
Who needs escharotomy and how do you do it?
Extremities with circumferential 3rd degree burn and swelling - medial and lateral aspects of the extremity
Trunk with circumferential 3rd degree burns with reduced inspiratory volumes - midaxillary line from axilla to lower edge of burn wound, across infraclavicular and subxiphoid line