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Jaspie - Surgery > 06 - Trauma and Burns > Flashcards

06 - Trauma and Burns Flashcards

1
Q

Identify the sign: periorbital ecchymosis

A

raccoon eyes

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2
Q

Eponym:

jaw thrust (for airway maintenance in trauma patients)

A

Esmarch maneuver

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3
Q

Where is the needle inserted in needle thoracostomy?

A

2nd IC in the MCL

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4
Q

Site for tube thoracostomy:

A

4th or 5th ICS MAL

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5
Q
  • Enumerate: Beck’s triad
  • What is the diagnosis?
A
  • distended neck veins
  • hypotension
  • muffled heart sounds

cardiac tamponade

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6
Q

Identify the sign: ecchymosis behind the ear

A

Battle sign

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7
Q

Explain: halo sign

A

dried blood surrounded by a halo of dried CSF -> (+) CSF

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8
Q

Identify: intraabdominal organ that is most commonly injured after blunt trauma

A

liver

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9
Q
  • Clamping of the hepatoduodenal ligament is called _______
  • Why is the purpose of this maneuver?
  • What structures (3) are found inside the hepatoduodenal ligament?
A
  • Pringle maneuver
  • to halt hemorrhaging of the liver
  • hepatic artery, portal vein, and common bile duct
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10
Q

Identify: Second most commonly injured intraabdominal organ after blunt abdominal trauma

A

splee

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11
Q

Enumerate: postplenectomy vaccine prophylaxis

A
  • polyvalent pneumococcal
  • quadrivalent pneumococcal or diphtheria conjugate
  • quadrivalent meningococcal polysaccharide
  • Haemophilus B conjugate
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12
Q

Identify the sign: perineal or scrotal hematoma

A

Destot sign

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13
Q

Explain: Boari flap

A

flap surgery done to bridge the gap in distal ureteral injuries

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14
Q

Identify: fracture of the distal radius with the fragment displaced dorsally

A

Colle’s fracture

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15
Q

Identify: fracture of the distal radius with the fragment displaced volarly

A

Smith’s (reverse Colle’s)

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16
Q

Identify: fracture of the radial styloid

A

Hutchinson’s / Chauffeur’s

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17
Q

Identify: fracture of the ulna with dislocation of the radial head

A

Monteggia fracture

mUnteggia = Ulnar fracture!!!!

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18
Q

Identify: fracture of the radius with dislocation of the distal radio-ulnar joint

A

Galeazzi fracture

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19
Q

Identify: horizontal fracture running through the maxilla superior to the maxillary alveolar process

A

Le Fort I

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20
Q

Identify: horizontal fracture passing through the superior orbital fissure, resulting in a complete separation of the facial bones from the cranium

A

Le Fort III

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21
Q

Identify: pyramidal fracture through the maxilla and orbit, outlining the nose

A

Le Fort II

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22
Q

Enumerate (5): major complications of Le Fort fractures:

A
  • facial anesthesia
  • malocclusion
  • trismus (lockjaw)
  • globe malposition, vision changes, and ectropion
  • midfacial distortion and nasal obstruction
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23
Q

Describe: zone 1 of penetrating neck injury:

A

-from the thoracic outlet to the cricoid cartilage superiorly

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24
Q

Describe: zone 2 of penetrating neck injury:

A

-from the cricoid cartilage to the angle of the mandible

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25
Q

Describe: zone 3 of penetrating neck injury:

A

-above the angle of the mandible

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26
Q

Zones of penetrating trauma: enumerate: most common common types?

A

zone 2 (but associated with lower morbidity and mortality)

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27
Q

Zones of penetrating trauma: enumerate: types with greatest risk for morbidity and mortality?

A

zone 1 and 3 (because they obstruct the airways)

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28
Q

Second most common facial fracture

A

Mandibular fracture

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29
Q

Most common facial fracture

A

nasal fracture

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30
Q

Confirmatory test for CSF leak

A

B-2 transferrin test

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31
Q

Most common cause of burn injury requiring hospital admission:

A

flame burn

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32
Q

Type of burn injury with the highest mortality

A

flame burn

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33
Q

Enumerate: guidelines for referral to a burn center

A
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34
Q

another name for the rule of nines:

A

rule of Wallace

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35
Q

Most accurate method of estimating burn size:

A

Lund and Browder chart

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36
Q

Parkland’s formula

A

4 mL pLR /kg/%TBSA

  • 1st half given in the first 8 hours
  • 2nd half given in the next 16 hours
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37
Q

Curreri formula

A

25 kcal/kg/day + 40 kcal/TBSA/day

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38
Q

Most common cause of death in burns

A

burn wound sepsis

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39
Q

Another name for stress ulcers

A

Curling ulcers

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40
Q

Classes of hemorrhagic shock and estimated blood loss:

A
41
Q

These spinal tract control motor function:

Where do these tracts decussate?

A
  • lateral and anterior corticospinal tracts (pyramidal tract)
  • level of the medulla
42
Q

These spinal tract convey protopathic sensation:

What are the components of protopathic sensation? (3)

Where do these tracts decussate?

A
  • anterior and lateral spinothalamic tracts
  • temperature, pain, and crude touch
  • only at the segmental level or shortly above
43
Q

Hyperextension injury often results to this type of incomplete spinal cord syndrome:

A

central cord syndrome

44
Q

occlusion of anterior spinal artery often results to this type of incomplete spinal cord syndrome:

A

anterior cord syndrome

45
Q

occlusion of the posterior spinal artery often results to this type of incomplete spinal cord syndrome:

A

posterior cord syndrome

46
Q

Spinal cord compression often results to this type of incomplete spinal cord syndrome:

another name for this syndrome:

A

Brown-Sequard syndrome

a.k.a. hemisection syndrome

47
Q

Injuries below the L1 vertebral level often result to this type of incomplete spinal cord syndrome:

A

Cauda Equina syndrome:

48
Q

Identify the type of incomplete spinal cord injury: ipsilateral loss of proprioception, vibration, and tactile discrination, with spastic paralysis below the level of the lesion, and contralateral loss of pain and temperature sensation one or two levels below the lesion:

A

Brown-Sequard syndrome

49
Q

Identify the type of incomplete spinal cord injury: bilateral paresis, upper > lower extremity

A

Central cord syndrome

50
Q

Identify the type of incomplete spinal cord injury: ipsilateral loss of proprioception, vibration, and touch sensation below the level of the lesion

A

posterior cord syndrome

51
Q

Identify the type of incomplete spinal cord injury: flaccidity, areflexia, and impairment of bowel and bladder function

A

cauda equina syndrome

52
Q

Identify the type of incomplete spinal cord injury: bilateral motor paralysis, loss of pain and temperature sensation

A

anterior cord syndrome

53
Q

These spinal tract convey epicritic sensation and proprioception:

What are the components of epicritic sensation? (3)

Where do these tracts decussate?

A
  • gracile and cuneate fasciculi (posterior column)
  • fine touch, vibration, and pressure
  • level of the medulla
54
Q
A
55
Q

Enumerate (3): penetrating injuries (trauma) can cause the following incomplete cord syndromes:

A
  • anterior cord syndrome
  • posterior cord syndrome
  • Brown-Sequard syndrome
56
Q

Yes or no: All patients with blunt trauma require cervical spine immobilization

A

Yes

57
Q

most common indication for intubation

A

altered mental status

58
Q

What is the indication of emergent tracheostomy

A

laryngotracheal separation or laryngeal fractures

59
Q

Treatment of flail chest with underlying pulmonary contusion

A

require presumptive intubation and mechanical ventilation

60
Q

treatment of tension pneumothorax

A

CTT

61
Q

treatment of open pneumothorax

A

closure of pneumothorax and CTT

62
Q

What is the direction of insertion of a CTT

A

directed superiorly and posteriorly 36F Chest tube

63
Q

where is the incision of a CTT

A

4th - 5th ICS MAL

64
Q

pressure of carotid pulse

A

60 mmHG

65
Q

pressure of femoral pulse

A

70 mmHg

66
Q

pressure of radial pulse

A

80 mmHg

67
Q

Definition of massive hemothorax

A
  1. >1500 ml blood loss 2. 1/3 of blood volume in pediatrics
68
Q

what is the incision on emergency department thoracotomy

A

left anterolateral thoracotomy

69
Q

Indication of emergency department thoracotomy

A
  1. witnessed penetrating trauma with < 15 mins of prehospital CPR 2. witnessed blunt trauma with < 5 mins of prehospital cpr Persistent severe post injury hypotension BP <60 mmHg 3. cardiac tamponade 4. hemorrhage 5. air embolism
70
Q

Layers of the body passed by CTT

A
  1. skin 2. suuperficial fascia 3. serratus anterior 4. external intercostal 5. internal intercostal 6. innermost intercostals 7. endothoracic fascia 7. parietal pleura
71
Q

What is the most common cause of cardiogenic shock in a trauma patient

A

tension pneumothorax

72
Q

Areas in the body in performing physical exam that needs special attention

A
  1. axilla 2. back 3. perineum
73
Q

The big three radiographs in BLUNT trauma

A
  1. lateral cervical spine 2. chest 3. pelvic
74
Q

Radiograph for truncal gunshot wound

A
  1. anteroposterior and lateral chest and abdomen
75
Q

Target INR and PTT of trauma patients

A

INR < 1.5 PTT < 45 seconds

76
Q

What are the zones of the neck?

A

zone 1 - up to the level of cricoid zone 2 - cricoid up to the angle of mandible zone 3 - above the mandible

77
Q

What is the 5 plain radiograph views of the cervical spine

A
  1. lateral 2. anteroposterior 3. transoral odontoid 4. bilateral oblique views
78
Q

Treatment of penetrating neck injury that is asymptomatic

A

zone I -CT scan neck and chest, CTA esophagogram, bronchoscopy zone II a.transcervical GSW - like zone 1 b. all others - observe zone III -observe

79
Q

Treatment of penetrating neck injury that is symptomatic, stable

A

zone I -CT scan neck and chest, CTA esophagogram, bronchoscopy zone II a. operative exploration zone III -angiography - Interventional radiography embolization

80
Q

Treatment of GSW/Stab wound in the abdomen of stable patient

A

A. GSW 1. Anterior abdomen - explore lap 2. RUQ, tangential, back or flank - CT scan B. Stab wound 1. back, flank - CT scan 2. AASW + LWE - DPL, CT or Serial Exam

81
Q

Positive Result of DPL

A
  1. WBC > 500 ml 2. Amylase > 19 3. ALP > 2 4. Bilirubin >0.01 5. RBC a. AASW > 100,000 b. Thoraco abdominal >10,000 if between 1,000 - 10,000 do laparoscopy or thoracoscopy
82
Q

Areas of FAST

A
  1. subxiphoid 2. morison’s pouch/ hepatorenal recess 3. LUQ/ perisplenic 4. pelvis >250 ml blood
83
Q

What age is cricothyroidotoy is contraindicated

A

< 8 years old can cause subglottic stenosis

84
Q

What is the immediate management of air embolism

A

Trendelenberg position to trap air in the left ventricle

85
Q

What is the blood loss of a rib fracture

A

100 to 200 ml

86
Q

What is the blood loss of a pelvic fracture

A

>1000 ml

87
Q

What is the blood loss of a tibial fracture

A

300 to 500 ml

88
Q

What is the blood loss of a femur fracture

A

800 to 1000 ml

89
Q

Most common cause of burn

A

flame burn - thermal burn

90
Q

What are jackson’s three zones of tissue injury following a burn

A
  1. zone of coagulation - necrosis (needs excision and grafting)
  2. zone of stasis - questionable viability
  3. zone of hyperemia - heals with minimal or no scarring
91
Q

What degree of burns are not included in calculating %TBSA

A

superficial (first degree) burns

92
Q

What does cyanide poisoning inhibit

A

cytochrome oxidase which in turn inhibit cellular oxygenation

93
Q

what is the treatment of cyanide poisoning

A
  1. sodium thiosulfate 2. hydroxycobalamin 3. 100% oxygen
94
Q

what is tha parkland formula

A

4 mg/kg x %TBSA

95
Q

how do you give the parkland formula

A

1/2 of total fluid for first 8 hours 1/2 of total fluid for the next 16 hours

96
Q

Target of fluid resuscitation in burn victims

A
  1. MAP = 60 mmHg 2. UO = 30 cc/hr or 1 - 1.5 cc/kg/hr
97
Q

Children under 20 kg should be given additional treatmen in burn

A

glucose supplementation

98
Q

What is the side effect of silver sulfadiazine

A

neutropenia

99
Q

Formic acid burns are associated with

A

chemical burn hemoglobinuria and hemoylsis

Jaspie - Surgery (18 decks)

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