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Term 1 Definition 1
% Thorocotomy in blunt trauma less than 10%
% Thorocotomy with penetrating

15-30%
trauma
Stridor
dislocation of sternoclavicular
Changes in voice quality
joint causes the following airway
obvious trauma to the base of
symptoms
the neck
Extend shoulders
How to reduce a sternoclavicular Grasp clavicle with a pointed
dislo cation clamp
Manually reduce fracture
Unusual cause of tension

Thoracic spine fractures
pneumothorax
Where are chest tubes usually 5th interspace in the anterior

placed axillary line
Mechanism of trauma leading to Rapid deceleration injuries

myocardial injury. Sternal trauma
Tension pneumo
Cardiac tamponade
Causes of PEA
Severe hemorrhagic shock
Cardiac Rupture
Type of trauma causing Massive

Mostly from penetratng trauma
Hemothorax.
Disrupts systemic or hilar
vessels
What is injured that bleeds?
Hook up chest tube with 38 fr and autotransfusion

massive hemothorax to system
200ml/hr for 2-4 hours -

Probable indication for
greater than 1500 cc on initial
thoracotomy
chest tube
Mechanism of cardiac Mostly penetration sometimes

tamponade blunt
Distended neck veins -

Becks triad for cardiac
Hypotension -
tamponade
Muffled heart sounds -
A rise in venous pressure with

Kussmal's sign
inspiration
PEA or cardiac massage in

penetrating trauma but not blunt
Indications for resuscitative trauma -
thoracotomy
Left anterior thoracotomy is
performed
1.Evacuation of pericardial blood

-
2. direct control of bleeding -
3. Open massage -
4 advantages of resuscitative
- 4. Cross clamp if the
thoracotomy
descending aorta to slow blood
loss below the diaphragm and
inc perfusion to the brain and
heart
Simple pneumothorax
-Hemothorax
-Pulmonary contusion
-Tracheal bronch tree injury
Secondary survey 8 life
-Blunt cardiac trauma
threatening thoracic injuries
-Traumatic aortic rupture
-Traumatic diaphragmatic
injury---Mediastinal traversing
injuy
1. PENETRATING OR BLUNT
TRAUMA
Causes of simple hemothorax -2. Laceration of intercostals or
internal mammary
-3. Thoracic spine dislocation
Where is blunt trauma to the occur within 1 inch of the carina,

tracheal-bronchial tree located? usually DOA
hemoptysis
-subcu emphysema
Frequent signs of
-tension pneumo
tracheobronchia tree injury
-MORE THAN ONE CHEST TUBE
NECESSARY
Myocardial muscle contusion

3 INJURIES FROM BLUNT -Cardiac chamber rupture
CARDIAC INFJURY (usually leads to tamponade)
-Valvular rupture
2 Common causes of traumatic Auto collision

aortic rupture -fall from great height
1. Incomplete laceration near

the ligamentum arteriosum
Surviviors of aortic disruption 2. Intact adventitial layer
3. Contained mediastinum
hematoma
Aortic disruption and rare because contained by

hypotension in surviviors hematoma
% positiive angiograms with

3%
widened mediastinum
History of deceleration injury

High suspicon of aortic Characteristic 11 radiologic
disruption findings
Followed by angiography
What % of widened mediastinum

3%
= abn angio
Widened mediatstinum
Obliteration of the aortic knob
Deviation of trachea to right
Obscuration of AP window
adjunctive radiologic signs of Depression of left main
aortic disruption bronchus
Deviation of esaphogus and ng
tube to the right
Widened paratracheal stripe
Presence of pleural or apical cap
Term 29 f Definition 29
Aortic disruption and TEE Useful and less invasive tool
Accurate screening, if negative

Aortic disruption and Helical no need for angio, if positive
contrast-enhanced CT of chest need angio to assess extent of
injury.
Blunt - large radial tears

Blunt vs penetrating results of
diapragmatic injury - Pentrating - small holes taking
years to diagnose
Penetrating objects that

transverse the mediatinum
diagnosed with careful
Define mediastinal transversing examination of chest with
injuries entrance wound in one
hemithorax and the exit or
missiles found in the
contralateral chest.
Contrast helical CT or
angiography
-If negative:
Diagnosis of mediastinal
- Water contrast esophagoscopy
transversing injuries
- esaphagoscopy
- Bronchoscopy
- CT or TTE of heart
Overall mortality rate of

20%
mediastinal penetrating wounds
%Mediastinal traversing injury

40%
with hemodynamic instability
50% present hemodynamically

More facts about mediastinal
unstable
traversing wounds
- 30% have positive diagnostic
% unstabe?
evaluation warranting operative
% requiring surgery?
intervention.
Left hemo or pneumothorax

- Severe blow to the lower
Mechanisms and signs that lead sternum or epigstric area
the doctor to suspect blunt - Particulate matter in chest
esaphageal rupture tube
- Mediastinal air (get contrast
study or esaphacoscopy)
The pelvic cavity peritoneal Contains both the peritoneal and

components? retroperitoneal space
Diaphragm
Liver
Upper peritoneal cavity 5 organs
Spleen
(thoracoabdominal)
Stomach
Transverse colon
Small Bowel
Lower peritoneal cavity contains Parts of ascending colon
5 organs Parts of descending colon
Sigmoid colon
Spleen (40-55%)
Blunt abdominal trauma - organs Liver (35-45%)
affected Small Bowel (5-10%)
retroperitoneal hematoma (15%)
Liver 40%
Small Bowel 30%
Abdominal Stab Wounds
Diaphragm 20%
Colon 15%
trajectory and kinetic energy

favor bowel injury and vascular
injury
Abdominal Gunshot wounds Small bowel 50%

Colon 40%
Liver 30%
Abdominal Vascular Structures -
25%
What % of stab wounds do not

25-33%
penetrate the peritoneum
50% incidence of intraabdominal

Penetrating injuries to buttocks
injury
Hemodynamically abnormal
patient with multiple blunt
injuries esp.......
Indication for diagnostic Change is sensorium central and

Peritoneal Lavage spinal cord
Injury to lower ribs, pelvis and

lumbar spine
Previous abdominal operations

Relative contraindications to Morbid obesity
DPL Advanced cirrhosis
Preexisting coagulopathy
Focused Assesment Sonography

What does FAST stand for?
in Trauma
Subcu air
FAST difficult to use with Obesity
Previous abdominal surgery
Direct blow that compresses the

pancreas against the vertebral
mechanism and diagnosis of column
Pancreatic Injury
Duble contrast CT may not
identify injury in the first 8 hours
Thrombosis of renal artery

Urological injuries with negative - Disruption of renal pedicle
blood in urine secondary to deceleration injury
(has severe abdominal pain)
Transverse ecchymosis on the

abdominal wall.
Seat Belt sign
- May lead to small bowel injury
(look - for Chance fracture)
Better choice to diagnose small

DPL and seat belt sign
bowel injury
Tear or avulsion of mesentery

Lap Seat Belt - Compression - Rupture of small bowel or
injury describe organ systems colon
involved. - Thrombosis of iliac atery or
abdominal aorta
Lap seat belt - Hyperflexion

Chance fracture of lumbar
causes what kind of spinal
vertebrae
injury?
Intimal tear of inominate,carotid,

Shoulder Harness - Submarining subclavian or vertebral artery
causes what type of injuries?
- Fraction dislocation of c-spine
Intimal tear or thrombosis in

subclavian artery
-Rib fractures
Shoulder harness - compression
causes what type of injuries?
-Pulmonary contusion
-Rupture of upper abdominal

viscera
Air bag (contact deceleration)

causes what type of devastating cardiac rupture
injury?
airbag Contact causes what kind eye injuries, face and neck
of injuries? injuries
Worry about hip dislocation in deformation to the front of the

what type of vehicle crashes? vehicle from a head on collision
Sternal
Bent steering wheel
clavicular
deformation of the dashboard
spinal
damage to the windscreen
hip dislocation
signal must have a triphasic

Doppler evaluation quality to assure no proximal
lesion.
less than.9 is indicative is

Doppler ankle/brachial index
indicative of abnormal flow.
Doppler ststolic pressure of the

Calculation of the ankle/brachial injured ankle divided bt the
doppler index doppler systolic pressure of the
normal brachial artery.
The only reasons not to get x- Vascular compromise

rays prior to treatment of a
dislocation especiallt ankles Impending skin breakdown
Closes down the pelvic volume,

however the pubis is driven into
Lateral force to the pelvs
the lower gu system creating
injury to the bladder and urethra
Occasionally disrupts the iliac

AP force the the pelvis
system
Leg length instability
Usually external rotation of the

Indication of pelvic instability
leg.
Muscular pull and gravity
Longitudinal traction through the
skin and bones
Internal rotation by
Techniques to stabilize pelvic
fractures 1. Sheet wrapped around the
pelvis as a sling
2. a vacuum type long spine

splinting device
How many hours can a muscle

6 hours
tolerate ishemia?
arteriography must not be delay

Arteriography and the avascular reestablishing arterial blood
extremity flow and is only indicated after
surgical consultation.
Which fractures are at high risk tibia;

for compartment syndrome? -and forearm fractures
Status of pulses in compartment

Loss of pulses are a late sign
syndrome
Tissue pressures associated

35-45 mmHg
with compartment syndrome
FACE AND OR NECK BURNS -
Singing of eyebrow and nasal

hair -
Clinical indications of inhalation
injury include Carbon deposits and acute
inflammatory changes in the
oropharynx -
Hoarsness -
Burn % requiring circulatory

20%
support
CO levels causing headache 20 to 30%
CO levels causing confusion 30-40%

CO levels causing coma 40-60%
CO levlels causing death > 60%
How to reduce neck and chest

Head of the bed 20 to 30 %
edema
Unexplained hypotension may

be the only initial indication of
Important concept about pelvic
major pelvic disruption with
fractures.
instability in the posterior
ligamentous complex.
Progressive:-
Most important physical signs of
Flank
pelvic fracture
scrotal
or perianal swelling or bruising
Open fracture wounds about the

pelvis -
High riding prostate gland -
Signs of pelvic ring instability
Blood at the urethral meatus -
Demonstratable machanics
instability-
Leg length discrepancy or

Indications of pelvic ring
rotational deformity (usually
instability
external) -
External counter pressure with
pneumatic antishock garment -
Longitudinal traction applied

Mechanical stabilization of the throgh the skin -
pelvis
Internal rotation by:
Sling the pelvis -

A vacuum type long spine

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Term 1 Deﬁnition 1

% Thorocotomy in blunt trauma less than 10%

% Thorocotomy with penetrating

Unusual cause of tension

Where are chest tubes usually 5th interspace in the anterior

Mechanism of trauma leading to Rapid deceleration injuries

Type of trauma causing Massive

Hook up chest tube with 38 fr and autotransfusion

200ml/hr for 2-4 hours -

Mechanism of cardiac Mostly penetration sometimes

Distended neck veins -

A rise in venous pressure with

PEA or cardiac massage in

1.Evacuation of pericardial blood

Where is blunt trauma to the occur within 1 inch of the carina,

Myocardial muscle contusion

2 Common causes of traumatic Auto collision

1. Incomplete laceration near

Aortic disruption and rare because contained by

% positiive angiograms with

History of deceleration injury

What % of widened mediastinum

Aortic disruption and TEE Useful and less invasive tool

Accurate screening, if negative

Blunt - large radial tears

Penetrating objects that

Overall mortality rate of

%Mediastinal traversing injury

50% present hemodynamically

Left hemo or pneumothorax

The pelvic cavity peritoneal Contains both the peritoneal and

trajectory and kinetic energy

Abdominal Gunshot wounds Small bowel 50%

What % of stab wounds do not

50% incidence of intraabdominal

Indication for diagnostic Change is sensorium central and

Injury to lower ribs, pelvis and

Previous abdominal operations

Focused Assesment Sonography

Direct blow that compresses the

Thrombosis of renal artery

Transverse ecchymosis on the

Better choice to diagnose small

Tear or avulsion of mesentery

Lap seat belt - Hyperﬂexion

Intimal tear of inominate,carotid,

Intimal tear or thrombosis in

-Rupture of upper abdominal

Air bag (contact deceleration)

Worry about hip dislocation in deformation to the front of the

signal must have a triphasic

less than.9 is indicative is

Doppler ststolic pressure of the

The only reasons not to get x- Vascular compromise

Closes down the pelvic volume,

Occasionally disrupts the iliac

Leg length instability

Usually external rotation of the

Muscular pull and gravity

2. a vacuum type long spine

How many hours can a muscle

arteriography must not be delay