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1
Q

Which organ is most commonly injured in blunt trauma?

A

Liver

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2
Q

Which organ is most commonly injured in penetrating trauma?

A

small bowel

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3
Q

What is the best site for cutdown venous access during a trauma?

A

saphenous vein at the ankle

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4
Q

Indications for hemostatic resuscitation/massive transfusion?

A

requiring >= 4 units pRBCS in first hour or 10 in 24s

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5
Q

What makes a positive DPL?

A

> 10cc blood, > 100,000 RBCs/cc, food/bile, > 500 WBC/cc

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6
Q

Intra-abdominal HTN grading

A 
I = 12-15mmHg
II = 16-20
III = 21-25
IV = >25

greater than 20 = concerns for abdominal compartment syndrome

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7
Q

How is pericardium opened during ED thoracotomy?

A

anterior to phrenic nerve

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8
Q

Are thyroid hormones involved in fight or flight response?

A

no

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9
Q

What is raccoon eyes associated with?

A

anterior fossa fx

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10
Q

What is Battle’s sign?

A

mastoid ecchymosis associated with middle fossa fx

facial nerve may be involved

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11
Q

What causes coagulopathy during TBI?

A

release of tissue thromboplastin

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12
Q

What is a Jefferson fracture?

A

C1 burst

axial loading, nonop

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13
Q

What is a hangman’s fracutre?

A

C2 fx

distraction/extension, needs traction/halo

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14
Q

What are the odontoid fracture types?

A

C2 fx

Type I = above base; stable
Type II = at base, needs fusion
Type III = extends into vertebral body, needs fusion

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15
Q

3 columns of the spine

A 
Anterior = anterior longitudinal lig and half the body
Middle = post longitudinal lig and other half of body
Posterior = facets, spinous processes
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16
Q

What fracture is MC cause of facial nerve injury?

A

temporal bone fx

17
Q

What arteries associated with nosebleeds?

A

internal maxillary artery or ethmoidal artery (posterior bleeding)

18
Q

What are the neck zones?

A 
I = clavicle to cricoid
II = cricoid to mandibular angle
III = mandibular angle to skull base
19
Q

How to approach esophageal injuries by region?

A

neck = left neck
upper 2/3 of thoracic esophagus = R thoracotomy
lower 1/3 = L thoracotomy

20
Q

Describe tracheal injury surgical management

A

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

21
Q

How are acute traumatic carotid thrombosis managed?

A

emergent surgical repair

22
Q

Describe traumatic RLN injury management

A

repair primarily or reimplant in cricoarytenoid m

23
Q

Chest tube drainage operative indications

A

initial output > 1.5L
>200cc/hr for 4 hours
>2.5L/24 hours
hemodynamic instability with bleeding

24
Q

What is fallen lung sign?

A

suggests bronchial disruption; lung appears to have fallen away from hilum

25
Q

Approaches for tracheal injuries

A

proximal and middle thirds through collar incision +/- vertical extension
distal third via R thoracotomy

26
Q

How is proximal L mainstem bronchial injuries approached?

A

R thoracotomy; avoids aorta and ligamentum arteriosum

27
Q

Diaphragmatic injury management

A

if < 1 week then transabdominal repair
if > 1 week then chest approach
repair w/ nonabsorbable monofilament suture (like prolene)

28
Q

What is a flail chest? What is biggest pulmonary impairment with these?

A

two or more consecutive ribs broken at two or more sites

biggest impairment is underlying pulmonary contusion

29
Q

what are the borders for the chest box injuries?

A

clavicles, xiphoid, nipples

30
Q

Indications for sternal fx repair

A

chronic pain, unstable, infection

31
Q

How are cardiac injuries repaired?

A

w/ non-pledgeted nonabsorbable sutures in running or pursestring fashion

32
Q

MC cause of pelvic trauma?

A

MVCs

33
Q

Which patients should undergo angio for open book pelvic fxs regardless of clinical symptoms?

A

those older than 60

34
Q

Which pelvic fxs are associated with venous bleeding? arterial bleeding?

A 
anterior = venous
posterior = arterial
35
Q

What is gold standard test to dx pelvic fxs?

A

CT scan

36
Q

Which portion of the duodenum cannot undergo segmental resection after trauma? Tx for this portion?

A

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

37
Q

How do paraduodenal hematomas appear on CT scan and what is the management?

A

stacked coins or coiled spring

Tx = conservative, NPO/NGT/TPN, usually resolves over 2-3 weeks

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