NBME Shelf Review (Part 2) – Trauma

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9 • 816 Ratings

🗓️ 7 October 2018

⏱️ 12 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

Penetrating Abdominal Trauma

* Anything below the 4th intercostal space (nipple) is potentially an abdominal injury* Gunshot wounds to the abdomen* Needs immediate exploratory laparotomy* Stab wounds to the abdomen* Needs immediate exploratory laparotomy IF…* Hemodynamically unstable* Peritonitis on exam (rebound, rigidity, guarding)* Organs hanging out of abdomen

Blunt Abdominal Trauma

* If the patient is unstable* Perform FAST exam* If the patient is stable* CT scan of the abdomen/pelvis with contrast

Basilar Skull Fracture

* Bilateral post-auricular ecchymosis (Battle’s Sign)* Raccoon eyes* Hemotympanum* Otorrhea/Rhinorrhea

Tension Pneumothorax

* Classic findings* Hypotension* Obstructive shock* Absent breath sounds* Jugular vein distension (JVD)* Treatment* Needle decompression* 2nd intercostal space* Mid-clavicular line* Tube thoracostomy

Hemothorax

* Hypotension* Hemorrhagic shock* Absent breath sounds* NO jugular vein distension

Cardiac Tamponade

* Beck’s Triad* Hypotension* Obstructive shock* Jugular vein distension* Muffled heart sounds* Perform bedside ultrasound* Diastolic collapse of right ventricle (RV)* EKG* Electrical alterans

Traumatic Aortic Rupture

* Rapid deceleration injuries* Tears at ligamentum arteriosum* Widened mediastinum on chest X-Ray

Pulmonary Contusion

* Blunt chest trauma* Respiratory distress* NO paradoxical chest movement with breathing* Chest X-Ray* Shows non-lobar infiltrates* Located near location of injury

Additional Reading

* Abdominal Trauma (EM Clerkship)* Head Trauma (EM Clerkship)* Thoracic Trauma (EM Clerkship)

Transcript

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0:00.0	Hello, med students. This episode has been sponsored by Freed AI. Do you dread the thought of
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0:24.7	Focus your energy on what matters, providing good patient care.
0:29.5	Use coupon code EM50 to save 50% the first month you try it,
0:34.1	and you can cancel at any time if you decide it's not right for you. You can learn more at
0:39.3	www.gitfreed.a.i. Hey guys, it's Mike Estefan from the University of Rochester School of Medicine.
0:50.5	Today, we're going to continue where we left off with part two of this first episode of the Emergency Medicine Shelf Exam Review series.
0:59.8	The focus of this episode is going to be trauma, beginning with penetrating abdominal trauma.
1:06.7	Let's say we have a guy who comes in and he's shot just below his right nipple.
1:12.6	What's the next step for this guy?
1:15.8	So this guy needs an exploratory laparotomy, also known as an X-lap.
1:21.8	Any gunshot wound to the belly that goes through the peritoneum gets an X-lap regardless of peritoneal signs or of the patient's
1:31.0	blood pressure. And fun fact, any injury below the fourth intercostal space, which is approximately
1:38.6	at the level of the nipple, has the potential to be abdominal in nature.
1:44.7	All right.
1:49.8	So let's say another guy comes in and he's got a stab wound to his belly.
2:00.7	What three signs are you looking for that would influence your decision on whether or not to get some diagnostic testing before sending this guy to the OR.
2:09.2	So for the exam, in general, there are three signs that would indicate that you do not have time to do some diagnostic testing in this guy with a stab wound to his belly.
2:13.7	The first sign would be hemodynamic instability, which is essentially hypotension after resuscitation attempts.
2:22.3	Your second sign is going to be the presence of any signs of paratinitis, such as rebound or guarding.
	...

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