NBME Shelf Review (Part 2) – Trauma

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)