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ABSITE Review > ABSITE Review - Trauma > Flashcards

ABSITE Review - Trauma Flashcards

1
Q

What is the MC injured organ in blunt trauma?

A

Liver

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2
Q

What is the MC injured organ in penetrating trauma?

A

Small bowel

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3
Q

What is the MCC of airway obstruction in trauma?

A

Tongue –> Perform jaw trust

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4
Q

What is the best site to cutdown for access?

A

Saphenous vein at ankle

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5
Q

What is an indication for DPL? What is a positive DPL?

A

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

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6
Q

What injuries are missed in DPL, FAST and CT scans?

A

DPL - retroperitoneal bleeds, contained hematomas
FAST - retroperitoneal bleeding, hollow viscus injury
CT scan - hollow viscus injury, diaphragm injury

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7
Q

What is abdominal compartment syndrome?

A

Occurs after massive fluid resuscitation, trauma or abdominal surgery
Bladder pressure >25-30
Tx - decompressive laparotomy

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8
Q

When is an ER thoracotomy incdicated for blunt and penetrating trauma?

A

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

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9
Q

If emergent blood transfusion is needed, which blood do you give?

A

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

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10
Q

What is the MCC of a EDH? What is the usual presentation? What are the CT findings?

A

Arterial bleeding from Middle meningeal artery
LOC –> licd interval –> sudden deterioration
CT scan - lenticular (lens-shaped) deformity

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11
Q

What is the MCC of a SDH? What are the CT findings?

A

Tearing of venous plexus (bridging veins) between dure and arachnoids
Head CT scan - crescent-shaped deformity

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12
Q

What imaging is the best to assess diffuse axonal injury?

A

MRI is better than CT

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13
Q

What is the CPP formula?

A

CPP = MAP - ICP

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14
Q

Mentions signs of increased ICP (Normal ICP = 10).

A

decrease ventricular rate, loss of sulci, loss of cisterns

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15
Q

Mention some maneuvers for increased ICP.

A

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)

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16
Q

Raccoon eyes and Battle’s sign are compatible with…

A

Basilar skull fracture - raccon eyes (anterior fossa fracture) and battle’s sign (middle fossa fracture)

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17
Q

What is the MC facial nerve injury during a temporal skull fracture?

A

geniculate ganglion

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18
Q

What is a Jefferson’s fracture? What is the MC mechanism?

A

C1 burst fracture caused by axial loading

Tx - rigid collar

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19
Q

What is a Hangman’s fracture? What is the MC mechanism?

A

C2 fracture caused by distraction and extension

Tx - traction and halo

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20
Q

What are the three types of C2 odontoid fracture?

A

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

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21
Q

What are the columns of the thoracolumbar spine?

A

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

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22
Q

What are the indications for emergent surgical spine decompression?

A

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

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23
Q

What are the neck zones?

A

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

24
Q

What is the best approach to esophageal injuries?

A

Neck - left side
Upper 2/3 of thoracic esophagus - right thoracotomy
Lower 1/3 of thoracic esophagus - left thoracotomy

25
Q

What is the approach to bronchial injuries?

A

Right thoracotomy - right mainstem, trachea and proximal left mainstem injuries (avoids aorta)
Left thoracotomy - distal left mainstem injuries

26
Q

What is the MC site for traumatic diaphragmatic injuries?

A

Left

27
Q

What are the MC areas for aortic transection in trauma?

A

MC - ligamentum arteriosum

Other areas - near aortic valve and where the aorta traverses the diaphragm

28
Q

What is the approach to aortic injuries?

A

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

29
Q

Mention traumatic causes of cardiogenic shock.

A

Cardiac tamponade
Cardiac contusion
Tension PTX

30
Q

What type of bleeding is common in anterior and posterior pelvic fractures?

A

Anterior pelvic fractures - venous bleeding

Posterior pelvic fractures - arterial bleeding

31
Q

What is the MC are of duodenal trauma?

A

2nd portion of the duodenum (descending portion, near ampulla of Vater)

32
Q

How are duodenal hematomas diagnosed? What is the treatment?

A

UGI shows stacked coins or coiled spring

Conservative - TPN and NGT

33
Q

What is a Pringle maneuver?

A

Clamping the portal triad (common hepatic artery, portal vein and bile duct)

34
Q

What is the recommended repair for CBD injury?

A

50% or complex injury - go with chocledocchojejunostomy

35
Q

When is a saphenous vein graft needed for a vascular trauma?

A

If segment missing is >2cm

36
Q

What are the veins that need repair in trauma?

A

vena cava, femoral, popliteal, brachicephalic, subclavian and axillary

37
Q

What are the findings of compartment syndrome and the order of appereance?

A

Pain –> Paresthesia –> Anesthesia –> paralysis –> Poikolothermia –> Pulselessness

38
Q

When a saphenous vein graft or synthetic patch is needed for IVC repair?

A

If primary repair will cause residual stenosis of > 50% diameter of IVC

39
Q

Orthopedic Trauma

A

Mention the concomitant Nerve/Artery Injury

40
Q

Anterior Shoulder Dislocation

A

Axillary nerve

41
Q

Posterior Shoulder Dislocation

A

Axillary artery

42
Q

Proximal Humerus

A

Axillary nerve

43
Q

Midshaft humerus

A

Radial nerve

44
Q

Distal humerus

A

Brachial artery

45
Q

Elbow dislocation

A

Brachial artery

46
Q

Distal radius

A

Median nerve

47
Q

Anterior hip dislocation

A

Femoral artery

48
Q

Posterior hip dislocation

A

Sciatic nerve

49
Q

Distal femur

A

Popliteal artery

50
Q

Posterior knee dislocation

A

Popliteal artery

51
Q

Fibula Neck

A

Common peroneal nerve

52
Q

What is the best indicator of renal trauma?

A

HEMATURIA

53
Q

Which renal vein can be ligate in trauma and why?

A

Left renal vein near the IVC because has adrenal and gonadal veins as collaterals

54
Q

What is the anterior –> posterior location of the renal hilum structures?

A

vein –> artery –> pelvis

55
Q

How an ureteral injury is repair if a large ureteral segment is missing (>2cm)?

A

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

56
Q

How an ureteral injury is repair if a small ureteral segment is missing (<2cm)?

A

Primary repair over a stent or reimplant in the bladder

ABSITE Review (32 decks)

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