Traumatic brain injury (neuro- ABC's and warming)
Head injury- If not delirium from alcohol or drugs it is _____ till proven otherwise
20%-brain damage
70%-MVA
(stabilize cervical- get an Xray)
10 million in US have head trauma, of those
20% have _____
70% due to ______
Concussion
Immediate but short transient loss of consciousness
Spontaneous recovery
Amnesia
cou
Direct blow to head
contra-cou
bouncing of the head on recoil from direct blow
intracranial lesions 2/3 of time
skull fractures have ______ 2/3 of time
battle signs
bruising over the mastoid-->
raccoon eyes
bruising under the eyes
ears and nose
CSF can leak out _____ and ____ secondary to basilar skull fracture
sella turcica fracture
air fluid level in sphenoid sinus
3 (15 max)
Cannot have a GCS less than
11
GCS over ___= moderate chance of recovery (5% chance of death)
...
Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
Auditory
Glossalpharyngeal
Vestibular
Hematomas- subdural and epidural (burr hole)
Head injury
Stupor, Dilated pupils
epidural
Head injury- hematoma (epidural or subdural)
10%
More rapid swelling
Grade 1
Grade ____ concussion
transient confusion
no LOC
clears in < 5 minutes
back in game in 15 minutes
Grade 2
Grade ____ concussion
transient confusion
no LOC
clears in 15 minutes
return in weeks
remove from contest
Grade 3
Grade ____ concussion
any loss of consciousness
ambulance to ER (CT scan needed)
blow out fracture
Orbit fracture can lead to
nasal fractures
be aware of shards of bone that can enter the brain and puncture CSF with ____ fractures
5-0
forehead gets a ___ suture
6-0
face gets a ___ suture
almost always= jaw fracture
bruising under the tongue
16 guage needle decompression
tx for tension pneumothorax
pneumonia
four fold increase of _____ when collapsed lung is stabilized
3 or more
How many ribs need to be fractured in order to have a flail chest
ET and positive pressure ventilation
Tx for flail chest
clavicle
most frequently broken bone in body
chest tube
all patients with pneumothorax need a ____ after trauma
tube evacuation
hemothorax is tx with
tension pneumothorax
wide pulse pressure (pulsus parodoxus)
chest trauma history
bulging neck veins
after needle decompression
tensions pneumo should get an xray when?
commotio-cordis
Blunt chest trauma causing V-fib
1/2 MV2 (squared)
kinetic energy =
70-80%
% of lethality with cardiac stabbing injuries
Right ventricle
MC area of heart to be struck with stabbing injury
Cullen's sign
ecchymosis in abdomen under umbilicus in 48hrs
Intra-abdominal bleed or necrotizing pancreatitis
Grey Turner sign
ecchymosis in flanks
Intra-abdominal bleed or necrotizing pancreatitis
Diagnostic Peritoneal lavage
Abd bleed diagnosis
Focused assessment for sonogram for trauma (FAST)
Pericardial bleed
perihepatic bleed
Perisplenic bleed
Pelvic bleeds
-Unexplained shock, intoxicated pt
What is diagnostic test for?
intrathoracic
compartment of abdomen
-Liver, spleen and stomach
Pelvic
compartment of abdomen
-Bladder, urethra, rectum,, large bowel
Retroperitoneal
compartment of abdomen
-Pancreas, kidneys, great vessels, ureters
True abdomen
compartment of abdomen
-Intestines and pregnant uterus and bladder pushed upward
Peritonitis
Uncontrolled shock/ hemorrhage
Declining under observation
Blood on Lavage
Laparotomy done when
Laparotomy
Gunshot wound require
small bowel
MC gunshot wound site
liver
MC stabbing wound site
motor, sensory, autonomic nerves
three type of spinal nerves
A (B and C interchange sensory and motor/ D is normal)
5 types of spinal injury (transection)
-zero sensory
-no motor function esp sacral
Brown sequard syndrome
Hemisection lesion of spine with ipsilateral loss of motor and contra lateral loss of sensory? (look up to verify)
subcutaneous emphysema
air where there shouldn't be air (under mediastinum)
Pleurodynia
Devils grip (spasmodic)
NOT pleuritic pain but INTERCOSTAL pain (coxsackie virus)
-affects striated muscle
-highest in infants and kids (<5)
-97% have fever and self limiting
Pleural effusion
fluid in chest cavity (blood, pus, transudative) that shouldn't be there (pleural space)
exudative or transudative
has LDH
Protein concentration important
Ddx; change in solutes of blood, CHF, bad valves in veins
transudate (CHF)
Pleural effusion
water/ thinner (CHF)
exudative
Pleural effusion
inflammatory component
cloudy
has cells (increased LDH)
thoracentesis
Test of pleural effusion
Protein ratio > 50%= exudate
< 25 grams per liter= transudate
Lights criteria (review) for pleural effusion
Protein ratio > 50% (>25grams per liter) = _______
< 25 grams per liter= _______
lay down pt to see if it layers out
loculate diagnosis
Confusion- 1
Urine- (BUN)- >20
Respiratory- > 30
Blood Pressure- 90/60
65 (age above or below)
score of 1= go home
score of 2= general medicine
score of 3 or more= ICU
CURB 65
CAP (community acquired pneumonia)
Out patient acquired or within 24 hours post discharge pneumonia
strep pneumonia (MC)
mycoplasma pneumoniae
H-flu
chlamydia pneumoniae
viruses (entero, coccidio)
legionella
causes of pneumonia
3 million
deaths in US from pneumonia
strep pneumonia
rusty sputum
(pneumonia type)
H-flu
green sputum
(pneumonia type)
coccidiomycosis
red currant jelly sputum
(pneumonia type)
legionella (pneumonias typically are tachy)
bradycardia typically occurs with _____ (pneumonia type)
ARDS
Defined as less than 200 PaO2
defuse alveolar failure associated with other problems
Type 2
Makes surfactant in alveoli