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)