12 Trauma surgery Flashcards
Pulmonary contusion
-how to tx
Think ARDS, leaky capillaries
- AVOID crystalloids (lung is sensitive to fluid shifts, fluid will go to lung)
- Give colloids (blood, albumin)
- diuretics
- PEEP
central cord syndrome
-how present
elderly with neck hyperextension (no headrest in MVC)
weakness and sensory loss in UE but preserved fxn in LE
syringomyelia can do this too
Burns
-what to apply on skin, why
silver sulfadiazine
mafeinde
Abx, ppx against infection
Pt with animal bite
-when to rabies ppx
Domesticated animal, provoked: observe, if no signs/sxs of rabies in animal after 10 days, no need for vaccine. (also can check pet vaccination)
Wild animal: Kill and Bx. If -, observe
Wild animal: if can’t kill and bx, do IgG + Vaccine
Myocardial contusion
-how to dx, tx
- serial EKGs and Trops to look for myocardial injury
- tx like MI: tx arrythmias and HF as they occur
black widow bite
- tx
- how present
Ca gluconate, IV. stabilizes muscles
-abd pain, can have pancreatitis
Pt in ED with drug OD, no sxs. She said she just took lots of pills, does not say what.
Acetaminophen level 0, normal LFTs. Do what
Give NAC if even the slightest suspicion of Tylenol OD. May be too early to see levels. No harm, cheap.
Human bite
-tx
- surgical exploration, irrigation and debridement!
- Amox can be used for ppx
bugs: strep, staph, anaerobes
organophosphate poisoning
-tx
atropine and 2-PAM (pralidoxime)
Electrical burns
-what 3 things to remember acutely
- Rhabdo (check UA/myoglobin, serum CK). Hydrate and mannitol to avoid renal fail.
- arrythmias
- post shoulder d/l
Electrical burns
-long term sequelae (2)
- demyelination syndromes
- cataracts
Parkland formula
only 2nd and 3rd degree count
Parkland formula:
(Kg) (%BSA burned) (4cc) of LR + 2L D5W
Give half in 8h, half in next 16h
Anaphylaxis
what dose of Epi
1:1000 SQ Epi
toxic alcohols
- name them and complications
- which have AG and not
- what other test
When to use Woods lamp
Tests: AG and osmol gap. All have + osmol gap.
- Etoh–no AG
- isopropyl–no AG. Supportive, no fomepizole
- methanol–AG. Blindness.
- ethylene glycol–AG. Ca Stones
Woods lamp to show ethylene glycol in urine (antifreeze has it to detect radiator leaks)
Diffuse axonal injury
- dx
- how to manage
blurring of grey/white matter on CT/MRI
monitor and manage ICP (elevate HOB, mannitol, hyperventilate). Hope they come out of coma.
Neck zones, general rules based on onlinemeded
upper (angle of jaw upwards)–image
mid–safe to explore
lower–image
image can be CT, or arteriogram/esophagram/bronchogram
Burn victim:
- circumferential burns, do what
- then, careful about what
escharotomy
-once blood flow returns, beware of reperfusion injury, which can lead to compartment syndrome. (measure compartment pressures if sxs).
basilar skull fx signs
raccoon eyes
csf otorrhea and rhinorrhea (clear)
battle’s sign
Trauma:
If you see these 3 fx, think what 3?
If you see Flail chest, scapular fx, sternal fx
think: Cardiac contusion, pulmonary contusion, aortic dissection
brown recluse bite
- tx
- presentation
- debridement, possible grafts
- asx day 1, small ulcer day 2. Then, necrosis. Clinical Dx
syringomyelia
-how present
pain/temp lost first (fibers cross middle) in arms (cape like)
“didn’t realize burned hand on stove”
then can progress to motor. This is central cord syndrome
CO poisoning
-what test, what levels to know
carboxyHg test
normal <3%, but smokers can live at 10%
cyanide poisoning
- presentation
- tx
coma, sz, hypotension. Cherry-red skin, cherry-red blood
Thiosulfate
General concussion rules
-when can teenager go back to football practice
Grade 1: no LOC, no amnesia (sit out game)
Grade 2: LOC, no amnesia (sit out 1 week)
Grade 3: LOC, amnesia:(sit out all season)
