Geriatric Trauma
What is the single most predictive factor in predicting subsequent falls in geriatric trauma?
History of a single fall
The leading cause of unintentional injury in the pediatric population 1-4years?
What is drowning?
Until what week gestation does the pelvis shield the uterus in pelvic trauma?
What is 12 weeks?
1) Hypertension
2) Bradycardia
3) Irregular respiratory pattern
What is the Cushing Reflex?
The Cushing reflex is a sign of elevated ICP, which could be due to an expanding intracranial hematoma or diffuse brain swelling. If untreated, patients who exhibit a Cushing reflex typically progress to brain death
What factors increase the risk of injury in geriatric trauma patients? ( x4)
1. Cognitive impairment
2. Gait instability/imbalance
3. Polypharmacy
4. Decreased visual acuity
A standardized, colored pediatric measuring tape to rapidly estimate the IBW for emergency dosing.
Bonus: What side do you place at the head?
The Broselow Tape
RED to HEAD
The most common cause of Trauma in pregnancy is:
What is Domestic Violence.
1) This type of injury is due to physical mechanical injury to the brain while
2) This type of injury is caused by brain swelling that compromises brain flow in the subsequent hours to days.
1) Primary injury 2) secondary injury
Of note, secondary insults are additional injuries that occur to the brain after the initial primary brain injury. The most common causes of second insult are hypotension and hypoxia, each of which has been associated with significantly worse outcomes
Physiologic changes that occur with Aging:
1) ____ VC; ____ chest wall rigidity
2) ____ cardiac output
3) ___ autoregulation; ____ brain atrophy
1) decreased; increased
2) decreased
3) decreased; increased
Level of Consciousness Assessment in Pediatrics: What is AVPU
Alert: active and responds appropriately
Voice: responds to voice
Pain: difficult to arouse, responds to pain
Unresponsive: unconscious with no response
After an obstetric trauma, what are important labs to order? (x4)
What is:
1) Kleihaurer-Betke test: for both Rh- and Rh+ that sustain trauma
if Rh-, Rhogam is given to prevent alloimmunization
2) Fibrinogen - (low)
3) CBC/Platelets - (low)
4) Type and Cross
67yo M, MVC vs tree, brought in to the TB. On primary survey, he withdraws when you pinch his forearm, but does not open his eyes. He is making insensible sounds. What is his GCS? And what is your next best step?
E1V2M4 - intubate
An 83-year-old woman was struck by an automobile and is found to have a small subdural hematoma. She is admitted to the ICU for serial neurologic examinations. Her medical history is significant for hypertension, coronary artery disease with a myocardial infarction 5 years ago, and mild dementia. She lives with her daughter but is able to care for herself. She ambulates with a cane rarely. Laboratory studies include an albumin of 3.2 g/L. Which of the following carries the greatest risk of a worse discharge disposition in this situation?
Her history of an MI
What are clinical signs that may suggest signs of abuse? (x6)
1) bruising
2) pattern burns
3) retinal hemorrhage
4) long-bone fractures
5) injuries at different stages of healing
6) injuries inconsistent with history
What is the common respiratory acid-base disorder often found in pregnancy? What are some physiologic changes that lead to this? (x2)
1) Increased tidal volume with reduced FRC
2) Progesterone stimulates central respiratory center to increase minute ventilation
The net effect is a mild chronic respiratory alkalosis with a decrease in the arterial PaCO2, a slight increase in the PaO2 (alveolar gas equation), a slightly elevated pH
Associate the clinical signs with the injury:
1) Fracture at the anterior skull base
2) Fracture of the middle or lateral skull base
3) Fracture of the petrous bone
1) What is "raccoon eyes"
2) What is Battle Sign
3) CSF otorrhea; hemotypanum, ipsilateral facial weakness
A 66-year-old woman w/ AFIB on Warfarin presents to the ED following a motor vehicle–utility pole collision. Her car was extensively damaged, and extrication time was prolonged. She had a GCS score of 5 at the scene, and she is intubated en route. Her heart rate is 115 beats/min, blood pressure is 108/76 mm Hg, and SpO2 is 98% on 2 L nasal canula. A FAST examination is negative. CT of the head shows a large subdural hematoma with a 12-mm midline shift.
1) What is the next best step?
2) What do you need to administer to reverse her anticoagulation?
1) Decompressive craniectomy
2) PCCs
In children with blunt liver and spleen injury, what is the ideal management?
Vast majority are managed non-operatively, but should depend on the hemodynamic status.
For a child with BLSI and a stable hemoglobin, an abbreviated period of bed rest of 1 day or less is appropriate.
When should a perimortem cesarean delivery be performed? And what is the rate or survival?
Above what ICP level do you treat?
What are treatments for management?
>20 mmHg
1) elevate head of bed
2) maintain normothermia
3) hyperosmolar treatments (Hypertonic bullets or mannitol)
4) Sedation, neuromuscular blockade
5) Hyperventilation (to allow for hypocapnia)