Trauma

Concussion -- Mild TBI with GCS ≥13; may involve brief LOC, amnesia, vertigo, confusion, or delayed responses.
Coup/Contrecoup Injury -- Brain hits back and forth in skull
Post-Concussion Symptoms -- Vertigo, amnesia, delayed speech, disorientation, emotional lability, incoordination.
Post-Traumatic Seizures -- Occur in <5% within the first week after head injury.

Head CT Indications (Canadian Rules) -- LOC with head strike, GCS <15 after 2h, skull/basilar fracture signs, ≥2 vomiting, ≥65yo, amnesia ≥30min, dangerous mechanism, neuro deficit, seizure, anticoagulant use.
Head CT Indications (New Orleans Rule) -- GCS 15 + headache, vomiting, age >60, ETOH/drug use, anterograde amnesia, visible trauma above clavicle.
Head Injury Admission Criteria -- GCS <15, abnormal CT, seizures, bleeding diathesis, or anticoagulant use.

Concussion treatment — brain rest
Head Injury Discharge Precautions -- Return if confusion, worsening HA, vision change, weakness, vomiting, or seizure.

Cerebral Contusion -- Focal brain bleeding; monitor and admit for observation.
Epidural Hematoma -- Arterial bleed (middle meningeal artery) between skull and dura; lucid interval → rapid decline from brain herniation; needs evacuation of hematoma

Anasacoria- unequal pupils

Normal ICP— < 20

Do steroids help with trauma?? — no

Epidural Hematoma Prognosis -- Worse with large volume, midline shift, GCS <8.
Subdural Hematoma -- Venous bleed from bridging veins between dura and arachnoid; often from falls or ETOH.
Subdural Hematoma Symptoms -- LOC ± lucid interval, HA, N/V, ataxia, pupil defects.
Subdural Hematoma Treatment -- Surgery or observation based on severity.
Subarachnoid Injury -- Bleeding into subarachnoid space; risk of vasospasm and seizures due to brain parenchyma irritation

Secondary Brain Injury symptoms (Intracranial) -- Hemorrhage, ischemia, edema, ↑ICP, vasospasm, infection.
Secondary Brain Injury symptoms (Systemic) -- Hypoxia, hyper/hypocapnia, hyperglycemia, hypotension, fever, hyponatremia.
Cerebral Blood Flow Formula -- CBF = CPP - ICP; CPP = MAP - ICP.

Monroe-Kellie Hypothesis -- Skull is fixed space; ↑volume in one component ↑ICP.
Increased ICP Symptoms -- HA, diplopia (CN VI palsy), papilledema, bradycardia, HTN, ↓LOC.
Cushing’s Triad -- Bradycardia, hypertension, irregular respirations (brainstem compression).
ICP Management -- Keep ICP <20 mmHg; elevate HOB 30°, drain CSF, mannitol, brief hyperventilation.

Fever in Brain Injury -- Common; search for infection (sinusitis, UTI, PNA); cooling and antipyretics limited benefit.

Tension Pneumothorax -- Clinical diagnosis: absent breath sounds, JVD, tracheal deviation, hypotension.
Tension Pneumo Chest Tube -- 24–28F tube, 4–5th ICS midaxillary; relieves air accumulation.

Hemothorax -- Blood in pleural space; 24–28F tube at 4–5th ICS midaxillary; massive >1500 mL.
Thoracotomy Indication -- Drain >20 mL/kg initially or 1500/3hrs
Chest Tube Removal (Pneumo) -- No air leak, full expansion.
Chest Tube Removal (Hemo) -- <100 mL/day output, full expansion.

Traumatic Aortic Dissection -- Deceleration injury tearing aortic isthmus; fatal in 80% prehospital.
Aortic Dissection Signs -- Chest/back pain, L supraclavicular hematoma, widened mediastinum.
Aortic Injury CXR -- Wide mediastinum (>8cm supine), apical cap, L bronchus displacement.
Aortic Injury Management -- BP control (SBP <100), esmolol, CTA confirmation, endovascular repair preferred.

Cardiac Tamponade -- Blood in pericardial sac; 150 mL can be fatal.
Beck’s Triad -- Hypotension, JVD, muffled heart sounds.
Tamponade Signs -- Tachycardia, pulsus paradoxus( different pulses on each arm), enlarged silhouette, effusion on echo.
Tamponade Treatment -- IV fluids (support preload/filling), pericardiocentesis, thoracotomy.

Primary Survey (ABCDE) -- Airway, Breathing, Circulation, Disability, Exposure.
Life-Threatening Thoracic Injuries -- Tension/open pneumo, massive hemothorax, tamponade, flail chest, obstruction.

Flail Chest -- Paradoxical chest wall motion due to multiple broken ribs; may need fixation.
Rib Fracture Pain Control -- Multimodal (NSAIDs, acetaminophen, oxycodone, methocarbamol, nerve block).

Rib fracture treatment - symptomatic treatment only
PIC Score -- Monitors pain, incentive spirometry, cough quality.
Rib Fixation Indications -- Flail chest, severe pain, failed weaning, deformity.

Intubation Indications -- RR >30 or <9, SpO₂ <90%, PaO₂/FiO₂ <280, pulmonary contusion, age/poor reserve.
Ventilation Strategy -- Tidal volume 6–8 mL/kg, plateau <30, use PEEP, prone/ECMO for refractory hypoxemia.

Trauma Coagulopathy (TIC) -- Triad: acidosis, hypothermia, coagulopathy.
Massive bleeding Management -- Whole blood or 1:1:1 transfusion, minimize crystalloids, warm fluids, early TXA, LMWH prophylaxis.
TXA in Trauma -- Antifibrinolytic; give within 3 hours; not a procoagulant.

Blunt Cardiac Injury (BCI) -- Myocardial trauma from MVCs; causes arrhythmia, troponin ↑, hypotension.
BCI Screening -- ECG + troponin; normal results exclude BCI (100% NPV).
BCI Management -- Telemetry ≥24h if abnormal; ICU if unstable or arrhythmic.
BCI Dysrhythmias -- Sinus tachy, PVCs, AFib; treat per ACLS, correct electrolytes.
Commotio Cordis -- Sudden VF in young athlete; R-on-T impact; no structural injury.
Myocardial Rupture -- 80% fatal; requires immediate thoracotomy and pericardiotomy.

Valvular Injury (Trauma) -- Aortic (AR/shock), Mitral (papillary rupture), Tricuspid (RHF); surgical repair.
Coronary Artery Injury -- LAD most common; causes traumatic STEMI; PCI or bypass.

Blunt Aortic Injury (BTAI) -- Deceleration tear at ligamentum arteriosum.
Blunt Aortic Injury Imaging -- US, CTA = gold standard (100% sens, 99.7% spec).
Blunt Aortic Injury Treatment -- Esmolol, SBP <120, TEVAR preferred; open repair if arch small.

FAST Exam (EFAST) -- Bedside US for pericardial, hepatorenal, splenorenal, pelvic, and pleural fluid.
FAST Sensitivity -- 42–100%.
Abdominal Trauma Workup -- Low threshold for CT; serial exams; labs (HCG, T&S).

Renal/GU Trauma Mechanism -- Usually blunt (MVCs, falls, straddle).
Renal/GU Injury Signs -- Hematuria, blood at meatus/introitus = urethral injury.
Retrograde Urethrogram -- Consider if blood at meatus.
GU Imaging -- CT angio may miss urethral injury; US for testicular trauma.

Junctional Hemorrhage -- Bleeding at neck, axilla, groin, buttocks, or perineum—difficult to compress.
Junctional Tourniquets -- Abdominal aortic, combat ready clamp, SAM, junctional emergency tool.
Abdominal Aortic Tourniquet -- Inflates to 80 lbs pressure; effective in small trials.
SAM Junctional Tourniquet -- Fast application (<30s); approved for axillary and pelvic bleeding.

Elderly Trauma Patients -- Higher morbidity due to comorbidities, meds, poor compensation.
Elderly Resuscitation Risks -- Sensitive to fluid overload and under-resuscitation; fragile bones.

Crystalloid Risks -- Dilutional coagulopathy, hyperchloremic acidosis, edema, hypothermia.
Effective Fluid Strategy -- Permissive hypotension, hemorrhage control, avoid hypothermia, balanced transfusion.

TXA Uses -- Trauma, postpartum hemorrhage, epistaxis, ICH; poor in GI bleed or angioedema.

Most deadly type of pelvic fracture- open book