Trauma 2

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Questions and Answers

What is the treatment for peak ICP (max brain swelling) occurring 48–72 hours after injury?

Ventriculostomy w/ CSF drainage

Craniotomy decompression (correct)

Barbiturate coma

Fosphenytoin or Keppra

What are the components of Cushing’s reflex (triad)?

Hypertension, tachycardia, normal respirations

Bradycardia, HTN, low/altered respirations (correct)

Tachycardia, hypotension, rapid respirations

Bradycardia, hypotension, rapid respirations

What should be done if a patient with a blown pupil is unstable?

Address hypotension before getting head CT (correct)

Get head CT without delay

Perform burr hole immediately

Administer Fosphenytoin or Keppra prophylactically

What is the most common site of facial nerve injury?

Geniculate ganglion Signup and view all the answers

When should surgical treatment be considered for skull fractures?

> 1 cm depression, open fracture, persistent CSF leak not responding to conservative therapy Signup and view all the answers

What is the recommended approach if a patient with head trauma and on Coumadin/NOAC has an abnormal head CT?

Reverse with PCC or NOAC reversal agent Signup and view all the answers

What can occur if a patient has intracranial bleeding alone?

Hypovolemic shock or neurogenic shock Signup and view all the answers

What is the recommended course of action for a patient with an unstable anterior abdominal stab wound?

Perform a laparotomy Signup and view all the answers

What should be done if the fascia is found to be violated in a stable patient with an anterior abdominal stab wound?

Perform a diagnostic laparoscopy Signup and view all the answers

What diagnostic procedure is recommended for flank stab wounds due to possible injury to retroperitoneal contents?

Abdominal CT scan with triple contrast Signup and view all the answers

What is the suggested diagnostic approach for a thoracoabdominal stab wound due to difficulty in diagnosing diaphragm injury even with CT?

Diagnostic laparoscopy Signup and view all the answers

What signs and symptoms suggest abdominal compartment syndrome?

Hypotension, distended abdomen, low urine output, increased airway pressures Signup and view all the answers

What does a bladder pressure of more than 25–30 suggest in the context of abdominal compartment syndrome?

It suggests increased intra-abdominal pressure Signup and view all the answers

What is the most important prognostic indicator for head injuries?

GCS score Signup and view all the answers

What is the most common brain injury in trauma?

Diffuse axonal injury Signup and view all the answers

What is the main indication for performing a craniotomy in cases of subdural hematoma?

Neurological deterioration over days to weeks and more than 5 mm shift Signup and view all the answers

Which blood type can be administered relatively safely, but may have effects from antibodies to HLA minor antigens in the donated blood?

Type-specific blood (nonscreened, non-cross-matched) Signup and view all the answers

When are ICP monitors indicated for patients with head injury?

GCS ≤ 8 with head injury Signup and view all the answers

What is the primary purpose of anterolateral thoracotomy in trauma?

Control any cardiac injury Signup and view all the answers

What is the most common cause of subdural hematoma?

Tearing of venous plexus (bridging veins) Signup and view all the answers

What does a head CT show in cases of subdural hematoma?

Crescent-shaped deformity Signup and view all the answers

What indicates the need for resuscitative thoracotomy in cases of penetrating trauma?

Hypotension unresponsive to fluid resuscitation Signup and view all the answers

Study Notes

Treatment for Peak ICP

Treatment for peak intracranial pressure (ICP) occurring 48–72 hours post-injury may include mannitol administration, hyperventilation, and positioning the patient to optimize venous drainage.

Cushing’s Reflex Components

Cushing’s reflex is characterized by hypertension, bradycardia, and irregular respirations, indicating increased intracranial pressure.

Blown Pupil Management

If a patient presents with a blown pupil and instability, immediate evaluation for possible surgical intervention is necessary to relieve pressure or control bleeding.

Facial Nerve Injury

The most common site of facial nerve injury is at the facial canal, particularly during temporal bone fractures.

Surgical Treatment for Skull Fractures

Surgical intervention should be considered for depressed skull fractures, open fractures, or fractures with neurological deficits.

Abnormal Head CT in Anticoagulated Patients

If a patient on Coumadin or NOAC has an abnormal head CT, they may require reversal of anticoagulation and possible surgical intervention, depending on the bleeding severity.

Intracranial Bleeding Consequences

Intracranial bleeding alone can lead to increased ICP, brain herniation, and subsequent neurological deficits.

Management of Unstable Abdominal Wound

An unstable anterior abdominal stab wound necessitates immediate exploratory surgery to assess for organ damage and control bleeding.

Stable Patient with Violation of Fascia

In a stable patient with fascia violated by an anterior abdominal stab wound, surgical exploration is indicated to evaluate for any internal injury.

Flank Stab Wound Diagnostics

For flank stab wounds, a CT scan or focused assessment with sonography for trauma (FAST) is recommended due to potential retroperitoneal injury.

Thoracoabdominal Stab Wound Diagnostics

Diagnostic laparoscopy or thoracoscopy is suggested for thoracoabdominal stab wounds due to the challenge in diagnosing diaphragm injuries even with CT.

Abdominal Compartment Syndrome Symptoms

Signs of abdominal compartment syndrome include abdominal distension, increased intra-abdominal pressure, and organ dysfunction.

Bladder Pressure in Compartment Syndrome

A bladder pressure exceeding 25–30 mmHg suggests possible abdominal compartment syndrome, requiring intervention to relieve pressure.

Prognostic Indicator for Head Injuries

The most critical prognostic indicator for head injuries is the Glasgow Coma Scale (GCS) score upon presentation.

Common Brain Injury in Trauma

The most common type of brain injury in trauma is a concussion, characterized by temporary loss of function.

Indication for Craniotomy

The main indication for craniotomy in subdural hematomas is significant mass effect or neurological compromise.

Safe Blood Type Administration

O negative blood can be administered safely but may still have effects from antibodies against HLA minor antigens present in the donor blood.

ICP Monitor Indications

ICP monitors are indicated for patients with severe head injury, Glasgow Coma Scale (GCS) less than 8, or worsening neurological status.

Purpose of Anterolateral Thoracotomy

The primary purpose of anterolateral thoracotomy in trauma is to gain rapid access to the thoracic cavity for evaluation and control of bleeding.

Common Cause of Subdural Hematoma

The most common cause of subdural hematomas is acceleration-deceleration injuries, typically seen in falls or vehicular accidents.

Head CT Findings in Subdural Hematoma

A head CT in cases of subdural hematoma will typically show crescent-shaped hyperdensity along the inner skull surface.

Resuscitative Thoracotomy Indications

The need for resuscitative thoracotomy in cases of penetrating trauma is indicated by unstable vital signs and signs of massive hemorrhage.

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Description

Test your knowledge of the management of penetrating abdominal wounds and stab wounds. Explore the different protocols for unstable and stable patients and the criteria for exploratory laparotomy.