Absite Flashcards
Which organ is most commonly injured in blunt trauma?
Liver
Which organ is most commonly injured in penetrating trauma?
small bowel
What is the best site for cutdown venous access during a trauma?
saphenous vein at the ankle
Indications for hemostatic resuscitation/massive transfusion?
requiring >= 4 units pRBCS in first hour or 10 in 24s
What makes a positive DPL?
> 10cc blood, > 100,000 RBCs/cc, food/bile, > 500 WBC/cc
Intra-abdominal HTN grading
I = 12-15mmHg II = 16-20 III = 21-25 IV = >25
greater than 20 = concerns for abdominal compartment syndrome
How is pericardium opened during ED thoracotomy?
anterior to phrenic nerve
Are thyroid hormones involved in fight or flight response?
no
What is raccoon eyes associated with?
anterior fossa fx
What is Battle’s sign?
mastoid ecchymosis associated with middle fossa fx
facial nerve may be involved
What causes coagulopathy during TBI?
release of tissue thromboplastin
What is a Jefferson fracture?
C1 burst
axial loading, nonop
What is a hangman’s fracutre?
C2 fx
distraction/extension, needs traction/halo
What are the odontoid fracture types?
C2 fx
Type I = above base; stable
Type II = at base, needs fusion
Type III = extends into vertebral body, needs fusion
3 columns of the spine
Anterior = anterior longitudinal lig and half the body Middle = post longitudinal lig and other half of body Posterior = facets, spinous processes
What fracture is MC cause of facial nerve injury?
temporal bone fx
What arteries associated with nosebleeds?
internal maxillary artery or ethmoidal artery (posterior bleeding)
What are the neck zones?
I = clavicle to cricoid II = cricoid to mandibular angle III = mandibular angle to skull base
How to approach esophageal injuries by region?
neck = left neck
upper 2/3 of thoracic esophagus = R thoracotomy
lower 1/3 = L thoracotomy
Describe tracheal injury surgical management
primary anastomosis possible in defects up to 5-6 rings
lengthen trachea by mobilizing intrathoracic trachea and laryngeal complex
large posterior defects can be closed primarily with protective tracheostomy
repair: single layer interrupted absorbable sutures w/ strap m buttress
How are acute traumatic carotid thrombosis managed?
emergent surgical repair
Describe traumatic RLN injury management
repair primarily or reimplant in cricoarytenoid m
Chest tube drainage operative indications
initial output > 1.5L
>200cc/hr for 4 hours
>2.5L/24 hours
hemodynamic instability with bleeding
What is fallen lung sign?
suggests bronchial disruption; lung appears to have fallen away from hilum
Approaches for tracheal injuries
proximal and middle thirds through collar incision +/- vertical extension
distal third via R thoracotomy
How is proximal L mainstem bronchial injuries approached?
R thoracotomy; avoids aorta and ligamentum arteriosum
Diaphragmatic injury management
if < 1 week then transabdominal repair
if > 1 week then chest approach
repair w/ nonabsorbable monofilament suture (like prolene)
What is a flail chest? What is biggest pulmonary impairment with these?
two or more consecutive ribs broken at two or more sites
biggest impairment is underlying pulmonary contusion
what are the borders for the chest box injuries?
clavicles, xiphoid, nipples
Indications for sternal fx repair
chronic pain, unstable, infection
How are cardiac injuries repaired?
w/ non-pledgeted nonabsorbable sutures in running or pursestring fashion
MC cause of pelvic trauma?
MVCs
Which patients should undergo angio for open book pelvic fxs regardless of clinical symptoms?
those older than 60
Which pelvic fxs are associated with venous bleeding? arterial bleeding?
anterior = venous posterior = arterial
What is gold standard test to dx pelvic fxs?
CT scan
Which portion of the duodenum cannot undergo segmental resection after trauma? Tx for this portion?
D2 (also most commonly injured portion)
Tx = drainage, can consider jejunal serosal patch, may need whipple otherwise should at least need pyloric exclusion and GJ
How do paraduodenal hematomas appear on CT scan and what is the management?
stacked coins or coiled spring
Tx = conservative, NPO/NGT/TPN, usually resolves over 2-3 weeks
