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Surgery final (Sabiston) > 16 - ATLS & management of acute trauma > Flashcards

16 - ATLS & management of acute trauma Flashcards

1
Q

Primary survey should be repeated every time there is a __ in the patient’s status.

A

change

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2
Q

What are the stage of ATLS?

A 
Airway + C spine
Breathing
Circulation
Disability / neurological condition
Exposure & environmental control
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3
Q

The basic fundamentals of ATLS determine that:

  1. patients in the most acute __ should be treated first
  2. Diagnosis should not __ treatment
  3. detailed __ is not crucial to assess and treat
A

risk
delay
history

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4
Q

If the patients can produce __ response= AW is protected.

A

verbal

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5
Q

What are the main indications to manage AW?

A 
GCS < 8 + cannot speak
airflow obstruction
laud breathing
facial trauma/burn
spreading neck hematoma
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6
Q

GCS (3-15) =
eye movement -
verbal response -
motor response -

A

1-4
1-5
1-6

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7
Q 
GCS eye movement:
1-
2-
3- 
4-
A

1- none
2- to pain
3- to voice
4- spontaneous

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8
Q 
GCS verbal response:
1-
2-
3- 
4-
5-
A 
1- none
2- incomprehensible 
3- inappropriate 
4- confused
5- oriented
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9
Q 
GCS motor response:
1-
2-
3- 
4-
5-
6-
A 
1- none
2- extension
3- flexion
4- withdraws to pain 
5- localized pain
6- obeys commands
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10
Q

If GCS < _ or 2 points lower than the previous rotation= mental status __.

A

decrease

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11
Q

A patient with an airway problem should be __.

A

intubated

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12
Q

When the patient is being prepared to be intubated, pre __ should be performed with: 3

A

oxygenation
ambo
mask
airway

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13
Q

Sellick maneuver = __

A

cricoid pressure to prevent aspiration

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14
Q

If we want to get a better view of the glottis give fast acting muscle relaxants such as: 2. Consider also hypotonic/sedative drugs such as: 3

A 
succinylcholine
rocuronium (esmeron)
midazolam
ketamine 
etomidate
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15
Q

What are the ways to know if the intubation is well placed in the trachea? 3

A

chest auscultation
CXr
ETCO2

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16
Q

What are the indications for surgical airway?

A 
glottis edema
laryngeal pathology
2 failed intubation attempts   
severe oropharyngeal bleeding
voice cord injury
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17
Q

What is preferred surgical airway in the trauma room?

A

cricothyroidotomy (coniotomy)

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18
Q

Tracheostomy is recommended when there is a __ injury and the anatomy of the __ membrane is abnormal.

A

larynx

cricothyroid

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19
Q

We can remove the __ part of the orthopedic cervical collar to gain access.

A

anterior

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20
Q

Rigid long spine boards is good to mobilize the patient, but should be __ ASAP to avoid fast evolving __.

A

removed

pressure ulcers

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21
Q

Use the - technique to move the patient (keeping one axis).

A

log-roll

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22
Q

How do we assess the breathing in ATLS?

A

observing chest movement (symmetric? contusions?)
auscultations in the apex and axilla
saturation
tracheal deviation
subcutaneous emphysema
Jugular vein distention (tension pneumothorax/tamponade)

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23
Q

Name 5 “breathing killers” of ATLS which requires an immediate attention:

A 
tension pneumothorax
massive hemothorax
flail chest + lung contusion
open pneumothorax
cardiac contusion
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24
Q

In tension pneumothorax air goes __ but cannot get back __.

A

out

in

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25
Q

What are the clinical signs of tension pneumothorax? 5

A 
tachycardia
tachypnea
tracheal deviation
hypotension
unilateral decreased breathing sound 
Jugular vein distention
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26
Q

What is the treatment for tension pneumothorax?

A

thoracic decompression with needle application in the midclavicular line, 2nd rib (first intracoastal space after the clavicula)

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27
Q

What is the trauma room treatment for tension pneumothorax?

A

intracoastal trocar + CXr

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28
Q

Massive hemothorax is caused by __/__ blood vessels damage leading to > _ L in first drainage / flow > __ cc/hour.

A

lung/intracoastal
1.5
100

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29
Q

In massive hemothorax, __ may be necessary. The bleeding may spread to the: 5

A 
thoracotomy
lung
abdomen
pelvis 
retroperitoneum
thighs
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30
Q

Flail chest= abnormal movement of parts of the chest wall due to > _ broken ribs in > _ places each. That causes __ breathing.

A

3
2
paradoxical

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31
Q

How to you treat flail chst?

A

aggressive ventilation with high PEEP

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32
Q

What is the treatment for open pneumothorax?

A

bandaging the hole with partial closure of the wound + chest trocar

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33
Q

What can cardiac contusion cause? 4

A

tamponade
VF
papillary muscle rapture
large vessels rapture

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34
Q

In cardiac contusion remember to always perform __. In case of pathology / __ signs -> __ admission.

A

ECG
tamponade
ICU

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35
Q

When managing a patient with a problems in the breathing part of ATLS, always give ___, sometime add also __ and then perform __.

A

oxygen
chest trocar
CXr

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36
Q

What is the most common cause for shock in trauma?

A

bleeding

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37
Q

When examining the circulation part of ATLS- check:4

A

pulse
BP
temperature
capillary feeling

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38
Q

What are the main shock signs in a trauma patient? 6

A 
agitation / confusion 
tachycardia/tachypnea
diaphoresis 
cold periphery/reduced pulse
oliguria
hypotension
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39
Q 
What is 1st degree hemorrhagic shock?
blood loss- 
pulse- 
systolic BP- 
pulse pressure- 
RR- 
urine production- 
mental status-
A 
blood loss- <750 ml (15%)
pulse- <100
systolic BP- normal
pulse pressure- normal
RR- 14-20
urine production- >30
mental status- anxious
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40
Q 
What is 2nd degree hemorrhagic shock?
blood loss- 
pulse- 
systolic BP- 
pulse pressure- 
RR- 
urine production- 
mental status-
A 
blood loss- 750-1500 ml (15-30%)
pulse- 100-120
systolic BP- normal
pulse pressure- decreased 
RR- 20-30
urine production- 20-30
mental status- very anxious
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41
Q 
What is 3rd degree hemorrhagic shock?
blood loss- 
pulse- 
systolic BP- 
pulse pressure- 
RR- 
urine production- 
mental status-
A 
blood loss- 1500-2000 ml (30-40%)
pulse- 120-140
systolic BP- decreased
pulse pressure- decreased
RR- 30-40
urine production- 5-15
mental status- anxious/confused
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42
Q 
What is 4th degree hemorrhagic shock?
blood loss- 
pulse- 
systolic BP- 
pulse pressure- 
RR- 
urine production- 
mental status-
A 
blood loss- >2000 (40%)
pulse- >140
systolic BP- decreased 
pulse pressure- decreased 
RR- >40
urine production- negligible 
mental status- confused/lethargic
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43
Q 
What is the primary treatment for each the shock degrees according to ATLS?
1st- 
2nd- 
3rd- 
4th-
A

1st- crystalloid
2nd- crystalloid
3rd- crystalloid + blood
4th- crystalloid + blood

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44
Q

What are the 6 steps in managing a patient with ATLS circulation problem?

A 
open 2 lines
rehydration
blood transfusion
look for bleeding source
resuscitative thoracotomy
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45
Q

When opening lines in a trauma patient include the following tests: 6

A 
blood type
chemistry
coagulation
ABG
hemoglobin
beta hCG
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46
Q

Rehydration of a trauma patient consists of: 3

A

1-2 l bolus of crystalloid (ringer lactate/NS), warmed IV

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47
Q

In case rehydration does not elicit a response- give __ transfusion. Do not strive for normal __ (it may increase the __).

A

blood
BP
bleeding

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48
Q

Blood transfusion should be administrated only if __ is non responsive or level __ shock.

A

rehydration

III

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49
Q

What are the main areas in which life threatening bleeding may occur in a trauma patient?

A

external- direct pressure
chest- CXr + trocar (consider thoracotomy)
abdominal- FAST (if unstable- laparotomy)
retroperitoneum (hip fractures)- hip Xr
multiple fractures in long bones

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50
Q

What is the Beck’s triad? What does it suggest?

A

hypotension
distanced heart sounds
increased JVP
tamponade

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51
Q

What are the FAST points? 4

A

hepatorenal
splenorenal
pelvic (Douglas pouch)
pericardium

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52
Q

Resuscitative thoracotomy is performed in the __ room for patients with lost __, in cases of __ trauma.

A

trauma
life signs (pulse disappeared)
penetrating

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53
Q

What are the 4 goals of resuscitative thoracotomy?

A

open pericardium to release potential tamponade
direct heart massage
cross clamp on the descending aorta
control chest bleeding

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54
Q

Blunt trauma patients showing lost signs of life have _% survival rates. Do not perform __.

A

1

resuscitative thoracotomy

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55
Q

REBOA= __

A

resuscitative endovascular balloon of the aorta

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56
Q

REBOA is useful for uncontrolled __ bleeding (__ rapture). It allows blood supply to the __ and __ + slowing the bleeding in the __ and __.

A 
abdominal
aneurism
brain
chest
abdomen
pelvis
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57
Q

GCS helps us divide head injuries into different severities:
severe- <= __
moderate- -
mild- -

A

<=8
9-12
13-15

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58
Q

All trauma patients, beside __ rapture, should get a urine catheter.

A

urethra

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59
Q

In case of urethra rapture retrograde __/__ + contrast is required before inserting __.

A

cystography
CT
urine catheter

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60
Q

What are the C/I for urine catheter in a trauma patient?

A

meatus bleeding
peritoneum/scrotum hematoma
high riding prostate
significant pelvic fracture

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61
Q

__ tube should be placed in every trauma patient due to stomach distension caused by the trauma (acute __). It also helps with reducing __ and assessing __.

A

nasogastric
gastric dilatation
aspiration
UGIB

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62
Q

In case of suspected skull fracture, insert the nasogastric tube through the __.

A

mouth

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63
Q

Name 4 signs suggesting skull injury:

A

racoon eyes
CSF leakage from ears/nose
Battle’s sign (mastoid ecchymosis)
hemotympanum

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64
Q

In trauma, hope for urine production > __ ml/h/kg and pH around __.

A
  1. 5-1

7. 4

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65
Q

Penetrating trauma requires __ + imaging of the __.

A

CXr

area

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66
Q

Blunt trauma requires __ + __:
CT for assessing __ in stable patients.
FAST in __ patient

A

CXr
pelvic Xr
C spine
unstable

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67
Q

If FAST is unavailable, diagnostic __ can be performed. When > __ ml of blood- abdominal bleeding requiring emergency __.

A

peritoneal lavage
10
laparotomy

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68
Q

Full history should be taken in __ survey.

A

secondary

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69
Q

Which cases require chest trocar? 6

A 
tension pneumothorax
hemothorax
open pneumothorax
flail chest
pleural effusion
empyema
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70
Q

Where should you insert chest trocar? After placing it, perform __ to make sure it is in place.

A

4-5 intracoastal space midaxillary line (nipple line)

CXr

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71
Q

When should we remove the chest trocar?
> _ hours without __ released
< _ ml of __ drained

A

> 24 hours with no air release

< 100 ml of fluid

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72
Q

What are the 3 indications for OR thoracotomy?

  • > __ ml of blood when inserting the trocar, or > __ ml/hr for _ straight hours.
  • Massive __
  • __/__ content in the trocar.
A 
> 1500
300
3
air leak (uncontrolled pneumothorax)
esophageal/stomach
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73
Q

What is the indication for emergency thoracotomy?

Immediate need for __ in patients with __ trauma witness lost __ of life.

A

aortic clamp
penetrating
signs

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74
Q

What are the three approaches for surgical thoracotomy?

A

posterolateral thoracotomy
left thoracotomy
median sternotomy

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75
Q

What is the deadly triad?

A

hypothermia
coagulopathy
metabolic acidosis

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76
Q

When performing damage control, first exploration should include:

  1. fast __ control
  2. look for __ organ damage
  3. __ closure of the chest/abdomen
  4. leave __
A

bleeding
hollow
temporary
trocars

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77
Q

In order to control the bleeding, use intra __/__ __.
Remove them one at a time and __/__ bleeding vessels (IVC/suprarenal/SVC/SMV/popliteal vein). Bleeding spleen- __, bleeding liver- __.

A 
abdominal/thoracic
packing
ligate/clamp
splenectomy
packing
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78
Q

In trauma damage control, hollow organs should be __ or __. No __ + place __.

A

primary repaired
resected
anastomosis
trocar

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79
Q

Aggressive resuscitation with massive transfusion should include 1:1:1:1 replacement of:

A

packed red blood cells
plasma
platelets
cryoprecipitate

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80
Q

What is the most common etiology of traumatic brain injuries?

A

falling from great height

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81
Q

What are the 5 types of brain injuries?

A 
epidural hematomas (lens)
subdural hematomas (crescent)
subarachnoid bleeding (
parenchymal contusions of brain tissue  
diffuse axonal injury (DAI)
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82
Q

Epidural hematomas have a __ like shape. It does not cross the __. The main etiology is __ fracture, leading to __ arterial bleeding.

A

lens
sutures
lateral
middle meningeal

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83
Q

What is the clinical manifestation of epidural hematomas?

  1. loss of __ ->
  2. __ interval (the __ increases)
  3. big hematoma causing significant __
A

conciseness
lucid
hematoma
neurological deuteriation

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84
Q

What is the treatment for epidural hematoma?

A

decompression

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85
Q

Subdural hematoma is __ shaped, and crosses the __. It usually causes __ damage to the proximal brain tissue.

A

crescent
sutures
severe

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86
Q

In subdural hematoma, the clinical manifestation is determined by the __ damage rather than the __ itself, which can increase the __.

A

axonal
hematoma
ICP

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87
Q

Subarachnoid bleeding is indicative for spread __ from the brain __. The bleeding in itself is __.

A

bleeding
parenchyma
benign

88
Q

Parenchymal contusions of brain tissue is caused by direct energy transfer to the adjacent __. Look for __ injury.

A

tissue

contralateral

89
Q

The main reason for morbidity in parenchymal contusion is due to __ brain injury caused by ___.

A

secondary

edema

90
Q

DAI is secondary to severe __ forces causing shearing effect. Imaging does not capture the damage well, showing: __ hemorrhage and loss of border between __ and __ matter.

A

rotational
punctate (small)
white
grey

91
Q

We should suspect DAI when the imaging test is __ while the neurological status is __.

A

normal

decreased

92
Q

What are the component of primary care of TBI (traumatic brain injury)? 3

A

airway control
bleeding control and resuscitation (BP>90
reverse effect of antiplatelet/anticoagulation

93
Q

What is the Cushing triad for increased ICP?

A

hypertension
bradycardia
irregular breathing

94
Q

What are the steps of initial assessment of TBI? 3

A
  • GCS
  • pupil reaction
  • imaging (CT w/o contrast)
95
Q

What are the additional treatment methods for TBI? 2

A

surgical decompression

reducing ICP

96
Q

What are the indications for surgical decompression? 3

A

epidural/subdural hematoma with mass effect
compression fractures
increased refractory ICP

97
Q

How do you calculate CPP (cerebral perfusion pressure)?

A

Mean arterial pressure - ICP

98
Q

What are the ways to decrease ICP? 6

A

head elevation to 30 degrees
ventriculostomy
moderate hyperventilation (PCO2 30-35 mmHg)
sedation and pain control
hyperosmolar treatment (mannitol/hypertonic saline)
barbiturate induced coma

99
Q

__ is not part of treating acute head injury.

A

steroids

100
Q

What are the main etiologies of spinal cord injury? what is the mortality rate? 2

A

vehicle accident
gunshot injuries
13-17%

101
Q

What are the first steps in initial treatment for spinal cord injuries? 4

A

spinal fixation with collar and back board
ventilation if necessary
neurogenic shock treatment (vasopressors-dopamine/epinephrine)

102
Q

What are the manifestations of neurogenic shock? 5

A 
decreased CO and SVR
hypotension + bradycardia
warm periphery
paralysis/reduced sphincteric tonus 
no response to rehydration
103
Q

Steroids should be given to patients with spinal cord injury only if it __ and with low risk for __.

A

isolated

infection

104
Q

Neck injuries are __, but lead to the highest __ rate (__%) than any other area of the body.

A

uncommon
mortality
20

105
Q

Blunt trauma neck injury may cause compression with __/__ fracture leading to __/__ infection if left untreated.

A

pharynx/larynx

neck/mediastinum

106
Q

Blunt trauma neck injury can also damage the __ & __ arteries. Usually due to __ or severe __-__ mechanism.

A

Carotid
vertebral
seatbelt
flexion-extension

107
Q

BCVI=__. The morbidity is usually related to __ secondary to __ caused by vascular injury.

A

blunt cerebrovascular injuries
stroke
thromboembolism

108
Q

Penetrating neck injuries can be classified into 3 according to their anatomical location:
Zone I: __.
Zone II: __.
Zone III: __.

A

thoracic inlet-crocoid (large vessels, trachea, pharynx)
cricoid- mandibular angle (jugular veins, carotid & vertebral arteries, GI tracts, URT)
mandibular angle- skull base

109
Q 
The first step in treating penetrating neck injury is to secure \_\_:
1-\_\_
2-\_\_
3-\_\_
4-\_\_
A 
airway
immediate intubation
surgical airway (tracheostomy)
bleeding control
surgical exploration
110
Q

We must perform immediate intubation in penetrating neck trauma when we find expending cervical __ or when we suspect eminent __ damage.

A

hematoma

airway

111
Q

What are the indications of surgical exploration of a penetrating neck injury? 6

A 
unstable patient
expending hematoma
active bleeding
air bubbling
neurological disorder
hematemesis
112
Q

Patients with penetrating neck injury in zone __ who are __ but __(active bleeding/respiratory disorder), should go through __.

A

II
stable
symptomatic
surgical exploration

113
Q

Unstable patients with penetrating neck injury should be taken directly to __. Stable patients- __ room.

A

surgery

trauma

114
Q

What are the 4 steps of initial assessment of patients with penetrating neck injury?

A

physical examination (which zone?)
imaging
identifying BCVI
clinical assessment of the trachea and esophagus

115
Q

Imaging of patients with penetrating neck injury:
CTA-__
angiography-__
doppler US-__

A

CTA- assessing vessels and injury route
angiography- gunshot wounds, BCVI
doppler US- carotid & vertebral arteries

116
Q

Which signs will make you suspect BCVI? 5

A 
expanding neck hematoma
arterial bleeding from the neck/mouth/nose
focal neurological deficiency
hematoma in patients > 50
stroke seen in CT/MRI
117
Q

What are the indications for immediate surgery in patients with penetrating neck injury? 4

A

unstable
active bleeding
expanding neck hematoma
significant injury to trachea/esophagus

118
Q

טכניקות ניתוחיות ב 87

A

טכניקות ניתוחיות ב 87

119
Q

When should we suspect a mediastinal penetrating injury which require assessing bleeding/perforation? 4

A

injury with the following borders:
superior- sternal notch,
inferior- rib cage
lateral- nipple

120
Q

If the clinical presentation matches that of a tamponade, but FAST is inconclusive, perform __ surgery in __ pericardial window approach.

A

diagnostic

subxiphoid

121
Q

Subxiphoid pericardial window approach allows reaching the __, checking the presence of __. If found, extend to __.

A

pericardium
blood
midline sternotomy

122
Q

Perform CXr in __ chest injury at the end of __ survey. If __/__- insert chest trocar

A

every
primary
pneumothorax/hemothorax

123
Q

What is the GS imaging for chest injury?

A

CTA

124
Q

In case of suspected tracheal/bronchi injury, perform __ imaging.

A

bronchoscopy

125
Q

In case of suspected esophageal injury, perform __ imaging + __.

A

esophagoscopy

contrast

126
Q

What is the main complication of broken ribs? What is the best way to prevent it? 2

A

pneumonia

pain management

127
Q

What is the best way to manage pain7 in chest wall and pleural space injuries? (remember to include respiratory physiotherapy)
mild-
moderate-
severe-

A

NSAID
opioid
epidural catheter

128
Q

Cardiac injuries occur in _% of penetrating chest trauma, causing _% mortality.

A
  1. 7%

72. 9%

129
Q

Cardiac injuries usually present with __ bleeding and __.

A

pericardium

tamponade

130
Q

In patients with cardiac injuries and severe __/__ perform __ in the __ room.

A

hypotension/loss of life signs
thoracotomy
trauma

131
Q

In suspected contusion to the heart perform __. If normal/minimal changes- monitor for __ hours. In case of arrhythmia- monitor for - hours and treat accordingly. In case of heart failure- __.

A

ECG
12
24-48
ECO

132
Q

Thoracic aorta injury is rare, but has high mortality rate- __% in blunt, __% in penetrating.

A

37%

88%

133
Q

Which Xr signs suggest aorta injury 4

A

mediastinal expansion
apical capping
aortic knob loss
left main bronchus deviation

134
Q

The immediate treatment for thoracic aorta injury includes: 5

A 
hemodynamic stabilization
treating other life threatning injuries 
beta blocker
endovascular repair
left thoracotomy surgical repair
135
Q

How do you diagnose esophageal injury? 3

A 
upper gastrointestinal series (UGI)- a radiographic Xr 
\+
contrast 
\+
esophagoscopy
136
Q

What is the treatment for esophageal injury? 3

A

diagnose and treat ASAP

  • upper/middle injury- right poster lateral thoracotomy along rib #5
  • lower injury- left thoracotomy along rib #7
137
Q

In case of esophageal injury + mediastinitis- no __, instead- __ with a __/__ or if necessary- __.

A

primary repair
drainage
gastrostomy/jejunotomy
esophagectomy

138
Q

Diaphragmatic injury usually occur on the __ side. Diagnosis is usually made in the __. Treatment involves ___ followed by __ repair.

A

left
OR
exploratory laparotomy
primary

139
Q

What is the main source of morbidity and mortality in injuries to the abdomen?

A

bleeding and perforation leading to sepsis

140
Q

Which patients with blunt abdominal trauma should go through- immediate ___ in the __? 2

A

exploratory laparotomy
OR
unstable + positive FAST/DPL>10 ml)
peritonitis signs during primary survey

141
Q

What is the management of other blunt abdominal trauma?

A

CT + IV contrast

142
Q

In which cases of abdominal trauma with free __ fluid should __ laparotomy be performed? 4

A 
peritoneal
exploratory 
large fluid volume
seatbelt sign
vital signs disorder
DPL > 500 WBC/mm, increased amylase/bilirubin/GI content
143
Q

In abdominal gunshot wounds __ usually required.

A

surgery

144
Q

In abdominal stabbing wound __ not usually required.

A

surgery

145
Q

In which cases urgent surgery is necessary for patients with abdominal stabbing wound? 3

A

hemodynamic instability
peritonitis
extravasation

146
Q

In case of posterior abdominal penetrating wounds CT with __ contrast (__/__/__) is necessary.

A

triple

IV/drinking/enema

147
Q

Which abdominal injuries require immediate exploratory laparotomy? 2

A

anterior abdomen gunshot

unstable/peritonitis/extravasation stab wound

148
Q

In case of positive splenic injury + positive FAST->__. In other cases->___.

A

directly to the OR (usually if unstable->splenectomy)

CT

149
Q

Angiography and embolization are only for __ patients with contrast __ in CT.

A

stable

extravasation

150
Q

Define level I AAST spleen injury scale:

  • __ - subcapsular, < __% surface area

* __- capsular tear < _ cm parenchymal depth

A

hematoma
10
laceration
1

151
Q

Define level II AAST spleen injury scale:
* __ - subcapsular, -% surface area
intraparenchymal,

A 
hematoma
10-50
5
laceration
1-3
152
Q

Define level III AAST spleen injury scale:
* __ - subcapsular, > __% surface area or __.
intraparenchymal hematoma >=_ cm in diameter
* __- capsular tear >_ cm parenchymal depth

A 
hematoma
50%
expanding 
5
laceration
3
153
Q

Define level IV AAST spleen injury scale:

* __ - involving segmental/hilar vessels producing major ___ (>__% of spleen).

A

laceration
devascularization
25

154
Q

Define level V AAST spleen injury scale:

  • __ - completely __ spleen

* __- hilar vascular injury __ spleen

A

hematoma
shattered
devascularized

155
Q

Blunt spleen injury conservative treatment consists of __ in the __. Notice that patients> __ are in higher risk for conservative treatment failure.

A

monitoring
ICU
55

156
Q

Which blunt spleen injury should receive conservative treatment?

A

stable
no active bleeding
no need for blood products
grade I-III

157
Q

Blunt splenic injury patients in grade _ or _ have _ and _ respective chances for conservative treatment failure.

A

IV
V
33
75

158
Q

Surgical treatment- __ is for splenic blunt injury patients who are __ or suffer from __ bleeding.

A

splenectomy
unstable
active

159
Q

In case of penetrating splenic injury, the decision if __ is necessary will depend on if __ bleeding is present.

A

splenectomy

active

160
Q

Which organ is most likely to get damaged in penetrating injury to the abdomen?

A

liver

161
Q

In case of hepatic injuries, if FAST is positive- __, if not __.

A

OR

CT

162
Q

Classify the AAST hepatic injury grade I:

I- Hematoma: subcapsular,

A

10

1

163
Q

Classify the AAST hepatic injury grade II:

  • Hematoma- subcapsular -% of surface area, the intraparenchymal hematoma < __ cm
  • Laceration- capsular rapture, - cm into the parenchyma and < _ cm in length.
A

10-50%
10
1-3
10

164
Q

Classify the AAST hepatic injury grade III:
- Hematoma- subcapsular > % of surface area
intra parenchymal > _ cm / __
- Laceration- rapture > cm.

A

50%
10
expanding
3

165
Q

Classify the AAST hepatic injury grade V:
-Laceration involving >_ of the liver lobe / _ segments in one lobe.
Vascular- __/__ injury.

A

25-75%
3
IVC/hepatic vein

166
Q

Classify the AAST hepatic injury grade VI:

- hepatic __.

A

avulsion (tearing away of a body part)

167
Q

Classify the AAST hepatic injury grade VI:

- hepatic __.

A

avulsion (tearing away of a body part)

168
Q

What is the best success predictor for conservative treatment in hepatic injury? Which patients should be treated conservatively?

A

hemodynamic stability

stable W/O active bleeding

169
Q

Which hepatic injury patients should be treated with embolization?

A

stable + active bleeding

170
Q

Which hepatic injury patients should be treated with urgent surgery?

A

unstable + active bleeding

171
Q

In IVC injury, the preferred treatment is __ and __

A

conservative

packing

172
Q

Name 4 possible complications in hepatic injury:

A

bile leakage
hepatic abscess
hemobilia
biloma

173
Q

Hepatic injury damage control consists of:
bleeding control with __ and temporary abdominal __. In case of diffuse bleeding __ the abdomen until stable and consider__ of the bleeding arteries.

A

packing
closure
close
embolization

174
Q

How do you diagnose gastric injury?

A

physical (peritonitis/penetrating wound)

CT (less effective)

175
Q

How do you treat gastric injury?

A

surgery (stiches/stapler)

total/partial gastrectomy (Billroth I/II) in severe cases

176
Q

How do you diagnose pancreatic injury? 3

A

3D CT
lab (increased amylase 3 post injury)
ERCP/MRCP

177
Q

Describe 4 CT findings suggesting pancreatic injury:

A

decreased pancreatic perfusion
liquid surrounding the pancreas
hematoma
unclear structures around the pancreas (cloudiness)

178
Q

Most cases of pancreatic injury will require __ treatment.

A

surgical

179
Q

Body/tail pancreatic injuries are of the duct to the left of the __.
They should be treated by ___.

A

superior mesenteric vessels
duct
distal pancreatectomy

180
Q

Head pancreatic injury should be treated by ___ in limited injuries or __ when more extensive.

A

drainage

Whipple

181
Q

In pancreatic injury, leave __ to prevent retroperitoneal organs exposed to pancreatic __.

A

trocars

enzymes

182
Q

What are the indications for external drainage in pancreatic injury?

A

does not involve the duct
hematoma/contusion
capsular laceration, w/o parenchymal penetration

183
Q

Colon injuries should be assessed with: __ or __ only in __ patients.

A

PR
proctosigmoidoscopy
stable

184
Q

What are the C/I for post injury primary colon anastomosis?

A

unstable/shock
peritonitis
severe comorbidity
other severe injuries

185
Q

Colon injury <= 50% should be treated with __ closure with _ layers of stiches.

A

primary

2

186
Q

What is the diameter of the following GI tracts?
small bowel-
colon
cecum-

A

3 cm
6 cm
9 cm

187
Q

Colon injury > 50% should be treated with __ and immediate __. If unstable- __.

A

resection
primary anastomosis
colostomy

188
Q

Colon injuries proximal to the middle colic artery should be treated with: __ + __.

A

right hemicolectomy

ileocolostomy

189
Q

Colon injuries distal to the middle colic artery should be treated with: __ + __.

A

segmental resection

colo-colostomy

190
Q

Rectum injury should be treated with surgery: 2.

If > 50 % of the diameter- __ + __.

A

loop/end colostomy
presacral drainage
resection + end colostomy

191
Q

In case of infra renal hematoma or right kidney contusion repair the blood vessels by __ and __ control.

A

proximal

distal

192
Q

What is the treatment for stable patients with blunt abdominal great vessels trauma and no active bleeding?

A

endovascular repair

193
Q

When treating retroperitoneal hematoma the treatment is decided by the anatomical region:
zone I - __
zone II - __
zone III -__

A

zone I - surgery and exploration (aorta/IVC)
zone II - conservative/exploration if it expands (kidney)
zone III -conservative/exploration in massive active bleeding (pelvis)

194
Q

How do you diagnose genitourinary blunt trauma injuries? 4

A

gross hematuria
physical examination (displaced prostate…)
CT + contrast
CT cystography

195
Q

Most kidney injuries are __. Usually requires __ surgical involvement. If severe __.

A

blunt
minimal
nephrectomy

196
Q

What is the treatment for ureter trauma? 3

A

if stable- primary repair
nephrectomy
endoscopic stent + ureter diversion

197
Q

Although most bladder injuries are caused by __ trauma, __ trauma should be treated with __.

A

blunt
penetrating
surgery

198
Q

In case of bladder injury with intraperitoneal leakage-__ repair of the bladder’s __ + __. Follow up with __ to confirm recovery.

A

primary
borders
Foley catheter (supra pubic exit)

199
Q

In case of bladder injury with extraperitoneal leakage-__ the bladder with urine catheter, followed by __ to confirm recovery.

A

decompress

CT cystography

200
Q

What are the indication for CT + contrast in kidney trauma?

A

stable + BP>90
hematuria (micro/macro)
renal injury suspicion

201
Q

In which cases of kidney injury should IVP (Intravenous Pyelogram) be performed? 2

A

unstable

going to surgery

202
Q 
What are the grades of kidney injury?
I-\_\_
II-\_\_
III-\_\_
IV-\_\_
V-\_\_
A

I-subcapsular hematoma
II-hematoma + laceration<1 cm
III-hematoma + laceration>1cm
IV-laceration into collecting system and/or renal vein/artery injury and/or arterial clot from endothelial injury
V-kidney shattered and/or avulsion of helium

203
Q

Hemodynamic stable patient with kidney injury should be treated according to the CT result:
I-III-__
IV-__
V-__

A

no surgery
conservative, if unstable/vascular injury- surgery
exploratory surgery-reconstruction/resection

204
Q

Hemodynamic unstable patient with kidney injury should be sent to __ and treated according to the __ results.

A

surgery

IVP

205
Q

What are the indications for surgical exploration in an unstable kidney injury? 5

A

expanding hematoma
contentious renal bleeding contrast extravasation
non viable renal parenchyma
arterial injury

206
Q

What are the indication for angiography and embolization in an unstable kidney injury? 4

A

continuous extravasation of contrast (blush)
perirenal ring hematoma > 25 mm
medial hematoma
conservative treatment with > 2 blood packs

207
Q

In case of positive FAST for pelvic injury- __, if negative __, if the patient is responsive-__, if not- __ with __.

A 
surgery
rehydration
CT
angiography
embolization
208
Q

What are the steps for pelvic injury treatment?

A

sheet fixation-better for venous bleeding
angiography + embolization (arterial bleeding)
packing surgery (active bleeding + unstable)
orthopedic surgery (after stabilization)

209
Q

What are the hard signs for vascular injuries requiring emergency surgery?

A 
pulsatile bleeding
expanding hematoma 
thrill palpation / bruit sound  
ischemic limb
penetrating trauma with arterial/venous injury
210
Q

What are the soft signs for vascular injuries requiring imaging (CTA/angiography)? 5

A

Hx of moderate bleeding
proximal dislocation and/or penetrating injury
reduced pulse
peripheral nerve deficiency near a main vessel
wounds proximal to the limb

211
Q

Which arteries should not be ligated? 4

A 
SMA
brachial
superficial femoral
external iliac 
popliteal
212
Q

In vascular injuries damage control for patients with vascular instability the treatment is mostly: 2

A

ligation

intraluminal shunts

213
Q

The _ nerve is injured in 60% of arterial limb injuries . Treatment is __ and __, followed by arterial __ or graft from the __ vein

A 
median
surgery
thrombectomy 
anastomosis
saphenous vein
214
Q

Lower limbs injury should be repaired with __ graft using the __ vein from the __ leg.

A

interposition
saphenous
contralateral

215
Q

What are the indications for acute limb amputation?

A
  • severe crushing car accident
  • unrecoverable limb
  • extensive soft tissue lost
    severe scapulothoracic dislocation with neurological deficiencies
  • extensive fractures/vascular damage
  • MESS>7

Surgery final (Sabiston) (54 decks)

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