ABSITE Review - Trauma Flashcards
What is the MC injured organ in blunt trauma?
Liver
What is the MC injured organ in penetrating trauma?
Small bowel
What is the MCC of airway obstruction in trauma?
Tongue –> Perform jaw trust
What is the best site to cutdown for access?
Saphenous vein at ankle
What is an indication for DPL? What is a positive DPL?
Used in hypotensive patients with blunt trauma
Positive if >10cc blood, >100,000 RBCs/cc, food particles, bile, bacteria, > 500 WBC/cc
Needs to be supraumbilical if pelvic fracture present
What injuries are missed in DPL, FAST and CT scans?
DPL - retroperitoneal bleeds, contained hematomas
FAST - retroperitoneal bleeding, hollow viscus injury
CT scan - hollow viscus injury, diaphragm injury
What is abdominal compartment syndrome?
Occurs after massive fluid resuscitation, trauma or abdominal surgery
Bladder pressure >25-30
Tx - decompressive laparotomy
When is an ER thoracotomy incdicated for blunt and penetrating trauma?
Blunt trauma - only if pressure/pulse is lost in ER
Penetrating trauma - usu only if pressure/pulse lost on way to ER or in ER
If emergent blood transfusion is needed, which blood do you give?
Type O blood (universal donor) - contains no A or B antigens
Male - can receive RH-positive blood
Female - who are prepubescent or of child-bearing age should receive Rh-negative blood
What is the MCC of a EDH? What is the usual presentation? What are the CT findings?
Arterial bleeding from Middle meningeal artery
LOC –> licd interval –> sudden deterioration
CT scan - lenticular (lens-shaped) deformity
What is the MCC of a SDH? What are the CT findings?
Tearing of venous plexus (bridging veins) between dure and arachnoids
Head CT scan - crescent-shaped deformity
What imaging is the best to assess diffuse axonal injury?
MRI is better than CT
What is the CPP formula?
CPP = MAP - ICP
Mentions signs of increased ICP (Normal ICP = 10).
decrease ventricular rate, loss of sulci, loss of cisterns
Mention some maneuvers for increased ICP.
Sedation and paralysis
Raise HOB
Relative hyperventilation for cerebral vasoconstriction (CO2 30-35)
Mannitol - load 1g/kg, give 0.25mg/kg q4
Barbiturate coma
Ventriculostomy w CSF drainage
Craniotomy decompression (also Burr hole)
Raccoon eyes and Battle’s sign are compatible with…
Basilar skull fracture - raccon eyes (anterior fossa fracture) and battle’s sign (middle fossa fracture)
What is the MC facial nerve injury during a temporal skull fracture?
geniculate ganglion
What is a Jefferson’s fracture? What is the MC mechanism?
C1 burst fracture caused by axial loading
Tx - rigid collar
What is a Hangman’s fracture? What is the MC mechanism?
C2 fracture caused by distraction and extension
Tx - traction and halo
What are the three types of C2 odontoid fracture?
Type I - above the base, stable
Type II - at base, unstable –> will need fusion or halo
Type III - extends into vertebral body –> will need fusion or halo
What are the columns of the thoracolumbar spine?
Anterior - ant longitudinal ligament and anterior 1/2 of vertebral body
Middle - posterior 1/2 of the vertebral body and post longitudinal ligament
Posterior - facet joints, lamina, spinous process, interspinous ligament
What are the indications for emergent surgical spine decompression?
Fracture or dislocation not reducible with distraction; Acute anterior spinal syndrome; open fracture; soft tissue or bony compression of the cord; and progressive neurologic dysfunction
What are the neck zones?
Zone I - Clavicle to cricoid cartilage
Zone II - Cricoid cartilage to angle of mandible –> Needs OR exploration
Zone III - Angle of mandible to the base of the skull
What is the best approach to esophageal injuries?
Neck - left side
Upper 2/3 of thoracic esophagus - right thoracotomy
Lower 1/3 of thoracic esophagus - left thoracotomy
What is the approach to bronchial injuries?
Right thoracotomy - right mainstem, trachea and proximal left mainstem injuries (avoids aorta)
Left thoracotomy - distal left mainstem injuries
What is the MC site for traumatic diaphragmatic injuries?
Left
What are the MC areas for aortic transection in trauma?
MC - ligamentum arteriosum
Other areas - near aortic valve and where the aorta traverses the diaphragm
What is the approach to aortic injuries?
Median sternotomy - for injuries to ascending aorta, innominate artery, proximal right subclavian artery, innominate vein, proximal left common carotid
Left thoracotomy - for injuries to left subclavian artery, descending aorta
Distal right subclavian artery - midclavicular incision 1/2 resection of medial clavicle
Mention traumatic causes of cardiogenic shock.
Cardiac tamponade
Cardiac contusion
Tension PTX
What type of bleeding is common in anterior and posterior pelvic fractures?
Anterior pelvic fractures - venous bleeding
Posterior pelvic fractures - arterial bleeding
What is the MC are of duodenal trauma?
2nd portion of the duodenum (descending portion, near ampulla of Vater)
How are duodenal hematomas diagnosed? What is the treatment?
UGI shows stacked coins or coiled spring
Conservative - TPN and NGT
What is a Pringle maneuver?
Clamping the portal triad (common hepatic artery, portal vein and bile duct)
What is the recommended repair for CBD injury?
50% or complex injury - go with chocledocchojejunostomy
When is a saphenous vein graft needed for a vascular trauma?
If segment missing is >2cm
What are the veins that need repair in trauma?
vena cava, femoral, popliteal, brachicephalic, subclavian and axillary
What are the findings of compartment syndrome and the order of appereance?
Pain –> Paresthesia –> Anesthesia –> paralysis –> Poikolothermia –> Pulselessness
When a saphenous vein graft or synthetic patch is needed for IVC repair?
If primary repair will cause residual stenosis of > 50% diameter of IVC
Orthopedic Trauma
Mention the concomitant Nerve/Artery Injury
Anterior Shoulder Dislocation
Axillary nerve
Posterior Shoulder Dislocation
Axillary artery
Proximal Humerus
Axillary nerve
Midshaft humerus
Radial nerve
Distal humerus
Brachial artery
Elbow dislocation
Brachial artery
Distal radius
Median nerve
Anterior hip dislocation
Femoral artery
Posterior hip dislocation
Sciatic nerve
Distal femur
Popliteal artery
Posterior knee dislocation
Popliteal artery
Fibula Neck
Common peroneal nerve
What is the best indicator of renal trauma?
HEMATURIA
Which renal vein can be ligate in trauma and why?
Left renal vein near the IVC because has adrenal and gonadal veins as collaterals
What is the anterior –> posterior location of the renal hilum structures?
vein –> artery –> pelvis
How an ureteral injury is repair if a large ureteral segment is missing (>2cm)?
Upper 1/3 injuries and middle 1/3 injuries that won’t reach the bladder - temporize with percutaneous nephrostomy tubes. Alternatives if pt is stable, ileal interposition, transureteroureterostomy
Lower 1/3 injuries - reimplant in the bladder, may need bladder hitch procedure
How an ureteral injury is repair if a small ureteral segment is missing (<2cm)?
Primary repair over a stent or reimplant in the bladder
